Nutrient and fluid requirements in post-bariatric patients performing physical activity: A systematic review

The evidence for the benefits of physical activity in post-bariatric patients is growing. Nevertheless, it remains unclear whether nutritional regimens should be adapted to physical activity levels. The aim of this systematic review was to summarize current evidence regarding nutrient and fluid requirements in physically active post-bariatric patients.

We conducted this systematic review according to the PRISMA guidelines. We searched MEDLINE, Embase, and the Cochrane Library for studies assessing nutritional aspects in physically active post-bariatric patients. Data were extracted based on a predefined, standardized form, and assessed for risk of bias.

Of 582 records, 8 studies were included, mostly implementing general fitness programs (30-60 min/d, 3-4 × /wk). There is no evidence for increased energy requirements in physically active post-bariatric patients. None of the studies determined energy, fat, or carbohydrate requirements. Most studies focused on protein, recommending a minimum intake of 60 g/d to preserve or increase muscle mass (upper limit 1.5 g protein/kg ideal body weight/d). Higher protein intake (108 g/d, thereof 48 g whey protein) combined with physical activity increased muscle strength. The effects of physical activity on micronutrient requirements remain unstudied, whereas fluid requirements appear to be increased.

The present findings strengthen the importance of adequate protein intake in physically active post-bariatric patients. Nutrient reference values for physically active post-bariatric patients are not definable based on the current evidence. Consequently, clinicians should pay special attention to the monitoring of macro- and micronutrients and fluid balance, especially when post-bariatric patients engage in high levels of physical activity.