title: Impact of varying levels of protein intake on protein status indicators after gastric bypass in patients with multiple complications requiring nutritional support.
abstract: BACKGROUND
  <6% of patients who undergo Roux-en-Y gastric bypass (RYGBP) for morbid obesity require nutritional support after surgery. Protein and caloric needs have been estimated as 14-21 kcal, 1.2 g protein/kg/current body weight/day in uncomplicated morbidly obese patients. This study assesses the effect of varying protein-calorie intake in complicated patients after RYGBP on two markers of protein status: thyroxine-binding prealbumin (TBPA) and serum albumin.
  
  
  METHODS
  This 25-month retrospective study consisted of 22 patients with postoperative complications. Serum albumin, TBPA, medical nutrition care-plans, laboratory data and history were reviewed. These post-RYGBP patients who had BMI>35 and no multi-system organ failure or fistulas, had complications after surgery requiring nutrition support services (NSS). Serum albumin and TBPA were matched to fed levels of protein using random coefficient regression analysis.
  
  
  RESULTS
  Mean incremental increases of 2.34 mg/dl (TBPA, P=0.0113) and 0.11 g/dl (serum albumin, P=0.0272) were found with each 0.5 g protein intake increase/kg ideal body weight/day (kg/IBW/day). Patients required NSS for 23+/-21 (mean+/-SD) days, with 15+/-19 days fed at goal rate. Initial serum albumin was 2.3+/-0.5, with a final measure of 2.7+/-0.5 g/dl. Goal protein and calorie intake were 2.1 g and 17 kcal/kg IBW/day versus actual intake of 1.6 g and 13 kcal/kg IBW/day.
  
  
  CONCLUSIONS
  Morbidly obese patients requiring NSS following RYGBP risk iatrogenic protein malnutrition. There was a positive linear relationship between protein status and protein intake that warrants further study of higher protein feeding in complicated post-RYGBP patients.
authors.affiliation: Department of Medical Nutrition Therapy, Poudre Valley Hospital, Fort Collins, CO 80524, and Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR, USA. ers3@pvhs.org
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Rinaldi Schinkel
authors.forename: Stefan M
authors.initials: SM
authors.lastname: Pettine
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Adams
authors.forename: Mary
authors.initials: M
authors.lastname: Harris
mesh_terms: D000328:Adult; D000418:Albumins / Q000032:analysis*; D004044:Dietary Proteins; D004435:Eating; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D018529:Nutritional Support; D009767:Obesity, Morbid / Q000601:surgery; D011183:Postoperative Complications; D011502:Protein-Energy Malnutrition / Q000209:etiology / Q000517:prevention & control; D013975:Thyroxine-Binding Proteins / Q000032:analysis*
chemical_list: D000418:Albumins; D004044:Dietary Proteins; D013975:Thyroxine-Binding Proteins