Focus on nutritional management for children with cystic fibrosis / 中华实用儿科临床杂志

Cystic fibrosis (CF) is a life-threatening autosomal recessive hereditary disease, involving multiple organs and systems such as respiratory and digestive systems.Malnutrition caused by various factors is common in CF children.CF children with pancreatic dysfunction suffer from malabsorption and/or growth disorder at birth or 1 year old.Nutritional status is associated with lung function and prognosis of CF patients, so nutritional management is extremely important to CF children.However, there is inadequate nutritional management for CF children in clinical practice in China, and Chinese CF children has shorter survival time than CF children in European and American countries.Thus, in this study, the importance of nutritional management, nutritional management methods, nutritional assessment and monitoring of CF patients were introduced.The aim is to enhance clinical attention to the nutritional status of CF children and clinical understanding of nutritional management.Early identification and intervention can improve prognosis and prolong the life of pediatric CF patients.

Nutritional management for children with cystic fibrosis: interpretation of clinical guidelines for care of children with cystic fibrosis in Royal Brompton Hospital (2020) / 中华实用儿科临床杂志

Cystic fibrosis (CF) is a monogenetic disease involving multiple organs.Malnutrition is common in children with CF, and it is closely related to the prognosis and survival of children.Malnutrition is caused by various factors and individualized plans should be made for children with CF at different stages.Besides, it is essentially important to monitor and assess the nutritional status of CF patients in a long term.In 2020, the 8 th edition of the clinical guidelines for the care of children with CF in Royal Brompton Hospital was updated, in which the nutritional management of children with CF was recommended and guided.This part of the guidelines was interpreted in the present paper, including nutritional management and evaluation, tips for pancreatic enzyme replacement therapy, types of nutrition supplement and how to solve the feeding difficulties of children with CF.The aim of this paper is to guide early clinical nutritional management of CF patients and improve their prognosis.

Evaluación y apoyo nutricional en el paciente pediátrico críticamente enfermo: Revisión de la literatura

RESUMEN Esta revisión se basa en la mejor evidencia actualmente disponible, y en ella se definen las directrices en relación con la evaluación y manejo nutricional en niños críticamente enfermos. Estas directrices incluyen, los criterios para la detección de la malnutrición, tanto por déficit o exceso, así como, se identifican las recomendaciones y consensos de expertos sobre la estimación energética y de macronutrientes, los cuales pueden ser determinantes en prevenir tanto la sobrealimentación como subalimentación. También se señalan las recomendaciones internacionales sobre el momento de inicio del soporte nutricional para que esta sea oportuna, efectiva y segura, eligiendo la vía de alimentación según condición clínica y tipo de patología en función de disminuir el riesgo de morbimortalidad de estos pacientes. A modo general, se sugiere intensificar la investigación científica, con el fin de disponer de mejor evidencia para diseñar protocolos clínicos internacionales y locales para el manejo nutricional del paciente pediátrico críticamente enfermo.

ABSTRACT This review is based on the best evidence currently available and defines the guidelines for the nutritional assessment and management of critically ill children. These guidelines include the criteria for detecting malnutrition, whether due to deficit or excess, as well as the recommendations and consensus of experts on the estimation of energy and macronutrients, which can be decisive in preventing both overfeeding and underfeeding. International recommendations on the time of initiation of nutritional support are also indicated so that it is timely, effective and safe. Choice of feeding route according to clinical condition and pathology type in order to reduce the risk of morbi-mortality of these patients are discussed. In general, an increase in scientific research is suggested, in order to have better evidence to design international and local clinical protocols for the nutritional management of critically ill pediatric patients.

