American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient 2016 Update: Micronutrients.
TL;DR: The focus of this paper is to update the 2008 American Society for Metabolic and Bariatric Surgery Nutrition in Bariatric surgery Guidelines with key micronutrient research in laparoscopic adjustable gastric banding, Roux-en-Y gastric bypass, Laparoscopic sleeve gastrectomy, biliopancreatic diversion, and bilioplatform switch.
About: This article is published in Surgery for Obesity and Related Diseases.The article was published on 2017-05-01. It has received 434 citations till now. The article focuses on the topics: Duodenal switch & Micronutrient.
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TL;DR: Given the higher risk of adult obesity that develops in childhood, MBS should not be withheld from adolescents when severe co-morbidities, such as depressed health-related quality of life score, type 2 diabetes, obstructive sleep apnea, and nonalcoholic steatohepatitis exist.
305 citations
Icahn School of Medicine at Mount Sinai1, Boston University2, Ohio State University3, University of Alabama at Birmingham4, Harborview Medical Center5, Harvard University6, Northwestern University7, Providence Health & Services8, University of Texas Health Science Center at San Antonio9, Brigham and Women's Hospital10, American Association of Clinical Endocrinologists11, University of Arizona12, Mayo Clinic13, Gundersen Health System14, University of Texas Health Science Center at Houston15, Geisinger Health System16
TL;DR: These updated clinical practice guidelines for bariatric procedures remain a safe and effective intervention for higher-risk patients with obesity and clinical decision-making should be evidence-based within the context of a chronic disease.
302 citations
TL;DR: In the present recommendations, the basic notions needed to provide first-level adequate medical care to post-bariatric patients are summarised and a short list of clinical practical recommendations is included.
Abstract: Bariatric surgery is today the most effective long-term therapy for the management of patients with severe obesity, and its use is recommended by the relevant guidelines of the management of obesity in adults. Bariatric surgery is in general safe and effective, but it can cause new clinical problems and is associated with specific diagnostic, preventive and therapeutic needs. For clinicians, the acquisition of special knowledge and skills is required in order to deliver appropriate and effective care to the post-bariatric patient. In the present recommendations, the basic notions needed to provide first-level adequate medical care to post-bariatric patients are summarised. Basic information about nutrition, management of co-morbidities, pregnancy, psychological issues as well as weight regain prevention and management is derived from current evidences and existing guidelines. A short list of clinical practical recommendations is included for each item. It remains clear that referral to a bariatric multidisciplinary centre, preferably the one performing the original procedure, should be considered in case of more complex clinical situations.
252 citations
Mount Sinai Hospital1, Icahn School of Medicine at Mount Sinai2, Boston University3, Ohio State University4, Veterans Health Administration5, University of Alabama at Birmingham6, Harborview Medical Center7, Harvard University8, Northwestern University9, Providence Health & Services10, University of Texas Health Science Center at San Antonio11, Brigham and Women's Hospital12, American Association of Clinical Endocrinologists13, University of Arizona14, Mayo Clinic15, Gundersen Health System16, University of Texas Health Science Center at Houston17, Geisinger Health System18
TL;DR: Bariatric procedures remain a safe and effective intervention for higher-risk patients with obesity and clinical decision-making should be evidence-based within the context of a chronic disease.
245 citations
TL;DR: A personalized approach for preventing and managing T2DM should consider biological and behavioral models, and embed nutrition education as part of lifestyle diabetes prevention studies, as functional foods may provide additional benefits in such an approach.
