Bariatrik Cerrahide Enerji ve Makro Besin Ögeleri Gereksinimi

Yıl 2026, Cilt: 9 Sayı: 1, 1 - 11, 18.01.2026

Büşra Meltem Ecertaş , Nihal Zekiye Erdem

https://doi.org/10.48124/husagbilder.1699368

Öz

Bariatrik cerrahi (BC), ağırlık kaybı ve obeziteye dair komorbiditelerin iyileşmesinde önemli bir yöntemdir. BC öncesi ve sonrasında hastanın beslenme durumu diyetisyen tarafından Amerikan Metabolik ve Bariatrik Cerrahi Topluluğu (ASMBS) kılavunzlarına göre ayrıntılı olarak değerlendirilmelidir.
Cerrahi sonrası başarıyı sağlayabilmek adına, cerrahi öncesi ve sonrası uygun enerji ve makro besin ögesi kompozisyonları sağlanmalıdır. Cerrahi öncesi kalori kısıtlaması ile ağırlık kaybının sağlanması ameliyat sürecindeki komplikasyonları azaltarak, iyileşme sürecini de hızlandırmaktadır. Cerrahi öncesi ve sonrasında makro besin öğelerinin kompozisyonu için net bir görüş bulunmamaktadır. Cerrahi sonrası protein alımının en az >60 g olması kas kaybını önlemeye yardımcı olur. Cerrahi sonrası oluşan emilim bozukluğu sebebiyle düşen serum omega-3 (n-3) düzeylerini engellemek için diyette n-3’ten zengin besinlere yer verilebilir, gerekirse n-3 takviyeleri uygulanabilir.

Anahtar Kelimeler

Bariatrik cerrahi , makrobesin ögesi alımı , enerji alımı

Energy and Macronutrient Requirements in Bariatric Surgery

Öz

Bariatric surgery (BC) is an important method for weight loss and recovery from obesity-related comorbidities. The nutritional status of the patient before and after BC should be evaluated in detail by a dietician according to the American Society for Metabolic and Bariatric Surgery (ASMBS) guidelines.
In order to ensure success after surgery, appropriate energy and macronutrient compositions should be provided before and after surgery. Weight loss with calorie restriction before surgery, reduces complications during the surgery and accelerates the recovery process. There is no clear view on the composition of macronutrients before and after surgery. A protein intake of at least >60 g after surgery helps prevent muscle loss. In order to prevent serum omega-3 (n-3) levels that decrease due to malabsorption after surgery, foods rich in n-3 can be included in the diet, and n-3 supplements can be applied if it necessary.

