LONG TERM NUTRITIONAL AND METABOLIC COMPLICATIONS AFTER MALABSORPTIVE BARIATRIC SURGERY

Objective Bariatric surgery is the most effective treatment for weight reducing and weight loss maintaining in patients with severe obesity. Malabsorptive interventions, in particular, may be responsible of severe long term complications. Methods and procedures Twenty-one patients (9 M, 12 F; 50,8 ± 10,3 years) already followed up at the outpatient unit for secondary malnutrition were evaluated. Results The time from surgery was 14,6 ± 6,64 years (min 3 – max 25). Seven patients (2 M, 5 F) received Roux-en-Y Gastric Bypass (GBP) and 14 (5 M, 7 F) Bilio-pancreatic diversion (BPD). Eight patients received oral nutritional supplements (2 GBP - 6 BPD) and 6 (1 GBP – 5 BPD) intravenous hydroelectrolitic supplementation up to parenteral nutrition. Bone densitometry (Dual energy X ray absorpimetry, DXA) on lumbar spine and left femur neck showed osteoporosis in 8 patients (38%), osteopenia in 9 (43%) and normal bone mineral densitometry in 4 patients (19%). Body composition was measured by bioimpedenziometry (BIA). According to the criteria of the European Working Group on Sarcopenia 2010, seven (33%) patients had severe sarcopenia, 12 (57%) moderate sarcopenia and 2 (10%) normal body composition Conclusion The obtained results highlight high rates of bone and muscle mass depletion in these patients, despite they were already followed up and supplemented. An accurate pre-surgical evaluation to unmask and correct possible nutritional deficiencies and a regular post-surgery follow up are recommended, in order to prevent possible long term complications of bariatric malabsorptive procedure.