Nutrition Bariatric surgery patients need nutritional education

Patients undergoing bariatric surgery must be continuously educated on proper nutrition so they can avoid the risk of developing significant vitamin B12 deficiencies, according a study from the University of Connecticut, Farmington.

The research, which is published in SOARD also stated that patients should also learn about the role supplements can play in avoiding catastrophic consequences of nutritional deficiencies.

According to the authors, advances in bariatric surgery have “brought about a paradigm shift in the management of obesity, with benefits extending beyond weight loss”. However, they claim that nutritional deficiencies are “an inherent problem in the postoperative period and oftentimes requires life-long supplementation”. They highlight that Vitamin B12 (or cobalamin) is one of the most common micronutrient deficiencies affecting bariatric surgical patients.

It is estimated that 9% to 14% of bariatric surgical patients have vitamin B12 deficiency going into surgery, and the condition is exacerbated by malabsorption following the procedure.

Their literature review examined the pathophysiology of cobalamin deficiency in bariatric patients and reported on the effectiveness of various available vitamin B12 formulations.

They found that intramuscular vitamin B12 continues to be the ‘gold standard’ of therapy for vitamin B12 deficiency, especially in symptomatic patients. In select patients with asymptomatic vitamin B12 deficiency, they report that high-dose oral cyanocobalamin should be given a consideration, especially if there are concerns with the adherence to intramuscular therapy or if compliance comes into question.

“Given the long-term experience with the intramuscular formulation and its proven efficacy, we believe that it should remain the preferred route of administration for the immediate postoperative period after bariatric surgery, until stable serum levels are achieved,” they note.

However, patients undergoing restrictive procedures may be maintained postoperatively on a lower dose daily vitamin B12 supplementation. They stated that efficacy data of nasal and sublingual routes for maintenance therapy is currently unavailable.

Patients undergoing bariatric surgery must be continuously educated on proper nutrition, the risk of developing significant vitamin B12 deficiency and the role of supplements in avoiding catastrophic consequences.

“Although definite recommendations are not currently available for patients undergoing sleeve gastrectomy or gastric banding, oral supplementation at recommended daily allowance appears to be sufficient to prevent postoperative B12 deficiency in this population,” the authors write.