Fluid diet - bariatric surgery - full
This document is part of the ACI Diet Specifications for Adult Inpatients. It is not to be used for patient education.
Aim
To provide a diet appropriate for patients immediately after bariatric (weight loss) surgery, to prevent gastrointestinal symptoms, complications and to replace or maintain the body’s fluid balance.
Characteristics
This diet includes only fluids or foods that liquefy at room temperature. All carbonated liquids are excluded. Fluids containing fat are limited. Only three items are provided at each meal with a maximum of 100–120mL per item with the exception of water.
Indications
Where appropriate, clinicians may consider ordering this diet for patients:
- Post-bariatric surgery, as clinically indicated or as per the surgeon’s recommendations (e.g. may be commenced after Fluids - Bariatric surgery – clear diet or 1–3 days post-surgery).
Nutritional adequacy
This diet is inadequate in all nutrients and should not be used as the sole source of nutritional support for more than three days. Patients will require assessment and monitoring by a dietitian (note: assessment may occur pre or post-surgery). If used for more than three days, patients require a reduced fat, ≥3.5g protein/100ml liquid nutrition supplement recommended by a dietitian. Patients will require vitamin and mineral supplementation if length of stay > 3 days and longterm; chewable or liquid forms are preferable.
Precautions
Patients do not receive a menu. For best tolerance patients should not use straws, should take small sips, start with liquids and sip them slowly throughout the day. To prevent dehydration, patients should sip low-energy fluids slowly throughout the day (30–60mL over 30 minutes), aiming for 1–1.5L per day. To prevent hypoglycaemia, the patient’s insulin regimens should be reviewed due to minimal carbohydrate provision. To prevent unwanted catabolism in adolescents and adults the protein content should be reviewed by a dietitian. Patients should be provided education and encouraged to avoid caffeine. One 100–120ml serve of tea or coffee per day is allowed. Commercial thickening agents are a source of fibre.
Paediatrics
This diet is suitable for use in adolescents (≥15 years) when combined with an age-appropriate diet. However, it is noted that surgery can be considered at 14 years of age in exceptional circumstances.
Specific menu planning guidelines
| Allowed | Not allowed | |
|---|---|---|
| Hot main dishes | None | - |
| Sauces, gravies | None | - |
| Starchy vegetables / pasta / rice | None | - |
| Vegetables | None | - |
| Soups | Soup with ≤ 4.5g fat and ≤ 1.5g fibre per 100ml serve without visible food pieces including homogenised or pureed soups | Soups with visible food pieces Cream, tomato or spicy soups |
| Sandwiches | None | - |
| Salads, dressings | None | - |
| Breads, cereals | None | - |
| Spreads | None | - |
| Hot breakfast choices | None | - |
| Fruit | None | - |
| Yoghurt | Smooth fat-free, smooth low-fat or natural yogurt or drinking yoghurt without food pieces | All others |
| Desserts | None | - |
| Milk and cheese | Skim milk | All other milk All cheeses |
| Beverages | Water Low-joule cordial Strained vegetable juices One 100–120ml serve of tea/coffee per day (with or without skim milk) | All others including orange, pineapple, tomato and prune juices, and carbonated fluids |
| Biscuits | None | - |
| Miscellaneous | Commercial liquid supplements containing ≤ 4.5g fat, ≥ 3.5g protein and ≤ 1.5g fibre per 100ml Commercial liquid thickened fluids containing ≤ 4.5g fat and ≥ 3.5g protein per 100ml Low-joule ice blocks Pepper, sweetener Note: Milk powder or protein powder may be added to drinks or soups to increase protein content | Cream, sugar and salt Confectionary and chewing gum Other commercial nutritional supplements Other commercial thickened fluids |
References
- Dietitians Association of Australia. Nutrition manual. 9th ed. Canberra: DAA; 2014.
- Snyder-Marlow G, Taylor D, Lenhard J. Nutrition care for patients undergoing laparoscopic sleeve gastrectomy for weight loss. Journal of The American Dietetic Association. 2010;110:600-7.
- Parkes E. Nutritional management of patients after bariatric surgery. Am J Med Sci. 2006;331:207-13.
- Mechanick J, Kushner R, Sugerman H, et al. American Association of Clinical Endocrinologists, The Obesity Society, and The American Society for Metabolic and Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Obesity. 2009;17(1):S3–S72.
- Aills, L, Blankenship J, Buffungton C, et al. ASMBS Allied Health Nutritional Guidelines for the Surgical Weight Loss Patient. Surgery for Obesity and Related Diseases. 2008(4);S73-S108.
- Shannon C, Gervasoni A, Williams T. The bariatric surgery patient: Nutritional considerations. Australian Family Physician. 2013;42(8):547-552.
- Dagan S, Goldenshluger, Globus I, et al. Nutritional Recommendations for Adult Bariatric Surgery Patients: Clinical Practice. American Society for Nutrition. 2017;8:382-94.