Nutritional Therapy for Asian Patients at Risk for Atherosclerotic Cardiovascular Disease

The burden of atherosclerotic cardiovascular disease (ASCVD) remains high worldwide, and its prevalence has increased in Asian countries over the last two decades. The increase in ASCVD may arise from complex interactions between genetic and lifestyle/environmental factors. Abnormal blood cholesterol levels, elevated blood glucose, obesity, elevated blood pressure, smoking, and family history are common risk factors of ASCVD. There is an increased burden of ASCVD in Asian countries, maybe due to rapid economic development and lifestyle changes in these countries. Nutrition is one of the major modifiable risk factors for ASCVD. Despite this, there are insufficient nutritional therapies for prevention and management of ASCVD in Asian patients. There is also a lack of relevant research in Asian populations. In this review, we describe the current nutritional guidelines and the findings from previous landmark studies regarding management and/or prevention of ASCVD. We also summarize the recommendations regarding evidence-based nutrition therapy/management strategies that may be effective in Asian subjects to prevent onset and/or to treat ASCVD.

Clinical guidelines on nutrition in end-stage liver disease / 中华肝脏病杂志

Malnutrition is common in patients with end-stage liver disease (ESLD) and is an independent risk factor for survival, therefore it should be treated as the same important guideline as ascites and hepatic encephalopathy. However, up to now, there is no clinical nutrition guideline for patients with ESLD in China. In order to standardize the nutrition treatment, Chinese Society of Hepatology (CSH) and Chinese Society of Gastroenterology (CSGE), Chinese Medical Association(CMA) co-organized and co-developed this guideline. Recommendations on nutritional screening and assessment as well as principles of intervention and management in patients with ESLD were provided to help clinicians make rational decisions on clinical malnutrition.

Nutritional problems of food allergies in infants and young children / 中华实用儿科临床杂志

Infants and young children with food allergies have a high incidence of feeding difficulties which affect children′s growth and development.Early standard nutritional management is critical to promoting their growth.Early diagnosis of food allergies, effective avoidance and substitution of certain food, proper timing of introducing sensitized foods, rational use of probiotics and appropriate micronutrients, together with the intervention of dietary behavior and exercise, and regular assessment of growth and nutrition are most essential for promoting these children′s physical growth.

Nutritional problems of food allergies in infants and young children / 中华实用儿科临床杂志

Infants and young children with food allergies have a high incidence of feeding difficulties which affect children's growth and development.Early standard nutritional management is critical to promoting their growth.Early diagnosis of food allergies,effective avoidance and substitution of certain food,proper timing of introducing sensitized foods,rational use of probiotics and appropriate micronutrients,together with the intervention of dietary behavior and exercise,and regular assessment of growth and nutrition are most essential for promoting these children's physical growth.

Nutritional management of infantile cholestatic liver disease / 中华实用儿科临床杂志

Cholestatic liver disease is the most common type of infantile liver disease,and malnutrition is very common in infantile cholestatic liver disease,which may seriously affect the growth and development of infants,and even lead to neuro-cognitive impairment.Some children with chronic cholestatic liver disease need liver transplantation at the end of the disease,while malnutrition might cause more complications and higher mortality.In order to improve the prognosis,active and appropriate nutritional management is considerably needed.

Clinical guidelines on nutrition in end-stage liver disease / 中华肝脏病杂志

Malnutrition is common in patients with end-stage liver disease (ESLD) and is an independent risk factor for survival, therefore it should be treated as the same important guideline as ascites and hepatic encephalopathy. However, up to now, there is no clinical nutrition guideline for patients with ESLD in China. In order to standardize the nutrition treatment, Chinese Society of Hepatology (CSH) and Chinese Society of Gastroenterology (CSGE), Chinese Medical Association(CMA) co-organized and co-developed this guideline. Recommendations on nutritional screening and assessment as well as principles of intervention and management in patients with ESLD were provided to help clinicians make rational decisions on clinical malnutrition.

A Nutrition Intervention Focused on Weight Management Through Lifestyle Improvements in Prediabetic Subjects

We reported the cases in order to evaluate the effects of individualized nutrition interventions for enhancing self-management abilities of prediabetic subjects. We conducted four nutrition interventions for weight control in two subjects with high-risk of type 2 diabetes. The first subject was a 53-year-old housewife, and the second subject was a 46-year-old male office worker. The subjects visited the medical center 4 times during the study period, and the lifestyle interventions were advised by a clinical team comprised physicians, clinical dietitians, and nurses. In particular, nutrition intervention to achieve weight loss focused on enhancing motivation and problem-solving skills to improve self-management ability. As a result, both subjects achieved weight loss by the time of their last visits. These two case studies, which differed in terms of sex, occupation, and dietary habits showed the importance of individualized nutrition intervention and forming an intimate relationship based on trust centered on prediabetic subjects. In conclusion, systematic collaboration within the clinical team is necessary, and social infrastructure should be prepared to fully realize the benefits of a systematic intervention program.

