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Perioperative nutritional practices in patients undergoing bariatric surgery in India: A delphi consensus
Sarfaraz Jalil Baig1, Pallawi Priya1, Abhishek Katakwar2, Aparna Govil Bhasker3, Atul N. C. Peters4, Carlyne Remedios5, Deeba Siddiqui6, Kankona Dey7, Madhu Goel8, Manish Khaitan9, Mariam Lakdawala3, Rajkumar Palaniappan10, Ramen Goel11, Randeep Wadhawan12, Ritika Samaddar13
1 Belle Vue Clinic, Kolkata, West Bengal, India
2 Center for Obesity and Metabolic Therapy, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
3 Department of Bariatric Surgery, Saifee Hospital, Mumbai, Maharashtra, India
4 Department of Bariatric, MAS and Gen. Surgery, Max Smart Super Speciality Hospital, New Delhi, India
5 Department of Bariatric Surgery, Digestive Health Institute, Mumbai, Maharashtra, India
6 Department of Bariatric Surgery, Indraprastha Apollo Hospital, New Delhi, India
7 Department of Nutrition and Dietetics, The Maharaja Sayajirao University of Baroda, Vadodara, Gujarat, India
8 Center for Metabolic Surgery, Wockhardt Hospital, Mumbai, Maharashtra, India
9 Department of Bariatric Surgery, KD Hospital, Ahmedabad, Gujarat, India
10 Department of Bariatric Surgery, Institute of Bariatrics, Apollo Hospitals, Chennai, Tamil Nadu, India
11 Center of Metabolic Surgery, Wockhardt Hospitals, Mumbai, Maharashtra, India
12 Department of GI, MAS and Bariatric Surgery, Manipal Hospitals, New Delhi, India
13 Department of Bariatric Surgery, Max Healthcare, New Delhi, India
Correspondence Address:
Pallawi Priya
Belle Vue Clinic, Kolkata, West Bengal
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jbs.jbs_14_22
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Introduction: Variations in cultural practices, diet, socioeconomic factors, genetics, and procedure selection have a potential impact on nutritional outcomes after bariatric surgery. There are no updated guidelines from India on clinical practice on the nutritional management of patients undergoing bariatric surgery. This is the first attempt to have a consensus on the subject. Methods: An expert committee was constituted which voted for three rounds on 20 statements/questions based on a Delphi method. Results: There was consensus regarding preoperative screening of hemoglobin, packed cell volume, albumin, iron, ferritin, Vitamin D, Vitamin B12, preoperative weight loss, postoperative prophylactic protein supplementations, therapeutic supplementation of iron, B12, and Vitamin D, postoperative testing, and frequency of follow-up visits. Experts did not agree on the routine preoperative testing of serum folate and thiamine. There was no consensus on lifelong supplementation with bariatric formulation, difference of supplementation dosages for Roux-en-Y gastric bypass and one anastomosis gastric bypass, or postponement of surgery pending correction of nutritional deficiencies. Conclusion: We need a better-quality regional data to formulate guidelines that can provide evidence-based guidance for the clinical practice.
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