title: Severe protein malnutrition in a morbidly obese patient after bariatric surgery.
abstract: The aim of this study was to describe the clinical course of a morbidly obese patient who underwent Roux-en-Y gastric bypass (RYGB) surgery and, in the late postoperative period, presented the expected loss of weight, but also presented severe protein malnutrition (PM). A patient with morbid obesity, who in March 2012, presented PM (serum albumin = 2.4 g/dL) 2 y after the completion of RYGB surgery (loss of 52.7% of usual body weight). During the hospitalization, the patient received partial volumes of commercial semi-elemental, high-protein, low-fat diet by tube feeding with gastric positioning, associated with an oral low-fat, low-sodium, and bland-consistency diet. The patient presented a temporary clinical improvement, however, outpatient monitoring identified the need for subsequent hospitalizations due to the recurrence of severe hypoalbuminemia (e.g., 1.39 g/dL), anasarca (increase of 15 kg in 79 d), and normocytic and normochromic anemia (e.g., hemoglobin 9.2 g/dL). In July 2013 the RYGB partial reversal technique was performed with a reduction of 100 cm in the Roux-en-Y arm. Seventy days after surgery, the patient was asymptomatic (albumin 3.7 g/dL), however, she presented rapid and progressive recovery of the body weight (increase of 10.3 kg in 60 d, without edema). The effective treatment of morbid obesity is still a major challenge in clinical practice. Restrictive, malabsorptive bariatric techniques are associated with nutritional deficiencies. Severe PM is rarely reported as a late postoperative complication of RYGB, however, due to the serious consequences associated with this, it requires early diagnosis and treatment.
authors.affiliation: Faculty of Medicine, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil; Multidisciplinary Residency Program in Clinical Nutrition, Multidisciplinary Residency in Health, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil.
authors.forename: Tatiana de Castro Pereira
authors.initials: Tde C
authors.lastname: Martins
authors.affiliation: Faculty of Medicine, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil; Multidisciplinary Residency Program in Clinical Nutrition, Multidisciplinary Residency in Health, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil; Postgraduate Program in Health Sciences, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil.
authors.forename: Thaís Castro
authors.initials: TC
authors.lastname: Duarte
authors.affiliation: Faculty of Medicine, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil; Multidisciplinary Residency Program in Clinical Nutrition, Multidisciplinary Residency in Health, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil.
authors.forename: Etelvina Rocha Tolentino
authors.initials: ER
authors.lastname: Mosca
authors.affiliation: Department of Surgery, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil; Clinical Hospital, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil.
authors.forename: Conceição de Fátima
authors.initials: Cde F
authors.lastname: Pinheiro
authors.affiliation: Multidisciplinary Residency Program in Clinical Nutrition, Multidisciplinary Residency in Health, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil; Clinical Hospital, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil.
authors.forename: Maria Alzira
authors.initials: MA
authors.lastname: Marçola
authors.affiliation: Faculty of Medicine, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil; Multidisciplinary Residency Program in Clinical Nutrition, Multidisciplinary Residency in Health, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil; Postgraduate Program in Health Sciences, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil; Department of Internal Medicine, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil. Electronic address: daureas@ufu.br.
authors.forename: Daurea Abadia
authors.initials: DA
authors.lastname: De-Souza
mesh_terms: D000713:Anastomosis, Roux-en-Y; D000740:Anemia / Q000209:etiology; D050110:Bariatric Surgery; D015992:Body Mass Index; D004032:Diet; D004487:Edema / Q000209:etiology; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D034141:Hypoalbuminemia / Q000209:etiology; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery; D011502:Protein-Energy Malnutrition / Q000209:etiology* / Q000628:therapy; D012709:Serum Albumin / Q000378:metabolism; D013270:Stomach / Q000601:surgery*; D015430:Weight Gain; D015431:Weight Loss
chemical_list: D012709:Serum Albumin
keywords: Anemia; Malabsorptive bowel syndromes; Morbid obesity; Protein malnutrition; Roux-en-Y gastric bypass