DALLAS — More patients are presenting with complications resulting from poor eating patterns and failure to take required nutritional supplements after bariatric surgery, Margaret Malone, Ph.D., said at a conference sponsored by the American Society for Parenteral and Enteral Nutrition.
Most complications can be prevented by teaching patients how to adapt food and fluid intake to a stomach pouch with capacity limited to 15–30 mL and educating them about the need for lifelong supplements, stressed Dr. Malone, a professor at Albany (New York) College of Pharmacy.
According to a recent study, 10% of bariatric surgery patients require rehospitalization because of the inability to keep up with fluid requirements (Obesity Res. 2005;13:2202–9). Dr. Malone stressed the need to instruct patients to sip water all day, avoid large gulps, and separate liquids from solids at mealtime.
A major problem in managing these patients is that nutritional monitoring frequently stops after the first year, once the weight-loss goal has been achieved. To ensure adequate protein intake, Dr. Malone suggested that patients eat protein first, before becoming full, and/or use protein supplements. Vitamin B12, folate, and iron are commonly deficient in gastric bypass patients. Dr. Malone said she recommends 60 mg iron, 2–3 times daily. She stressed the need to monitor menstruating women for anemia, noting that many of them require IV iron replacement several times a year.
Alterations in medications routinely taken by patients may also be required after gastric bypass. Hydrophilic, or water soluble, drugs that are distributed into lean body mass should be dosed according to ideal body weight, she said, while dosage for lipophilic, or fat soluble, drugs, which are distributed equally between lean and fat body mass, should be calculated according to actual body weight. Drug dosages aimed at achieving a defined therapeutic outcome, such as blood pressure and blood glucose level, should be titrated upward until the goal is met, similar to what is done in normal-weight patients.
Dr. Malone recommended avoiding slow-release supplements, especially iron, as well as drugs that require acidic pH for absorption, such as ampicillin; drugs known for poor absorption in normal people, such as protease inhibitors; or drugs that cause gastric ulceration/irritation, such as NSAIDS, aspirin, and potassium. She also suggested selecting chewable or soluble calcium products, such as Citracal liquitabs, rather than large pills or tablets.
Gastric bypass patients also frequently report greater sensitivity to alcohol intake, Dr. Malone said, emphasizing the need to counsel patients on eliminating or limiting alcohol consumption, especially during the first year postop.