Abstract
In order to develop evidence-based recommendations and expert consensus for nutrition management of patients undergoing bariatric surgery and postoperative follow-up, we conducted a systematic literature search using PRISMA methodology plus critical appraisal following the SIGN and AGREE-II procedures. The results were discussed among all members of the GARIN group, and all members answered a Likert scale questionnaire to assess the degree of support for every recommendation. Patients undergoing bariatric surgery should be screened preoperatively for some micronutrient deficiencies and treated accordingly. A VLCD (Very Low-Calorie Diet) should be used for 4–8 weeks prior to surgery. Postoperatively, a liquid diet should be maintained for a month, followed by a semi-solid diet also for one month. Protein requirements (1–1.5 g/kg) should be estimated using adjusted weight. Systematic use of specific multivitamin supplements is encouraged. Calcium citrate and vitamin D supplements should be used at higher doses than are currently recommended. The use of proton-pump inhibitors should be individualised, and vitamin B12 and iron should be supplemented in case of deficit. All patients, especially pregnant women, teenagers, and elderly patients require a multidisciplinary approach and specialised follow-up. These recommendations and suggestions regarding nutrition management when undergoing bariatric surgery and postoperative follow-up have direct clinical applicability.
Highlights
Obesity is a pathology that has reached epidemic proportions in recent years
The GARIN group members held a virtual meeting to propose and select questions related to the clinical practice and management of obese patients undergoing obesity surgery
The article includes the responses obtained from the above-described process to twenty questions framed in three groups, according to the clinical situation of the bariatric patient, in the Preoperative period, during the Postoperative period or in the Obesity Surgery period in special situations
Summary
Obesity is a pathology that has reached epidemic proportions in recent years. Apart from treatment using hygienic-dietary measures and drug therapy, surgery is highly effective in the case of grade3 obesity (BMI > 40 Kg/m2 ), or grade 2 obesity (BMI > 35 Kg/m2 ) with associated comorbidities.The main techniques currently in use are divided into: restrictive practices (those that restrict gastric net volume, known as the gastric sleeve, SG, sleeve gastrectomy or Laparoscopic Sleeve Gastrectomy, LSG); malabsorptive practices (those that achieve a malabsorption of nutrients, such as BiliopancreaticDiversion); and mixed practices (those that combine both procedures, as in the case of the gastric bypass, RYGBP) [1,2]. Apart from treatment using hygienic-dietary measures and drug therapy, surgery is highly effective in the case of grade. 3 obesity (BMI > 40 Kg/m2 ), or grade 2 obesity (BMI > 35 Kg/m2 ) with associated comorbidities. The main techniques currently in use are divided into: restrictive practices (those that restrict gastric net volume, known as the gastric sleeve, SG, sleeve gastrectomy or Laparoscopic Sleeve Gastrectomy, LSG); malabsorptive practices The almost universal access route is Laparoscopic. These techniques are highly effective in terms of weight loss; there are aspects that still do not have clear answers, such as indications in special groups, pre- and postoperative nutritional management, supplementation needs and the necessary tests in the follow-up of these patients.
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