Anahtar Kelimeler

Bariatric surgery , macro nutrient , energy

Kaynakça

• 1. Bettini S, Belligoli A, Fabris R, Busetto L. Diet approach before and after bariatric surgery. Rev Endocr MetabDisord. 2020; 21, 297-306.
• 2. Baheeg M, Tag El-Din M, Labib MF, Elgohary SA, Hasan A. Long-term durability of weight loss after bariatric surgery; a retrospective study. Int J Surg Open. 2021; 28, 37–40
• 3. Mechanick JI, Apovian C, Brethauer S, Garvey WT, Joffe AM, Kim J, et al. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures– 2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Surg Obes Relat Dis. 2020; 16(2), 175-247.
• 4. Aguas-Ayesa M, Yárnoz-Esquíroz P, Olazarán L, Gómez-Ambrosi J, Frühbeck G, et al. Precision nutrition in the context of bariatric surgery. Rev Endocr Metab Disord. 2023; 1-13.
• 5. O’Kane M, Parretti HM, Pinkney J, Welbourn R, Hughes CA, Mok J, et al. British Obesity and Metabolic Surgery Society Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery—2020 update. Obes Rev. 2020; 21-11:e13087.
• 6. Boniecka I, Czerwonogrodzka-Senczyna A, Jeznach-Steinhagen A, Paśnik K, Szostak-Węgierek D, Zeair S. Nutritional Status, Selected Nutrients Intake, and Metabolic Disorders in Bariatric Surgery Patients. Nutrients. 2023; 15(11), 2479.
• 7. Van Wissen J, Bakker N, Doodeman HJ, Jansma EP, Bonjer HJ, Houdijk APJ. Preoperative methods to reduce liver volume in bariatric surgery: a systematic review. Obes Surg. 2016; 26, 251-256.
• 8. Anderin C, Gustafsson UO, Heijbel N, Thorell A. Weight loss before bariatric surgery and postoperative complications: data from the Scandinavian Obesity Registry (SOReg). Ann Surg. 2015; 261(5), 909-913.
• 9. Sherf-Dagan S, Sinai T, Goldenshluger A, Globus I, Kessler Y, Schweiger C, et al. Nutritional assessment and preparation for adult bariatric surgery candidates: clinical practice. Adv Nutr. 2021; 12(3), 1020-1031.
• 10. Lorenzo PM, Sajoux I, Izquierdo AG, Gomez-Arbelaez D, Zulet MA, Abete I, et al. Immunomodulatory effect of a very-low-calorie ketogenic diet compared with bariatric surgery and a low-calorie diet in patients with excessive body weight. Clin Nutr. 2022; 41(7), 1566-1577.
• 11. D’Abbondanza M, Ministrini S, Pucci G, Nulli Migliola E, Martorelli EE, Gandolfo V, et al. Very low-carbohydrate ketogenic diet for the treatment of severe obesity and associated non-alcoholic fatty liver disease: The role of sex differences. Nutrients. 2020; 12(9), 2748.
• 12. Romeijn MM, Kolen AM, Holthuijsen DD, Janssen L, Schep G, Leclercq WK, et al. Effectiveness of a low-calorie diet for liver volume reduction prior to bariatric surgery: a systematic review. Obes Surg. 2021; 31, 350-356.
• 13. Lange UG, Moulla Y, Schütz T, Blüher M, Peter V, Shang E, et al. Effectiveness and Tolerability of a Two- Week Hypocaloric Protein-Rich Diet Prior to Obesity Surgery with Two Different Diet Interventions: a Prospective Randomized Trial. Obes Surg. 2022; 32(9), 2903-2913.
• 14. Salman MA, Qassem MG, Aboul-Enein MS, Ameen M, Abdallah A, Omar H, et al. Effect of preoperative diet regimen on liver size before laparoscopic sleeve gastrectomy in morbidly obese patients. Surg Endosc. 2022; 36(5), 2981-2986.
• 15. Gils Contreras A, Bonada Sanjaume A, Montero Jaime, M, Rabassa Soler A, Sabench Pereferrer F, Molina López A, et al. Effects of two preoperatory weight loss diets on hepatic volume, metabolic parameters, and surgical complications in morbid obese bariatric surgery candidates: a randomized clinical trial. Obes Surg. 2018; 28, 3756-3768.
• 16. Dietch ZC, Guidry CA, Davies SW, Sawyer RG. Hypoalbuminemia is disproportionately associated with adverse outcomes in obese elective surgical patients. Surg Obes Relat Dis. 2015; 11(4), 912-918.
• 17. de Sousa Paredes SC, Mota-Garcia F. Prevalence of nutritional deficiencies in bariatric surgery candidates and its effect on metabolic status. Hormones (Athens). 2020; 19, 505-514.
• 18. Bae JC, Seo SH, Hur KY, Kim JH, Lee MS, Lee MK, et al. Association between serum albumin, insulin resistance, and incident diabetes in nondiabetic subjects. Endocrinol Metab (Seoul). 2013; 28(1):26–32.
• 19. Hart A, Sun Y, Titcomb TJ, Liu B, Smith JK, Correia ML, et al. Association between preoperative serum albumin levels with risk of death and postoperative complications after bariatric surgery: a retrospective cohort study. Surg Obes Relat Dis. 2022; 18(7), 928-934.
• 20. Ho C, Samwil SNM, Kahairudin Z, Jamhuri N, Abd Aziz A. Pre-habilitation with high whey-protein-based meal replacement therapy and exercise promote weight loss and preserve muscle mass before bariatric surgery. Asian J Surg. 2023.
• 21. Diab S, Bertin JB, Simeu B, Rohr S, Brigand C, Deharvengt C, et al. Impact of Preoperative Protein Sparing Modified Fast Diet on Bariatric Surgery. Obes Surg. 2023; 33(1), 17-24.
• 22. Mazzei M, Edwards MA. Poor glycemic control in bariatric patients: a reason to delay or a reason to proceed?. Surg Obes Relat Dis. 2021; 17(4), 744-755.
• 23. Perna M, Romagnuolo J, Morgan K, Byrne TK, Baker M. Preoperative hemoglobin A1c and postoperative glucose control in outcomes after gastric bypass for obesity. Surg Obes Relat Dis. 2012; 8(6), 685-690.
