PD381 - SEVERE UNDERNUTRITION AND PROTEIN DEFICIENCY IN A POST-BARIATRIC SURGERY PATIENT WITH A HISTORY OF PREVIOUS INTESTINAL RESECTION: A CASE REPORT.

PD381

SEVERE UNDERNUTRITION AND PROTEIN DEFICIENCY IN A POST-BARIATRIC SURGERY PATIENT WITH A HISTORY OF PREVIOUS INTESTINAL RESECTION: A CASE REPORT.

I. de La Rocque Barros Carlos da Silva¹, P. DAL BELLO^1,*, M. Hollanda Martins da Rocha¹, W. Macedo Lourenço de Faria¹, B. A. Davet¹, G. Gurginski Loures¹, L. A. Almeida Alves De Oliveira¹, T. Uehara Sakô ¹, B. Tavares Simões¹, J. Gonçalves Oliveira¹, G. B. Marques Tavares ¹, J. Cardoso Penteado Machado¹, B. Andrade de Souza¹, A. Dong Won Lee¹

¹Division of Clinical Nutrition, Department of Gastroenterology, Hospital das Clínicas, University of São Paulo, HCFMUSP, São Paulo, Brazil

Rationale: Brazil is a global leader in bariatric surgery, ranking second worldwide behind the United States. It remains the main treatment for obesity within the Brazilian Public Health System. This high volume increases the likelihood of performing procedures in patients with complex clinical backgrounds, such as prior intestinal resections, raising the risk of severe, synergistic malabsorption and malnutrition.

Methods: We report the case of a 34-year-old post-bariatric surgery woman admitted with chronic diarrhea, anasarca, and muscle weakness. The assessment included the Global Leadership Initiative on Malnutrition (GLIM) criteria, bioelectrical impedance analysis, and body composition analysis via computed tomography (CT) at the L3 level to assess the skeletal muscle index (SMI) and muscle quality using Hounsfield Units (HU).

Results: The patient had a history of a 40-cm enterectomy followed by a Roux-en-Y gastric bypass (RYGB) 14 months prior to admission. She presented with hair and eyelash depigmentation, atrophic glossitis, and severe hypoalbuminemia (1.5 g/dL). Labs showed low lipid profile and multiple vitamin and iron deficiencies. GLIM criteria confirmed Stage 2 severe malnutrition. Initial CT revealed an SMI of 46.1 cm²/m² with poor muscle quality (23 HU), and handgrip strength was reduced. After 30 days of optimized nutritional therapy, hair pigmentation and glossitis resolved (image) and albumin increased to 2.1 g/dL at discharge. At 3 months, CT showed normalized muscle quality (41.6 HU) and improved strength, despite a decrease in SMI to 35.6 cm²/m².

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Conclusion: Prior intestinal resections exacerbate malabsorption following RYGB.This case shows that targeted nutritional therapy can reverse severe deficiency signs and improve muscle quality and strength, even when muscle mass indices decrease.

Disclosure of Interest: None declared