Protein Energy Malnutrition (PEM) After Bariatric Surgery

Protein is absorbed across the entire intestinal tract, but is primarily absorbed in the mid-ileum, which is bypassed in many bariatric procedures. After bowel bypass only 57 % of ingested protein is estimated to be absorbed [8]. Research has shown that protein malabsorption occurs in 7-21 % after biliopancreatic diversion (BPD)/roux en Y gastric bypass (RYGB) and this is accompanied by a large loss of fat free mass [8-10]. Interestingly protein malabsorption can also occur after laparoscopic adjustable gastric banding (LAGB), vertical banded gastroplasty (VBG) and laparoscopic sleeve gastrectomy (LSG) [11-13]. Thus not just malabsorption but many other factors may also be involved in protein calorie malnutrition in bariatric patients including lack of adequate intake, food intolerance, food aversions, socio-economic status, vomiting, and diarrhea [14]. Therefore, most bariatric patients irrespective of the type of bariatric procedure will be at a risk of protein malnutrition.

It has been shown that post bariatric patients with inadequate protein intake find it difficult to lose weight and maintain weight [2]. Loss of lean body mass is more than expected with a consequent reduction in basal metabolic rate and physiological damage. Conversely, a protein-rich diet can lead to increased satiety, enhance weight loss and improved body composition. Hence increased consumption of dietary protein improves body weight management and prevention of weight regain in post bariatric surgery patients [2].

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