Abstract: Functional foods contain biologically active ingredients associated with physiological health benefits for preventing and managing chronic diseases, such as type 2 diabetes mellitus (T2DM). A regular consumption of functional foods may be associated with enhanced anti-oxidant, anti-inflammatory, insulin sensitivity, and anti-cholesterol functions, which are considered integral to prevent and manage T2DM. Components of the Mediterranean diet (MD)—such as fruits, vegetables, oily fish, olive oil, and tree nuts—serve as a model for functional foods based on their natural contents of nutraceuticals, including polyphenols, terpenoids, flavonoids, alkaloids, sterols, pigments, and unsaturated fatty acids. Polyphenols within MD and polyphenol-rich herbs—such as coffee, green tea, black tea, and yerba mate—have shown clinically-meaningful benefits on metabolic and microvascular activities, cholesterol and fasting glucose lowering, and anti-inflammation and anti-oxidation in high-risk and T2DM patients. However, combining exercise with functional food consumption can trigger and augment several metabolic and cardiovascular protective benefits, but it is under-investigated in people with T2DM and bariatric surgery patients. Detecting functional food benefits can now rely on an “omics” biological profiling of individuals’ molecular, genetics, transcriptomics, proteomics, and metabolomics, but is under-investigated in multi-component interventions. A personalized approach for preventing and managing T2DM should consider biological and behavioral models, and embed nutrition education as part of lifestyle diabetes prevention studies. Functional foods may provide additional benefits in such an approach.
221 citations
Cites background from "American Society for Metabolic and ..."
..., Roux-en-Y-gastric bypass; RYGB) procedures, is considered one of the most effective treatments for morbidly obese (BMI > 40 kg/m2) or obese (BMI = 35–40 kg/m2) patients with co-morbidities such as T2DM, hypertension, dyslipidemia, obstructive sleep apnea, obesity hypoventilation, gastroesophageal influx disease, asthma, venous stasis, polycystic ovary syndrome, and pseudotumor cerebri [96]....
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References
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Icahn School of Medicine at Mount Sinai1, Cedars-Sinai Medical Center2, Beth Israel Deaconess Medical Center3, University of Alabama at Birmingham4, Mayo Clinic5, Cleveland Clinic Lerner College of Medicine6, Northwestern University7, University of Utah8, Brigham and Women's Hospital9, Baker IDI Heart and Diabetes Institute10
TL;DR: These updated guidelines reflect recent additions to the evidence base and include Examples of expanded topics in this update include: the roles of sleeve gastrectomy, bariatric surgery in patients with type‐2 diabetes,bariatric surgery for patients with mild obesity, copper deficiency, informed consent, and behavioral issues.
Abstract: The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2010 protocol for standardized production of clinical practice guidelines (CPG). Each recommendation was re-evaluated and updated based on the evidence and subjective factors per protocol. Examples of expanded topics in this update include: the roles of sleeve gastrectomy, bariatric surgery in patients with type-2 diabetes, bariatric surgery for patients with mild obesity, copper deficiency, informed consent, and behavioral issues. There are 74 recommendations (of which 56 are revised and 2 are new) in this 2013 update, compared with 164 original recommendations in 2008. There are 403 citations, of which 33 (8.2%) are EL 1, 131 (32.5%) are EL 2, 170 (42.2%) are EL 3, and 69 (17.1%) are EL 4. There is a relatively high proportion (40.4%) of strong (EL 1 and 2) studies, compared with only 16.5% in the 2008 AACE-TOS-ASMBS CPG. These updated guidelines reflect recent additions to the evidence base. Bariatric surgery remains a safe and effective intervention for select patients with obesity. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.
1,565 citations
TL;DR: Allied Health Sciences Section Ad Hoc Nutrition Committee: Linda Aills, R.S., R.D., Cynthia Buffington, Ph.D, and Jeanne Blankenship, M.S.
510 citations
"American Society for Metabolic and ..." refers background in this paper
...This evaluation is necessary to identify preoperative nutritional deficiencies, as well as to evaluate a patient’s ability to incorporate nutritional changes before and after WLS [2]....
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...This document is intended to update the 2008 ASMBS Allied Health Nutritional Guidelines for the Surgical Weight Loss Patient [2]....
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...This paper is an update of the ASMBS Nutrition Committee’s Allied Health Nutritional Guidelines for the Surgical Weight Loss Patient (2008) [2] and serves as an educational tool not only for dietitians but also for other providers working with pre-WLS patients....
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...In 2008, the American Society for Metabolic and Bariatric Surgery (ASMBS) Nutrition Committee published the Allied Health Nutritional Guidelines for the Surgical Weight Loss Patient [2]....
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01 Jan 2011
TL;DR: This chapter provides a brief review of modern applications of scientific evidence in the development of clinical care and evolution of CPGs in the United States and internationally, as well as a review of the major guideline developers and users today.
