A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional
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B26 Bariatric Times • November 2016 • Supplement B FIRST INTERNATIONAL CONSENSUS CONFERENCE ON DUODENAL SWITCH Table 1. Suggested Postoperative Nutritional Supplementation VITAMIN/MINERAL SCREENING NORMAL RANGE SUPPLEMENT DAILY TOTAL COMMENTS Protein Serum albumin 4-6 g/dL Modular Protein Supplements 90 g/d T here are several types: complete protein concentrates, collagen-based concentrates, amino acid doses, or hybrids of protein plus an amino acid dose These options have different amino acid profiles, which will guide product selection. Vitamin D 25(OH)D 25-40 ng/mL Water soluble analogue 2000 IU Vitamin D Choose water soluble analogues May begin 2-4 weeks after surgery Additional supplementations based on serum levels Vitamin A Plasma retinol 20-80 µg/dL Multivitamin- mineral supplement Fat-soluble vitamins 200% of daily value Minimum of 10,000 IU of Vitamin A Additional supplements may be necessary Retinol sources of vitamin A should be used to calculate dosage Most supplements contain a high percentage of beta carotene which does not contribute to vitamin A toxicity Elemental calcium Choose a brand that contains calcium citrate, magnesium 1800-2400 mg/d Split into 500-600 mg doses; be mindful of serving size on supplement label; space doses evenly throughout day Wait ≥2 h after taking multivitamin or iron supplements Zinc Plasma zinc 60-130 µg/dL Multivitamin- mineral supplement 200% of daily value Additional supplements may be necessary Iron Ferritin Males: 15-200 ng/mL Females: 12-150 ng/mL Multivitamin- mineral supplement Elemental iron 200% of daily value Minimum of 18-27 mg/d Additional supplements may be necessary to achieve a total oral intake of 50-100 mg daily Dosage may need to be adjusted based on biochemical markers No enteric coating Do not mix iron and calcium supplements, take ≥2 h apart Vitamin C may enhance absorption of non-heme iron sources Based on to Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Surg Obes Relat Dis. 2013;9(2):159–191.