Severe protein-calorie malnutrition after bariatric procedures.
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.
Faintuch
Joel
J
Obesity Group, Hospital das Clínicas, São Paulo, SP, Brazil. faintuch@net.ipen.br
Matsuda
Mitsunori
M
Cruz
Maria Emilia L F
ME
Silva
Marlene M
MM
Teivelis
Marcelo P
MP
Garrido
Arthur B
AB
Gama-Rodrigues
J J
JJ
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*