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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.

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  • Authors+Show Affiliations

    ,

    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.

    ,

    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.

    ,

    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.

    ,

    Department of Surgery, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil; Clinical Hospital, 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; Clinical Hospital, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil.

    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.

    Source

    MeSH

    Anastomosis, Roux-en-Y
    Anemia
    Bariatric Surgery
    Body Mass Index
    Diet
    Edema
    Female
    Gastric Bypass
    Humans
    Hypoalbuminemia
    Middle Aged
    Obesity, Morbid
    Postoperative Complications
    Protein-Energy Malnutrition
    Serum Albumin
    Stomach
    Weight Gain
    Weight Loss

    Pub Type(s)

    Case Reports
    Journal Article

    Language

    eng

    PubMed ID

    25701346

    Citation

    Martins, Tatiana de Castro Pereira, et al. "Severe Protein Malnutrition in a Morbidly Obese Patient After Bariatric Surgery." Nutrition (Burbank, Los Angeles County, Calif.), vol. 31, no. 3, 2015, pp. 535-8.
    Martins Tde C, Duarte TC, Mosca ER, et al. Severe protein malnutrition in a morbidly obese patient after bariatric surgery. Nutrition. 2015;31(3):535-8.
    Martins, T. d. e. . C., Duarte, T. C., Mosca, E. R., Pinheiro, C. d. e. . F., Marçola, M. A., & De-Souza, D. A. (2015). Severe protein malnutrition in a morbidly obese patient after bariatric surgery. Nutrition (Burbank, Los Angeles County, Calif.), 31(3), pp. 535-8. doi:10.1016/j.nut.2014.10.011.
    Martins Tde C, et al. Severe Protein Malnutrition in a Morbidly Obese Patient After Bariatric Surgery. Nutrition. 2015;31(3):535-8. PubMed PMID: 25701346.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Severe protein malnutrition in a morbidly obese patient after bariatric surgery. AU - Martins,Tatiana de Castro Pereira, AU - Duarte,Thaís Castro, AU - Mosca,Etelvina Rocha Tolentino, AU - Pinheiro,Conceição de Fátima, AU - Marçola,Maria Alzira, AU - De-Souza,Daurea Abadia, Y1 - 2014/11/04/ PY - 2014/04/05/received PY - 2014/10/15/revised PY - 2014/10/21/accepted PY - 2015/2/22/entrez PY - 2015/2/24/pubmed PY - 2015/12/29/medline KW - Anemia KW - Malabsorptive bowel syndromes KW - Morbid obesity KW - Protein malnutrition KW - Roux-en-Y gastric bypass SP - 535 EP - 8 JF - Nutrition (Burbank, Los Angeles County, Calif.) JO - Nutrition VL - 31 IS - 3 N2 - 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. SN - 1873-1244 UR - https://www.unboundmedicine.com/medline/citation/25701346/Severe_protein_malnutrition_in_a_morbidly_obese_patient_after_bariatric_surgery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0899-9007(14)00449-3 DB - PRIME DP - Unbound Medicine ER -