Understanding Protein Energy Malnutrition: The Crucial Role of Protein After Bariatric Surgery

Understanding Protein and Its Importance

Protein is a macronutrient and building block of body tissues. It also serves as a fuel source, 1gm gives 4 Kcal. Protein is needed for growth and maintenance and can be found in all body cells (Total body protein = 50% in muscles + 20% in bones + 10% in skin + rest in other parts).

The term “Protein” comes from the Greek word ‘protos’ – to take first place!! The same applies to its intake after bariatric surgery. Bariatric patients are advised to feed themselves with protein first to fulfil their protein needs as well as for healthy weight loss.

Risks of Protein-Energy Malnutrition After Bariatric Surgery

After weight loss surgery patients can be at risk of PEM due to Inadequate protein and/or energy intake, food intolerances to good quality protein, restrictive/malabsorptive surgeries (reduced Length of gut hence less area available for absorption, Pancreatic), small stomach pouch, increased protein need for wound healing, food aversions or food faddism, poor compliance or ignorance of post-surgical nutrition guidelines and/or Inability to recognize or afford high-quality protein.

Sources and Requirements of Protein

Various sources of protein are available which can be included in the diet such as Pulses and legumes, Nuts, Eggs and poultry, Fish, Milk & Milk Products and supplements in different forms like Whey protein isolates, Whey protein concentrates, Soy protein and Pea protein to fulfil protein needs. WHEY PROTEIN ISOLATE is best suitable for bariatric surgery patients as this provides PDCAAS of 1.0, supplies 90% pure protein and is easily digested and absorbed.

Protein requirements after bariatric surgery are 1–1.5 g/kg IBW to maintain Fat-Free Mass during weight loss, whereas the normal RDA for Indian males and females is 1 g/kg body weight. In the case of Malabsorptive procedures, it should be 1.5–2 g/kg IBW. The protein provided should be of High Biological Value and is easily digested and absorbed.

Assessing and Managing Protein Energy Malnutrition (PEM)

PEM after bariatric surgery can be assessed by the ABCD approach, where ‘A’ stands for ANTHROPOMETRIC (Muscle mass and fat-free mass), ‘B’- BIOCHEMICAL (Total proteins, Albumin and Globulin), ‘C’- CLINICAL signs & symptoms and ‘D’- DIETARY RECALL. Clinical signs of PEM are generalized weakness, excessive hair loss, poor wound healing, loss of lean body mass and anaemia.

Based on blood protein levels PEM can be classified as:

Stages of PEM	Serum Albumin levels (g/dl)
Mild	3.0 to 3.5
Moderate	2.5 to 3.0
Severe	<2.5

PEM is generally observed at 3 to 6 months after surgery. Vomiting, diarrhoea, depression, and alcohol consumption, may also lead to/ or exacerbate this condition.

Recommendations for Managing Protein Energy Malnutrition (PEM)

For Mild to Moderate PEM Oral feeding with a high protein diet (1.5 to 2gm/kg IBW) and protein-rich supplements, esp. short-chain whey protein isolates is recommended.

For Severe PEM admission to the hospital is required and patients are managed with enteral feeding/Albumin infusion/Total Parental Nutrition/ Restoring the anatomy/ Feeding gastrostomy/ileostomy in select few cases is required.

Preventing and Monitoring Protein Energy Malnutrition (PEM)

To prevent PEM, pre-operative routine screening (laboratory measures of visceral proteins) is important to assess the risk of protein malnutrition. Post-operatively monitoring of serum albumin concentration (remains in the normal range until late) and/or Lean body mass. Close monitoring for any clinical signs and symptoms. Helping patients fulfil protein needs & identify high-quality protein foods and supplements (rich in leucine). Regular assessment of protein intake is critical. Patients are advised to include and choose protein first in all meals especially at breakfast to relieve the catabolic state of overnight fasting. Continued multidisciplinary efforts are important to establish best practices for protein intake.

Have more doubts or queries related to signs and symptoms of protein energy malnutrition or undernutrition after bariatric surgery? Schedule a consultation with us at Smart Cliniqs and get in touch with the top bariatric surgeon in Delhi.

Understanding the Gall Bladder Stones

Gall Bladder is a small pear-shaped organ situated just below the liver in the abdomen. The main function of Gall Bladder is to store and concentrate bile which is produced in the Liver. Only a part of the bile that is produced in the Liver goes to Gall Bladder where it concentrates. Rest all of the bile passes directly into small intestines. Sometimes this Gall Bladder becomes mal-functional leading to stone formation. While some people have only a single stone, others can have multiple stones. Many times these stones don’t cause problems. In a few patients, these stones can cause infection and inflammation in the Gall Bladder. This leads to pain with fever and jaundice if these stones slip into the bile ducts and block the flow of bile. Abdominal ultrasound is the best investigation to confirm this.

Treatment and Procedure

Once the diagnosis is confirmed upon ultrasound, the only and best treatment option is to remove this Gall Bladder by surgery.

The Gall Bladder surgery is done by Laparoscopy which is the key-hole technique. Open surgical procedure is almost abandoned.

This surgery is performed through three to four small holes. In uncomplicated cases, there are no stitches or bandages. Mostly, the patient can walk around and drink liquids in 3 hours and go home within 24 hours of the surgery. He or she might resume office in 3 to 4 days.

Expert Surgeons and Benefits

The best Gall Bladder Surgeon in Delhi takes only 15 min to 30 min to complete the procedure in uncomplicated cases. Short anaesthesia, quick recovery, and minimal pain lead to early recovery.

Gall bladder surgery in Delhi is being performed in almost all of the hospitals. The advantage of getting it done at Smart Cliniqs is the availability of experienced Gall Bladder surgeons who have performed collectively around 20000 laparoscopic Gall Bladder surgeries with minimal complication rates. According to Dr. Atul NC Peters, Director, Minimal Access, Metabolic and Bariatric Surgery, Max-Smart Super-Specialty Hospital, Saket, Laparoscopic Gall Bladder Surgery should be performed timely in patients who had episodes of pain due to infection in Gall Bladder to avoid further complications. Large stones in Gall Bladder have been linked to cancers of the Gall Bladder if they are left untreated for long.

Month: July 2020

Severe Protein Energy Malnutrition (PEM) after Bariatric Surgery