Nutritional assessment of bariatric surgery patients presenting for plastic surgery: a prospective analysis.
BACKGROUND
Assessment of nutritional status in the growing postbariatric patient population remains controversial. Previous literature suggests that these patients have poor nutrition that may have adverse effects on surgical outcomes. The authors sought to determine the optimal method of nutritional assessment in postbariatric patients.


METHODS
One hundred patients presenting for body contouring after bariatric surgery were consecutively enrolled in an institutional review board-approved prospective study. A trained nutritionist assessed protein and calorie intake. All patients underwent baseline laboratory assessment.


RESULTS
Eighteen percent of subjects had less than the recommended daily protein intake. Hypoalbuminemia was observed in 13.8 percent of subjects, with hypoprealbuminemia in 6.5 percent. Nearly forty percent of all patients had evidence of iron deficiency, with vitamin B12 deficiency present in 14.5 percent. Ten percent of subjects (all women) were confirmed to have iron deficiency anemia. Impaired fasting glucose was seen in 6.2 percent of subjects, whereas 3.6 percent had hemoglobin A1c levels greater than 6.5. Increasing age (odds ratio, 1.07) and greater change in body mass index (odds ratio, 1.11) were predictors of low protein intake. Dumping syndrome led to 13.3 times increased odds of low albumin levels.


CONCLUSIONS
The results suggest that inadequate nutrition is common among postbariatric patients presenting for body contouring. The lack of correlation between methods of nutritional assessment supports the combination of multiple methods in determining overall nutritional status. The presence of dumping syndrome, a large change in body mass index, and advanced age may help to identify patients with an increased risk of nutritional deficiency.
Naghshineh
Nima
N
Pittsburgh, Pa. From the Department of Surgery, Division of Plastic and Reconstructive Surgery, the Department of Internal Medicine, and the Department of Surgery, Division of General Surgery, University of Pittsburgh School of Medicine.
O'Brien Coon
Devin
D
McTigue
Kathleen
K
Courcoulas
Anita P
AP
Fernstrom
Madelyn
M
Rubin
J Peter
JP
D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D000740:Anemia / Q000175:diagnosis / Q000209:etiology; D001361:Avitaminosis / Q000175:diagnosis / Q000209:etiology; D050110:Bariatric Surgery / Q000009:adverse effects* / Q000379:methods; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000175:diagnosis* / Q000209:etiology; D008875:Middle Aged; D015596:Nutrition Assessment; D009751:Nutritional Requirements; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D013518:Surgery, Plastic / Q000379:methods*; D016896:Treatment Outcome