title: Long-term medical complications after malabsorptive procedures: effects of a late clinical nutritional intervention.
abstract: OBJECTIVE
  The growing prevalence of severe obesity, combined with the failure of conservative treatments, has led to a significant spread of bariatric surgical procedures. The aim of this study was to emphasize the need of adequate presurgery patient selection and close follow-up after malabsorptive procedures for bariatric surgery.
  
  
  METHODS
  The study retrospectively evaluated 25 (20 F, 5 M; mean age 43 ± 13 y) obese patients (mean weight before intervention 134 ± 30.7 kg, body mass index 50.7 ± 10.1 kg/m(2)) attending our outpatient clinical nutrition unit for severe malabsorption and secondary malnutrition after surgical intervention that had been performed outside the regional area.
  
  
  RESULTS
  All patients received personalized dietetic indications; in 12 of 25 (48%) cases integrated by oral protein supplements and in 5 of 25 (20%) by medium chain triglycerides. According to screening exams, patients were prescribed oral/parenteral iron, vitamins A, B group, D, and folate supplementation. In 14 of 25 (56%) patients, parenteral hydration and in 4 of 25 (16%), long-term parenteral nutrition was required. Five patients required hospitalization for severely complicated protein-energy malnutrition.
  
  
  CONCLUSIONS
  Nutritional deficiencies are common after malabsorptive procedures for bariatric surgery; these can be present or latent before surgery, frequently going unrecognized and/or inadequately treated particularly when patients are not strictly followed up by the operating center. Despite the adequate-even intensive-intervention, clinical nutritional status moderately improved in all patients.
authors.affiliation: Interuniversity Research Center for Obesity and Eating Disorder CISRO, Department of Clinical Medicine and Surgery, Naples, Italy. Electronic address: Lidia.santarpia@unina.it.
authors.forename: Lidia
authors.initials: L
authors.lastname: Santarpia
authors.affiliation: Interuniversity Research Center for Obesity and Eating Disorder CISRO, Department of Clinical Medicine and Surgery, Naples, Italy.
authors.forename: Ilenia
authors.initials: I
authors.lastname: Grandone
authors.affiliation: Interuniversity Research Center for Obesity and Eating Disorder CISRO, Department of Clinical Medicine and Surgery, Naples, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Alfonsi
authors.affiliation: Department of Public Health, Pre and Post Transplant Surgery, Federico II University Hospital, Naples, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Sodo
authors.affiliation: Interuniversity Research Center for Obesity and Eating Disorder CISRO, Department of Clinical Medicine and Surgery, Naples, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Contaldo
authors.affiliation: Interuniversity Research Center for Obesity and Eating Disorder CISRO, Department of Clinical Medicine and Surgery, Naples, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Pasanisi
mesh_terms: D050110:Bariatric Surgery / Q000009:adverse effects*; D015992:Body Mass Index; D019587:Dietary Supplements; D005260:Female; D006301:Health Services Needs and Demand; D006760:Hospitalization; D006801:Humans; D007501:Iron / Q000627:therapeutic use; D008286:Malabsorption Syndromes / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D009767:Obesity, Morbid / Q000601:surgery*; D010288:Parenteral Nutrition; D011183:Postoperative Complications / Q000178:diet therapy* / Q000628:therapy; D011502:Protein-Energy Malnutrition / Q000178:diet therapy* / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D014815:Vitamins / Q000627:therapeutic use
chemical_list: D014815:Vitamins; D007501:Iron
keywords: Bariatric surgery; Follow-up; Malabsorption; Nutritional supplements