Highlights
- •Protein malnutrition (PM) is a rare complication after proximal Roux-en-Y gastric bypass (RYGB), reported in 1.7% of patients in the present review.
- •A structured diagnostic algorithm is necessary to promptly identify and manage potential causes of PM after RYGB, as hypoalbuminemia may have devastating consequences if left untreated.
- •The most common cause of PM remains insufficient oral intake; a minimal protein intake of 60 g/d and up to 1.5 g/kg ideal body weight per day should be ensured.
- •Acute triggering factors such as intractable vomiting, dysphagia and other functional problems may increase the risk of PM in patients with RYGB.
- •A structured diagnostic algorithm needs to be followed in order to promptly identify and manage potential causes of PM after RYGB, as hypoalbuminemia may have devastating consequences in these patients if left untreated.
Abstract
Although protein malnutrition (PM) is often reported after highly malabsorptive procedures,
its exact incidence and mechanisms after Roux-en-Y gastric bypass (RYGB) are poorly
understood. The aim of this study was to present a challenging clinical case of PM
after RYGB and conduct a scoping review of the literature. Among the 18 studies with
3015 RYGB patients included in the review, the median incidence of PM was 1.7% (range,
0%–8.9%), and it was diagnosed 12 to 120 months after RYGB. The most common cause
is insufficient oral intake of protein; however, in cases of persistent hypoalbuminemia,
a thorough diagnostic workup needs to be performed. Risk factors for PM after RYGB
include specific triggering events such as intractable vomiting and dysphagia, and
a total alimentary limb length less than 250 to 300 cm.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Surgery for Obesity and Related DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Short-term outcomes of sleeve gastrectomy plus jejunojejunal bypass: a retrospective comparative study with sleeve gastrectomy and Roux-en-Y gastric bypass in Chinese patients with BMI ≥ 35 kg/m2.Obes Surg. 2019; 29: 1352-1359
- Long-term nutritional impact of sleeve gastrectomy.Surg Obes Relat Dis. 2017; 13: 1664-1673
- Starvation injury after gastric reduction for obesity.World J Surg. 1998; 22: 1002-1007
- Bariatric surgery and long-term nutritional issues.World J Diabetes. 2017; 8: 464-474
- The relevance of dietary protein after bariatric surgery: what do we know?.Curr Opin Clin Nutr Metab Care. 2018; 21: 58-63
- Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, the Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists.Obesity (Silver Spring). 2020; 28: O1-O58
- Nutritional recommendations for adult bariatric surgery patients: clinical practice.Adv Nutr. 2017; 8: 382-394
- Scoping studies: towards a methodological framework.Int J Soc Res Methodol. 2005; 8: 19-32
- Beyond PICO: the SPIDER tool for qualitative evidence synthesis.Qual Health Res. 2012; 22: 1435-1443
- PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation.Ann Intern Med. 2018; 169: 467-473
- Comparison of one-anastomosis gastric bypass and Roux-en-Y gastric bypass for treatment of obesity: a 5-year study.Surg Obes Relat Dis. 2019; 15: 2038-2044
- Early results of the Swiss Multicentre Bypass or Sleeve Study (SM-BOSS): a prospective randomized trial comparing laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass.Ann Surg. 2013; 258: 690-694
- Efficacy and safety of one anastomosis gastric bypass versus Roux-en-Y gastric bypass for obesity (YOMEGA): a multicentre, randomised, open-label, non-inferiority trial.Lancet. 2019; 393: 1299-1309
- Limb length in gastric bypass in super-obese patients-importance of length of total alimentary small bowel tract.Obes Surg. 2019; 29: 2012-2021
- Comparison of early and late complications after various bariatric procedures: incidence and treatment during 15 years at a single institution.World J Surg. 2011; 35: 93-101
- Long-term results of a prospective comparison of Roux-en-Y gastric bypass versus a variant of biliopancreatic diversion in a non-superobese population (BMI 35-50 kg/m(2)).Obes Surg. 2014; 24: 197-204
- Protein malnutrition incidence comparison after gastric bypass versus biliopancreatic diversion.Nutr Hosp. 2015; 32: 80-86
- Five-year outcomes after laparoscopic gastric bypass and laparoscopic duodenal switch in patients with body mass index of 50 to 60: a randomized clinical trial.JAMA Surg. 2015; 150: 352-361
- Comparing the efficacy and safety of Roux-en-Y gastric bypass with one-anastomosis gastric bypass with a biliopancreatic limb of 200 or 160 cm: 1-year results of the Tehran Obesity Treatment Study (TOTS).Obes Surg. 2020; 30: 3528-3535