• 24. Boniecka I, Czerwonogrodzka-Senczyna A, Jeznach-Steinhagen A, Paśnik K, Szostak-Węgierek D, Zeair S. Nutritional Status, Selected Nutrients Intake, and Metabolic Disorders in Bariatric Surgery Patients. Nutrients. 2023; 15(11), 2479.
• 25. Azagury DE, Ris F, Pichard C, Volonte F, Karsegard L, Huber O. Does perioperative nutrition and oral carbohydrate load sustainably preserve muscle mass after bariatric surgery? A randomized control trial. Surg Obes Relat Dis. 2015; 11(4):920–926
• 26. Stenberg E, dos Reis Falcao LF, O’Kane M, Liem R, Pournaras DJ, Salminen P, et al. Guidelines for perioperative care in bariatric surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations: a 2021 update. World J Surg. 2022; 46(4), 729-751.
• 27. Forbes R, Gasevic D, Watson EM, Ziegler TR, Lin E, Burgess JR, et al. Essential fatty acid plasma profiles following gastric bypass and adjusted gastric banding bariatric surgeries. Obes Surg. 2016; 26, 1237-1246.
• 28. Chalut-Carpentier A, Pataky Z, Golay A, Bobbioni-Harsch E. Involvement of dietary fatty acids in multiple biological and psychological functions, in morbidly obese subjects. Obes Surg. 2015; 25, 1031-1038.
• 29. Bakker N, van den Helder RS, Geenen RW, Hunfeld MA, Cense HA, Demirkiran A, et al. Four weeks of preoperative omega-3 fatty acids reduce liver volume: a randomised controlled trial. Obes Surg. 2019; 29, 2037-2044.
• 30. Bakker N, Rivera CF, Cense HA, Demirkiran A, Ramkhelawon B, Houdijk AP. Oral v-3 PUFA supplementation modulates inflammation in adipose tissue depots in morbidly obese women: A randomized trial. Nutrition. 2023; 111:112055.
• 31. Iannelli A, Martini F, Schneck AS, Ghavami B, Baudin G Anty R, et al. Preoperative 4-week supplementation with omega-3 polyunsaturated fatty acids reduces liver volume and facilitates bariatric surgery in morbidly obese patients. Obes Surg. 2013; 23, 1761-1765.
• 32. Al-Najim W, Docherty NG, le Roux CW. Food intake and eating behavior after bariatric surgery. Physiol Rev. 2018; 98(3), 1113-1141.
• 33. Tabesh MR, Maleklou F, Ejtehadi F, Alizadeh Z. Nutrition, physical activity, and prescription of supplements in pre-and post-bariatric surgery patients: a practical guideline. Obes Surg. 2019; 29, 3385-3400.
• 34. Erdem NZ, Gök FK. Bariatrik Hastaların Diyetlerinin İzlenmesi, Temel Beslenme ve Diyetetik, 2023; s:365-411. Ankara, Güneş Tıp Kitabevleri.
• 35. Abdulsalam F, Ali, HI, Altinoz A, Nimeri A. The Effect of Protein Consumption on Fat-Free Mass, Fat Mass, and Weight Loss 1 Year After Sleeve Gastrectomy and Roux-en-Y Gastric Bypass. Obes Surg. 2021; 31(11), 4741-4748.
• 36. Borges LPSL, de Carvalho KMB, da Costa THM. Usual dietary intake, physical activity, weight loss, and body composition after five years of Roux-en-Y gastric bypass. Int J Obes (Lond). 2023; 47(4), 263-272.
• 37. Vilela DL, Silva A, Pinto SL, Bressan J. Animal Protein Intake Is Associated with Obesity Remission After Roux-en-Y Gastric Bypass: an Isocaloric Replacement Analysis. Obes Surg. 2023; 33(5), 1382-1389.
• 38. Dagan SS, Goldenshluger A, Globus I, Schweiger C, Kessler Y, Sandbank GK, et al. Nutritional recommendations for adult bariatric surgery patients: clinical practice. Adv Nutr Int Rev J. 2017;8(2):382–394.
• 39. Alshamari S, Elsherif MA, Hanna F, El Akhal L, Abid H, Elhag W. The effect of protein supplements on weight loss, body composition, protein status, and micronutrients post laparoscopic sleeve gastrectomy (LSG): A Randomised Controlled Trial (RCT). Ann Med Surg (Lond). 2022; 74,103220.
• 40. Martínez MC, Meli EF, Candia FP, Cordero E, Hernández I, Vilallonga R, et al. Protein Supplementation with Short Peptides Prevents Early Muscle Mass Loss after Roux-en-Y-Gastric Bypass. Nutrients. 2022; 14(23), 5095.
• 41. Faria SL, Faria OP, Lopes TC, Galvão, MV, de Oliveira Kelly E, Ito MK. Relation between carbohydrate intake and weight loss after bariatric surgery. Obes Surg. 2009; 19, 708-716.
• 42. Moizé V, Andreu A, Flores L, Torres F, Ibarzabal A, Delgado S, et al. Long-term dietary intake and nutritional deficiencies following sleeve gastrectomy or Roux-En-Y gastric bypass in a mediterranean population. J Acad Nutr Diet. 2013; 113:400–410.
• 43. Hierons SJ, Abbas K, Sobczak AI, Cerone M, Smith TK, Ajjan RA, et al. Changes in plasma free fatty acids in obese patients before and after bariatric surgery highlight alterations in lipid metabolism. Sci Rep. 2022; 12(1), 15337.
• 44. Middleton ALO, Bryne JP, Calder PC. The influence of bariatric (metabolic) surgery on blood polyunsaturated fatty acids: A systematic review. Clin Nutr ESPEN. 2022; 48, 121-140.
• 45. Hajri T, Ewing D, Talishinskiy T, Amianda E, Eid S, Schmidt H. Depletion of Omega-3 fatty acids in RBCs and changes of inflammation markers in patients with morbid obesity undergoing gastric bypass. J Nutr. 2021; 151(9), 2689-2696.
• 46. Glaysher MA, Ward J, Aldhwayan M, Ruban A, Prechtl CG, Fisk HL, et al. The effect of a duodenal-jejunal bypass liner on lipid profile and blood concentrations of long chain polyunsaturated fatty acids. Clin Nutr. 2021; 40(4), 2343-2354.