British Obesity and Metabolic Surgery Society Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery-2020 update.

Jennifer Devin, Julian H Barth, Iris McMillan, Alex I Blakemore, Manisha Sharma, Kamal K Mahawar, Rachel L Batterham, Gail Pinnock, Karen D Coulman, Mary O'Kane, Denise Thomas, Nerissa Walker, Jessica Mok, Carly A Hughes, Richard Welbourn, Jonathan Pinkney, Helen M Parretti

Journal: Obesity reviews : an official journal of the International Association for the Study of Obesity 2021;21(11):e13087

PMID: 32743907

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Plain Language Summary

All bariatric surgery procedures impact on nutrition to varying degrees and can potentially cause clinically significant deficiencies of micronutrients. The British Obesity and Metabolic Surgery Society (BOMSS) published its first nutritional guidelines in 2014. In fact, the aim of this document is to systematically review the current evidence for preoperative and postoperative biochemical monitoring and micronutrient replacement for adolescents and adults undergoing bariatric surgery, and to update the recommendations for safe practice in the U.K. setting. One hundred and thirty-nine papers were included in the review. Results show that following surgery, the risk of nutritional deficiencies increases because of the impact of bariatric surgery on both oral intake and absorption. Thus, preoperative care should include: - a comprehensive nutritional assessment prior to bariatric surgery, - a clinically investigative and corrective approach of nutritional deficiencies before surgery, - preparatory support and education by a dietitian, and - guidance on following a low calorie/low carbohydrate diet. Whereas, postoperative care should include access to lifelong monitoring following bariatric surgery to ensure that nutritional requirements are met, and risks of developing post-bariatric surgery related nutritional deficiencies are reduced. Authors conclude that these guidelines have the potential to improve clinical practice and safety for people undergoing bariatric surgery and should be considered for adoption by healthcare organizations.

Abstract

Bariatric surgery is recognized as the most clinically and cost-effective treatment for people with severe and complex obesity. Many people presenting for surgery have pre-existing low vitamin and mineral concentrations. The incidence of these may increase after bariatric surgery as all procedures potentially cause clinically significant micronutrient deficiencies. Therefore, preparation for surgery and long-term nutritional monitoring and follow-up are essential components of bariatric surgical care. These guidelines update the 2014 British Obesity and Metabolic Surgery Society nutritional guidelines. Since the 2014 guidelines, the working group has been expanded to include healthcare professionals working in specialist and non-specialist care as well as patient representatives. In addition, in these updated guidelines, the current evidence has been systematically reviewed for adults and adolescents undergoing the following procedures: adjustable gastric band, sleeve gastrectomy, Roux-en-Y gastric bypass and biliopancreatic diversion/duodenal switch. Using methods based on Scottish Intercollegiate Guidelines Network methodology, the levels of evidence and recommendations have been graded. These guidelines are comprehensive, encompassing preoperative and postoperative biochemical monitoring, vitamin and mineral supplementation and correction of nutrition deficiencies before, and following bariatric surgery, and make recommendations for safe clinical practice in the U.K. setting.

Address: Dietetic Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK.; Norwich Medical School, University of East Anglia, Norwich, UK.; Faculty of Health and Human Sciences, Peninsula Schools of Medicine and Dentistry, Plymouth, UK.; Department of Endocrinology, Plymouth Hospitals NHS Trust, Plymouth, UK.; Department of Upper GI and Bariatric Surgery, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, UK.; Fakenham Weight Management Service, Fakenham Medical Practice, Fakenham, UK.; Centre for Obesity Research, Rayne Institute, Department of Medicine, University College London, London, UK.; School of Biosciences, Sutton Bonington Campus, University of Nottingham, Nottingham, UK.; Department of Nutrition and Dietetics, Portsmouth Hospitals NHS Trust, Portsmouth, UK.; Specialist Weight Management Service, Betsi Cadwaladr University Health Board, Wales, UK.; Population Health Sciences, Bristol Medical School. University of Bristol, Bristol, UK.; Obesity and Bariatric Surgery Service, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.; Freelance Dietitian, Somerset, UK.; Bariatric Centre for Weight Management and Metabolic Surgery, UCLH, University College London Hospital (UCLH), London, UK.; National Institute of Health Research, UCLH Biomedical Research Centre, London, UK.; Department of General Surgery, Sunderland Royal Hospital, Sunderland, UK.; Department of Clinical Biochemistry & Bariatric Surgery, Homerton University Hospital NHS Trust, London, UK.; Department of Life Sciences, Brunel University, London, UK.; Department of Medicine, Imperial College, London, UK.; Patient Representative, Edinburgh, UK.; Department of Chemical Pathology & Metabolic Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.

DOI: 10.1111/obr.13087

Patient Centred Factor

Mediators: Biochemical monitoring and micronutrient replacement

Clinical Imbalances

Hormonal Neurological

Modifiable Lifestyle Factors

Diet

Nutrition Evidence Keywords

Obesity Supplementation Type 2 diabetes Malnutrition Micronutrients Weight loss Anaemia Dyslipidaemia Malabsorption Nutritional deficiencies

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https://medlineplus.gov/weightlosssurgery.html

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MeSH Terms: Adolescent, Adult, Bariatric Surgery, Gastric Bypass, Humans, Micronutrients, Obesity, Morbid, Practice Guidelines as Topic, United Kingdom