title: Severe protein-calorie malnutrition after bariatric procedures.
abstract: BACKGROUND
  Serious nutritional complications after Roux-en-Y gastric bypass (RYGBP) are infrequent. In a retrospective study of patients operated during a 68-month period, malnutrition was investigated to analyze circumstances associated with nutritional failure.
  
  
  METHODS
  In 236 consecutive RYGBPs, 11 patients with severe malnutrition were identified (4.7%) with age 45.1 +/- 10.6 years (10 females/1 male) and initial BMI 54.6 +/- 8.4 kg/m(2).
  
  
  RESULTS
  In these 11 patients, the derangement was diagnosed 17.9 +/- 15.8 months after RYGBP, following defined events in 63.6% (gastric stenosis, associated diseases ) or mostly exaggeration of expected symptoms in 36.4% (vomiting without endoscopic abnormalities). BMI then was 31.4 +/- 8.6 kg/m(2) (42.5 +/- 9.9% total reduction, or 2.4 +/- 2.1% decrease/month), and serum albumin and hemoglobin were 24.0 +/- 8.2 g/L and 97.0 +/- 23.0 g/L respectively. Edema was present in 45.4% (5/11), hospitalization was required in 54.5% (6/11), and 18.2% (2/11) eventually died.
  
  
  CONCLUSIONS
  Serious malnutrition was unusual but not exceedingly rare in this series. Exogenous precipitating factors were clearly identified in 63.6% of the patients. Careful clinical and nutritional follow-up is recommended to prevent these uncommon but potentially dangerous complications.
authors.affiliation: Obesity Group, Hospital das Clínicas, São Paulo, SP, Brazil. faintuch@net.ipen.br
authors.forename: Joel
authors.initials: J
authors.lastname: Faintuch
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Matsuda
authors.forename: Maria Emilia L F
authors.initials: ME
authors.lastname: Cruz
authors.forename: Marlene M
authors.initials: MM
authors.lastname: Silva
authors.forename: Marcelo P
authors.initials: MP
authors.lastname: Teivelis
authors.forename: Arthur B
authors.initials: AB
authors.lastname: Garrido
authors.forename: J J
authors.initials: JJ
authors.lastname: Gama-Rodrigues
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D015992:Body Mass Index; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011502:Protein-Energy Malnutrition / Q000209:etiology* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013270:Stomach / Q000601:surgery*