- Protein deficiency after gastric bypass: the role of common limb length in revision surgery.Surg Obes Relat Dis. 2019; 15: 441-446
- Conversion of standard Roux-en-Y gastric bypass to distal bypass for weight loss failure and metabolic syndrome: 3-year follow-up and evolution of technique to reduce nutritional complications.Surg Obes Relat Dis. 2018; 14: 554-561
- A 7-year clinical audit of 1107 cases comparing sleeve gastrectomy, Roux-En-Y gastric bypass, and mini-gastric bypass, to determine an effective and safe bariatric and metabolic procedure.Obes Surg. 2016; 26: 926-932
- Obesity surgery results depending on technique performed: long-term outcome.Obes Surg. 2009; 19: 432-438
- Risk of malnutrition, trace metal, and vitamin deficiency post Roux-en-Y gastric bypass-a prospective study of 20 patients with BMI<35 kg/m2.Obes Surg. 2015; 25: 2125-2134
- Severe protein-calorie malnutrition after bariatric procedures.Obes Surg. 2004; 14: 175-181
- A prospective single-arm trial of modified long biliopancreatic and short alimentary limbs Roux-En-Y gastric bypass in type 2 diabetes patients with mild obesity.Obes Surg. 2018; 28: 599-605
- Gastric bypass is not associated with protein malnutrition in morbidly obese patients.Obes Surg. 2009; 19: 840-844
- The malnourished patient with obesity: a unique paradox in bariatric surgery.J Surg Res. 2018; 232: 456-463
- Long-term repercussions of Roux-en-Y gastric bypass in a low-income population: assessment ten years after surgery.Rev Col Bras Cir. 2018; 45e1916
- Practical recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the post-bariatric surgery medical management.Obesity Facts. 2017; 10: 597-632
- Energy and macronutrient intake after gastric bypass for morbid obesity: a 3-y observational study focused on protein consumption.Am J Clin Nutr. 2016; 103: 18-24
- Alteration pattern of taste perception after bariatric surgery: a systematic review of four taste domains.Obes Surg. 2019; 29: 1542-1550
- Revisional surgery for insufficient loss or regain of weight after Roux-en-Y gastric bypass: biliopancreatic limb length matters.Obes Surg. 2020; 30: 804-811
- Weight loss and malnutrition after conversion of the primary Roux-en-Y gastric bypass to distal gastric bypass in patients with morbid obesity.Surg Obes Relat Dis. 2020; 16: 381-388
- Long-term (>10 yrs) outcome of the laparoscopic biliopancreatic diversion with duodenal switch.Ann Surg. 2016; 264: 1029-1037
- Weight loss and nutritional outcomes 10 years after biliopancreatic diversion with duodenal switch.Obes Surg. 2017; 27: 1645-1650
- Reversal to normal anatomy after one-anastomosis/mini gastric bypass, indications and results: a systematic review and meta-analysis.Surg Obes Relat Dis. 2021; 17: 1489-1496
- The first consensus statement on one anastomosis/mini gastric bypass (OAGB/MGB) using a modified Delphi approach.Obes Surg. 2018; 28: 303-312
- Treatment of severe protein malnutrition after bariatric surgery.Obes Surg. 2019; 29: 3095-3102
- Nutritional deficiencies after bariatric surgery.Nat Rev Endocrinol. 2012; 8: 544-556
- Gastric bypass compared with sleeve gastrectomy for nonalcoholic fatty liver disease: a systematic review and meta-analysis.Obes Surg. 2021; 31: 2762-2772
- Hepatic complications of bariatric surgery: the reverse side of the coin.Acta Gastroenterol Belg. 2017; 80: 505-513
- Intestinal bypass surgery for morbid obesity: long-term results.JAMA. 2014; 312: 966
- The multicenter Belgian survey on liver transplantation for hepatocellular failure after bariatric surgery.Transplant Proc. 2010; 42: 4395-4398
- Retrospective cohort study of 925 OAGB procedures. The UK MGB/OAGB collaborative group.Int J Surg. 2019; 69: 13-18
- Short-term liver function after biliopancreatic diversion.Obes Surg. 2003; 13: 752-755
- Bariatric surgery provides long-term resolution of nonalcoholic steatohepatitis and regression of fibrosis.Gastroenterology. 2020; 159: 1290-1301
- Surgical management of small intestinal bacterial overgrowth after Roux-en-Y gastric bypass.Obes Surg. 2020; 30: 4677-4678
- Liver injury and acute liver failure after bariatric surgery: an overview of potential injury mechanisms.J Clin Gastroenterol. 2022; 56: 311-323
Article info
Publication history
Published online: December 27, 2022
Accepted:
December 17,
2022
Received:
September 8,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
This work was presented at the 9th IFSO-EC Chapter Congress in Prague, October 2021.
Identification
Copyright
© 2022 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
