Precision nutrition in the context of bariatric surgery

Abstract

Bariatric surgery (BS) is the most effective long-term treatment for severe obesity. This review summarizes the main nutritional deficiencies before and after BS, as well as current dietary and supplementation recommendations to avoid them. Likewise, we have reviewed all those aspects that in recent years have been shown to be related to postoperative weight loss (WL) and its subsequent maintenance, such as hormonal changes, dietary patterns, changes in food preference, adherence to recommendations and follow-up, genetic factors and microbiota, among others. Despite all the knowledge, nutritional deficiencies and weight regain after BS are frequent. It is essential to continue studying in this field in order to establish more precise recommendations according to the individual characteristics of patients. It is also a major objective to understand more deeply the role of the factors involved in WL and its maintenance. This will allow the development of precision treatments and nutrition for patients with obesity, optimizing their benefit after BS.

Evaluation of polyunsaturated fatty acids content in the three stages of breast milk: colostrum, transitional and mature milk of a nursing mother submitted to Roux-en-Y gastric bypass surgery two months prior to pregnancy: Case study

“…If both adipose tissue and plasma PUFAs reflect dietary intake, it is necessary to provide these PUFAs during pregnancy or even before conception and lactation to ensure availability to mothers and sufficient supply to the baby via BM. Perhaps, the participant in this study had no reservations due to the lack of an adequate diet prior to pregnancy, due to common dietary errors in obesity, as well as nutritional deficiencies that occur due to the presence of food intolerances and/or changes in intestinal absorption after BS (Aguas-Ayesa, et al, 2023;Mechanick, et al, 2020). de la Garza Puentes et al (2019) showed that breast milk of mothers with a high BMI presented decreased ALA and DHA concentrations than milk from normal weight nursing mothers.…”

Efficacy of multivitamin support following bariatric surgery in patients with obesity: a prospective observational study

“…BS can induce nutritional deficits that may exacerbate preexisting micronutrients deficiencies [ 18 – 21 ], which result from the poor nutritional quality of the diet, e.g. lack of fruits and vegetables (rich sources of vitamins and minerals), and from specific factors unique to patients with obesity [ 18 , 22 ].…”

“…The prevalence of 25-OH vitamin D deficiency was reported to be 35% higher in individuals with obesity compared with normal weight subjects [ 23 , 24 ]. Iron deficiency and low hemoglobin levels were reported to occur from 0 to 47% in individuals scheduled for BS [ 21 , 25 – 27 ]. Folic acid deficiency rates before BS varied from 0 to 23% [ 18 , 20 , 27 , 28 ], while vitamin B12 deficiency was reported to range from 0 to 23% [ 27 , 29 ].…”

“…The post-surgical management of patients is critical because of the BS-induced decrease of nutrients intake and/or absorption [ 55 , 56 ]. To prevent micronutrient deficiencies, the early administration of targeted food supplements after BS is crucial [ 21 ]. However, ensuring patients’ compliance with multiple supplements can be challenging and it may lead to a high incidence of unsuccessful outcomes, which may increase the sanitation costs due to a rise in emergency admissions, hospitalizations, and treatment expenses [ 57 ].…”

Os principais desafios nutricionais após a cirurgia bariátrica: estratégias de prevenção e intervenção

“…A ingestão insuficiente de alguns macros e micronutrientes, minerais e vitaminas, aumentam o risco de estados deficientes com resultados negativos para os pacientes, aqui destaca-se déficit de vitaminas B12 e D, cálcio e ferro, e doenças como anemia, osteoporose e desnutrição (Aguas-ayesa, 2023).…”