Is mini bypass as mini as we think it is? Nutritional consequences

Is mini bypass as mini as we think it is? Nutritional consequences

Mini/ single loop bypass What is a mini bypass? Single loop One anastomosis Mini Prevalence Increasing

Who is the single loop bypass for? Typical candidates would include: Remote geographic location High BMI Default procedure unless needs to be RYGB Contra-indications: Young females reproductive age range Not best procedure after removal of gastric band

What are the implications? Nutrient absorption Variation in technique

. What do we see in our single loop bypass cohort in practice Which deficiencies, if any Supplement protocols Prevention Treatment Patient experience Weight outcomes

Monitoring nutrition status Importance of nutrition assessment and dietary management Physical signs of deficiencies are often only seen late in the course of the deficiency Goal is long term health benefits of weight loss vs nutritional deficiencies Importance of food sources of vitamins and minerals

Vitamin D Routine screening required. Deficient in 60-80% pre-operatively Particularly important for peri-menopausal women (patient group) Our results: Pre-operative deficiency in 37% of single loop bypass patients 15% at 6months post SL bypass and 19% at 12months post SL bypass Varied levels post (any) bypass in literature Range from 50-63% at 12months post-op

Calcium and PTH Calcium malnutrition can be a predisposing condition for various chronic diseases so early identification is important. Ionised calcium is best marker and to be used in conjunction with PTH and vit D levels. Our results: 32% of SL Bypass patient group had elevated PTH levels prior to surgery. Relevant when 37% of same group had low vitamin D. Elevated PTH was relatively constant at 6 and 12months post surgery (32%, 33%) Literature: Some studies suggest that >50% of post RYGB females would have a negative calcium balance.

Vitamin A Changes in fat digestion as a result of SL bypass alters the digestion, absorption and transport of fat soluble vitamins. Normal absorption of vitamin A would occur passively in the upper small intestine. Our results: 45% of patients tested were deficient pre-operatively. Increased to 71% at 6months post SL bypass and similar (77%) at 12months. Literature: Some studies showed pre-op vit A deficiencies in as few as 7% of patients. As high as 52% at 12-18months post RYGB.

Zinc Zinc depends on fat absorption so likelihood of deficiency. Poor tolerance of zinc rich foods makes this common after any sort of bypass. Results: Only 7% patient group deficient prior to SL Bypass Deficiency present in 40% at 6months post op, 36% at 12months post op Literature: Can be as high as 28% pre-operatively in RYGB patients 36% of RYGB patients deficient at 12months post-op

Vitamin B12 and folate Involved in the maturation of red blood cells. Bypass patients have incomplete release of B12 from foods. Decreased IF availability, decrease in parietal cells SL Bypass results B12 1% of pre-op patients vit B12 deficient Deficiency in 6% of patients at 6months post op, 10% at 12months post op Folate 2% of pre-op patient with folate deficiency Rates at 6months = 27.5%, and at 12months = 15% Literature: B12 Pre op deficiency rates 2-18% Post op deficiency rates (at 2-5 years) < 20%. Usually due to food intolerances or low protein intake Folate Pre op deficiency rates 0-54% Post op deficiency rates up to 65%. Important to monitor frequently in post op patients planning a pregnancy.

Iron studies Absorption of iron can occur throughout small intestine but most efficient in duodenum and proximal jejunum bypassed. Reduced dietary intake of iron rich foods. SL bypass results Present in 9% pre op patients 10% at 6 months post op, 24% at 12months post op Literature From 15-60% in first 2 yrs post RYGB. Average 33% but thought to be as high as >50% among women of childbearing age

Conclusion.