*Disclaimer: The research referenced in this post has been conducted independently. The publication and study were not sponsored by FitForMe. It is important to note that patients paid for the supplement at their own expense.*

Single Anastomosis Duodenal-Ileal bypass (SADI)

Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) is a weight loss procedure that may be recommended for patients with high BMI or metabolic conditions. This surgical technique was developed as a modification of the standard biliopancreatic diversion with a duodenal switch. SADI-S has been shown to have significant bariatric and metabolic benefits. However, more research is needed to fully evaluate the mid-term outcomes of SADI-S, and there is still some uncertainty about the need for nutritional supplementation following the procedure. A recent research publication by Marincola et al. aims to shed some light on the topic.

Nutritional Deficiencies

Patients who undergo hypo-absorptive procedures such as SADI-S are at a higher risk of developing nutritional deficiencies due to changes in their gastrointestinal anatomy and reduced capacity for nutrient absorption. These procedures can cause a decrease in the production of gastric acid, leading to a less efficient detachment of micronutrients from food substrates and impairing the absorption of important nutrients like iron.

Moreover, SADI-S can also reduce the production of intrinsic factor, which is necessary for the active absorption of vitamin B12. Finally, the bypassing of the duodenum and proximal section of the jejunum, which are the areas where most active absorption of micronutrients occurs, can result in severe malnutrition caused by reduced caloric intake or nutrient deficiency [16, 17].

WLS Maximum

Marincola et al. evaluate the outcomes of SADI-S two years after the procedure, with a focus on nutrition, weight loss, and metabolic changes. The study also aims to investigate any potential long-term complications that may arise from the procedure. Out of the 121 patients who underwent SADI-S, 66 were included in the study as they completed the two-year nutritional follow-up. All patients were advised to take a specialized multivitamin supplement called WLS Maximum from FitForMe, which is based on scientific research and expert input. Although there is no multivitamin specifically designed for SADI-S patients, WLS Maximum is recommended as it is tailored for other hypo absorptive procedures like the biliopancreatic diversion with duodenal switch (BPD-DS), which shares similarities with SADI-S.

Nutritional Outcomes

The study measured the levels of vitamin D, vitamin B12, and folic acid in WLS Maximum. According to the authors, there were no significant micronutrient deficiencies and the nutritional status of the patients was satisfactory two years after undergoing SADI-S.

View the full nutritional results for the study population here.

Clinical Implications

In patients with pre-existing nutritional deficiencies and low adherence to oral supplementation, any hypo-absorptive procedure may lead to severe negative nutritional and metabolic outcomes. In fact, regretfully, one patient died two years after SADI-S surgery due to severe malnutrition resulting from non-adherence to supplementation and nutritional advice. It highlights the importance of appropriate patient selection, adequate supplementation, and rigorous nutritional monitoring for patients undergoing SADI-S. Although there is no specific evidence on how to treat micronutrient deficiencies in patients who have undergone SADI-S, current guidelines suggest following nutritional recommendations similar to those for BPD-DS treatment. For malabsorptive bariatric procedures like BPD-DS, monitoring is recommended at 3, 6, and 12 months in the first year, and at least annually thereafter.

Safe and Effective

This study is one of the first to evaluate the nutritional mid-term outcomes of SADI-S surgery. According to the findings, SADI-S is a safe and effective procedure that yields promising mid-term bariatric and metabolic results, along with acceptable postoperative nutritional complications. However, it is challenging to conduct a prospective randomized controlled trial since this procedure is not yet performed on a large scale.

Looking Ahead

In conclusion, the results of the study are promising, but further research is needed to draw more definitive conclusions. Ideally, future randomized controlled trials should provide additional information on factors such as adherence to multivitamin supplementation, possible additional supplementation for deficiency treatment, and dietary considerations.

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Source: Marincola, G., Velluti, V., Voloudakis, N., Gallucci, P., Ciccoritti, L., Greco, F., … & Raffaelli, M. (2023). Medium-Term Nutritional and Metabolic Outcome of Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S). Nutrients15(3), 742.

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