Abstract: Before specific consideration of standards for trustworthy clinical practice guidelines (CPGs), the committee examined the history of evidence-based medicine and guideline development. This chapter provides a brief review of modern applications of scientific evidence in the development of clinical care and evolution of CPGs in the United States and internationally, as well as a review of the major guideline developers and users today. The chapter is by no means an exhaustive history of guideline development or a complete list of current stakeholders; instead it aims to present the reader with a general overview of the guideline landscape.
369 citations
TL;DR: Postoperatively, significantly more vitamin B12 and vitamin D deficiencies and hyperparathyroidism were found in patients who had undergone LRYGB, and folate deficiency was more frequent (but not significantly so), while calcium levels were normal in all patients.
Abstract: Deficiencies in micronutrients after bariatric operations are frequent, despite routine supplementation. Main outcome measures were pre- and postoperative frequency of nutrient deficiencies and success rate of their treatment. Between 5/2004 and 12/2006, 136 patients (m:f = 0:4) with an average body mass index of 45 (35–58) kg/m2 and age of 53 (21–66) years were prospectively analysed. Laparoscopic Roux-Y-gastric bypass (LRYGB) was performed in 86 patients and laparoscopic sleeve gastrectomy (LSG) was performed in 50 patients. The patients were examined before surgery as well as 3, 6, 12, 24, 30, and 36 months postoperatively using a standard protocol including laboratory tests. The mean follow-up time was 24.4 (12–40) months; the follow-up rate was 100%. Prior to surgery, 57% of the patients had at least one deficiency, 23% of whom had vitamin D3 deficiency. Frequent postoperative deficiencies after LSG were zinc, vitamin D3, folic acid, iron, and vitamin B12; after LRYGB, vitamin B12, vitamin D3, zinc, and secondary hyperparathyroidism. No vitamin B1 or B6 deficiencies were found. Calcium levels were normal in all patients. Treatment of the deficiencies was mostly successful. Preoperatively, 57% of morbidly obese patients already had a deficiency. Postoperatively, significantly more vitamin B12 and vitamin D deficiencies and hyperparathyroidism were found in patients who had undergone LRYGB. After LSG, folate deficiency was more frequent (but not significantly so). Calcium levels were normal in all patients; therefore, parathyroid hormone and vitamin D3 levels are more sensitive markers for early detection of disorders of calcium metabolism. Iron deficiency anaemia is most efficiently treated by IV therapy.
354 citations
"American Society for Metabolic and ..." refers background in this paper
...Screening is important because it is common for patients presenting for WLS to have at least 1 vitamin or mineral deficiency preoperatively [11]....
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TL;DR: The relationship between vitamin D deficiency and the development of metabolic bone diseases, such as osteoporosis or osteomalacia, may explain the increased risk of hip fracture in patients after RYGB.
Abstract: Lifestyle intervention programmes often produce insufficient weight loss and poor weight loss maintenance. As a result, an increasing number of patients with obesity and related comorbidities undergo bariatric surgery, which includes approaches such as the adjustable gastric band or the 'divided' Roux-en-Y gastric bypass (RYGB). This Review summarizes the current knowledge on nutrient deficiencies that can develop after bariatric surgery and highlights follow-up and treatment options for bariatric surgery patients who develop a micronutrient deficiency. The major macronutrient deficiency after bariatric surgery is protein malnutrition. Deficiencies in micronutrients, which include trace elements, essential minerals, and water-soluble and fat-soluble vitamins, are common before bariatric surgery and often persist postoperatively, despite universal recommendations on multivitamin and mineral supplements. Other disorders, including small intestinal bacterial overgrowth, can promote micronutrient deficiencies, especially in patients with diabetes mellitus. Recognition of the clinical presentations of micronutrient deficiencies is important, both to enable early intervention and to minimize long-term adverse effects. A major clinical concern is the relationship between vitamin D deficiency and the development of metabolic bone diseases, such as osteoporosis or osteomalacia; metabolic bone diseases may explain the increased risk of hip fracture in patients after RYGB. Further studies are required to determine the optimal levels of nutrient supplementation and whether postoperative laboratory monitoring effectively detects nutrient deficiencies. In the absence of such data, clinicians should inquire about and treat symptoms that suggest nutrient deficiencies.
337 citations