What nutritional management is recommended for patients post-gastrectomy?

From the Guidelines

Nutritional management for post-gastrectomy patients should prioritize small, frequent meals (6-8 daily) with a focus on nutrient-dense foods, adequate protein, and prescribed supplements to mitigate potential nutritional deficiencies and complications. According to the latest clinical practice guidelines 1, patients post-gastrectomy are at risk of various nutritional deficiencies and complications, including early and late dumping, lactose intolerance, fat malabsorption, and osteopenia/osteoporosis.

To manage these risks, the following recommendations are suggested:

• Consuming smaller meals with low sugar and high protein content to prevent late dumping syndrome 1
• Avoiding drinking with meals to prevent early dumping syndrome 1
• Taking high potency multivitamins with additional vitamin B12, iron, and calcium citrate supplements, with correct dosing of vitamin B12 being essential 1
• Ensuring adequate supplementation of calcium citrate and vitamin D to prevent osteopenia/osteoporosis 1
• Eating multiple small meals throughout the day to prevent early satiety and weight loss 1

It is also crucial to monitor patients for nutritional deficiencies, with regular blood tests for vitamin B12, iron, folate, calcium, and vitamin D levels every 3-6 months initially, then annually. A daily multivitamin, vitamin B12 injections (1000 mcg monthly or 1000-2000 mcg oral daily), iron (325 mg ferrous sulfate 1-3 times daily), calcium (1200-1500 mg daily), and vitamin D (800-1000 IU daily) supplements are recommended 1. By following these guidelines, patients post-gastrectomy can minimize the risk of nutritional deficiencies and complications, ensuring optimal recovery and long-term health.

From the Research

Nutritional Deficiencies Following Gastrectomy

• Nutritional deficiencies are common after gastrectomy, with iron and vitamin D/calcium deficiency occurring in up to 50% of patients following Roux-en-Y Gastric Bypass (RYGB) 2.
• The aetiology of these deficiencies is diverse, including non-compliance, altered diet, unresolved preoperative deficiency, and differential degrees of post-operative malabsorption 2.
• Studies have shown that absorption of both iron and vitamin D/calcium is adversely affected following RYGB, with distribution and metabolism altered by the predominance of paracellular absorption pathways 2.

Predicting Nutritional Deficiencies

• Preoperative nutritional status and deficiencies can predict postoperative deficiencies, with deficiencies of hemoglobin, folate, and B12 before surgery being predictors for deficiencies 1 year after surgery 3.
• Focusing on preoperative nutritional status and tailoring a specific supplemental program for each individual can help prevent postoperative deficiencies 3.
• Vitamin B12 deficiency is an inevitable and rather early metabolic sequela after total gastrectomy, with elderly patients with low preoperative vitamin B12 levels being more likely to experience vitamin B12 deficiency after distal subtotal gastrectomy 4.

Nutritional Management

• Current supplementation strategies are efficacious to a degree in treating deficiency following RYGB, but generally, restoration of optimal status is not achieved 2.
• Oral supplement disposition is altered following RYGB, requiring patients to take regimens of oral supplementation indefinitely 2.
• An integrated team approach to risk assessment, patient education, and postoperative management is critical to optimal care of patients with gastric cancer, including preoperative nutritional assessment and treatment of common vitamin and mineral deficiencies after gastrectomy 5.
• It is crucial to efficiently assess, prevent, and manage nutritional deficiencies tailored to each surgical procedure, as bariatric surgeries are associated with nutritional deficiencies 6.