Nutritional Assessment of Bariatric Surgery Patients Presenting for Plastic Surgery
More and more post-bariatric patients are presenting for open body contouring every year. As we know, loss of massive weight in a relatively short period of time can result in any of several nutritional abnormalities, including negative protein balance, blood glucose instability, and vitamin deficiencies. A recent study (Plast. Reconstr. Surg. Vol 126, No 2., Aug, 2010. p602) sought to address the nutritional status of the nearly 220,000 new bariatric surgery patients that present every year, by assessing the methods of pre-operative nutritional evaluation.
Study Patients: 100 consecutive post-bariatric surgery body-contouring patients. Average pre-weight loss BMI was 52.1 +/- 9.1, time from weight loss procedure was 26.4 +/- 14.3 months. Average pre-contouring BMI was 30.9 +/- 6.2.
Summary of Findings:
1) Patients who were older & had greater weight loss or dumping syndrome following bariatric surgery were more likely to present with indicators of inadequate nutritional status.
2) Lab studies of coagulation (blood clotting ability), liver function (protein making ability) and electrolytes (cell & serum stability) were normal for essentially all patients.
3) Protein Balance: 17.7% of patients had less than the recommended daily protein intake (which should be about 0.8-1.0 time the ideal body weight). 13.8% had low serum albumIn levels (<3.5 g/dl). This is important since protein deficiency is known to cause delayed wound healing & decreased wound tensile strength, which can lead to wound separation. This is especially important after major surgery, when protein requirements can increase up to 25%.
4) Vitamin Deficiency, Mineral Deficiency & Anemia: Iron deficiency was seen in 39.7% (12% seen in the general premenopausal female population) & Vitamin B12 deficiency was seen in 14.5%. 24.6% of women had low hemoglobin levels (<12.5), while no men had low hemoglobin levels (<13.5). Only 10% of patients were shown to have true iron deficiency anemia. Folate deficiency was not seen.