Abstract
Bariatric surgery leads to the risk of metabolic and nutritional complications. The nutritional deficiencies observed are most often associated with malabsorption caused by the surgical technique, but the reduction in food intake and nutritional imbalance generated by food restriction are also at play. The high prevalence of iron deficiency (about one third of gastroplasty patients and more than 50% of gastric bypass patients) calls for regular monitoring of blood levels. Dietary supplements in cases of nutritional deficiency are recommended following restrictive surgery and gastric bypass procedures (GBP). Women of childbearing age who have undergone GBP must discuss regular dietary supplementation (200 mg of iron a day) with their healthcare providers. Vitamin B12 deficiency is highly prevalent after GBP, but also occurs at a significant rate after restrictive surgery (4–10%). Dietary supplements after GBP are crucial, and oral administration is possible (1,000 μg a week at 500 μg a day). Folic acid deficiency occurs in about 40% of patients after GBP. A dose of 400 μg at 1 mg a day is necessary to correct this deficiency. This must always be administered when pregnancy has been planned. Increased parathyroid hormone levels stemming from vitamin D deficiency and reduced calcium absorption, with its consequences on bone, occur frequently after GBP. Calcium and vitamin D supplements must be administered in this case (1,000–1,500 mg a day of calcium (citrate), combined with 400–1,000 UI of cholecalciferol). Symptoms of thiamine (vitamin B1) deficiency, responsible for Wernicke’s encephalopathy, are usually triggered by glucose administration in deficient patients (vomiting). Zinc and selenium deficiencies affect 25–30% of patients. Dietary supplements of iron, vitamin B12, folic acid, calcium and vitamin D, as well as comprehensive monitoring of nutritional status, are necessary after bariatric surgery, especially following gastric bypass procedures. Patients should be informed of this necessity. The assessment of patient compliance is a factor to take into account when evaluating indications.
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