Nutritional Management after Bariatric Surgery

Bariatric surgery is considered the only effective method of achieving long-term weight loss and ameliorating obesity-associated comorbidities in morbidly obese patients. However bariatric surgery is associated with risks of nutritional deficiencies and malnutrition. Therefore, postoperative nutritional follow-up and supplementation of vitamins and trace elements should be recommended. In this review, we provide essential information on nutritional complications and nutritional management after bariatric surgery.

The effect of full nutritional management on nutrition status to on tumor patients with chemotherapy / 中国医师进修杂志

Objective To investigate the effect of full nutrition management on cancer patients with chemotherapy, and to support theory bases for the standardized clinical nutrition of cancer patients. Methods From January 2016 to December 2017, a total of 88 patients with the first chemotherapy were recruited and randomly divided into experimental group and control group, with 44 patients in each group. These patients all complied with the inclusion and exclusion criteria, and volunteered for the study. The two groups all received the same of anti-tumor treatment and the same conventional nutritional support (according to the results of nutrition screening and nutrition assessment, the nutritional support was formulated and patients′dietary guidance was given), while only patients of the experimental group were given full nutritional management, including regularly following up the patient′s condition changes, gastrointestinal reactions, and the feed. According to the five-step treatment model of malnutrition, nutritional support was improved in a timely manner, and appropriate nutritional support was provided. At the end of chemotherapy, the change of weight, albumin, prealbumin, hemoglobin was compared with that before treatment in the two groups. Results After chemotherapy, albumin, prealbumin, hemoglobin had no obvious drop compared with that before treatment in two groups (P>0.05). The patients of experimental group showed stable weight after chemotherapy: (53.39 ± 9.24) kg vs. (54.66 ± 9.41) kg, P>0.05. Weight loss in the control group after chemotherapy was statistically significant:(54.61 ± 10.76) kg vs. (56.52 ± 10.46) kg, P<0.05. Conclusions The full nutritional management can help maintain nutrition status during chemotherapy, especially can prevent the weight loss.

Tutores de cães consideram a dieta caseira como adequada, mas alteram as fórmulas prescritas / Dog owners consider homemade diet as adequate, but change the prescribed formulas

O estudo objetivou avaliar a adesão e a percepção dos proprietários de cães, residentes na cidade de São Paulo/SP, quanto ao emprego de dieta caseira no manejo nutricional de seu animal de estimação. Foram entrevistados por contato telefônico 55 proprietários que forneciam dieta caseira no manejo nutricional do seu cão. O questionário contemplou perguntas relacionadas ao preparo e eficiência das dietas, bem como o manejo dos animais. Verificou-se que considerável número (parcela) de prescrições (45,9%) esteve associado a pacientes com hiporexia. Dentre os proprietários que relataram dificuldade no preparo (10,9%), o tempo dispendido (33,3%) foi a maior problemática. Quando questionados em relação às modificações nas fórmulas prescritas, 60% admitiram que a realizaram sem prévia recomendação. Na opinião dos entrevistados, a dieta caseira não causou alterações nas fezes (50%) e na pelagem (62,7%) dos animais em comparação ao emprego de um alimento comercial e foi considerada adequada pela maioria (79,0%). As dietas caseiras podem ser amplamente utilizadas, mostrando-se especialmente importantes em cães doentes e/ou hiporéticos por apresentarem maior aceite em relação à dieta comercial, no entanto, nem todos os tutores estão aptos a utilizá-la.(AU)

The aim of this study was to evaluate the adhesion and perception of dog owners from the city of São Paulo, Brazil, on the employment of homemade diet for the nutritional management of their pet. The participants were 55 owners that provided homemade diet for their dog. The interviews were conducted by telephone and the questionnaire included points related with the preparation and effectiveness of diets, as well as the handling of animals. It was found that a considerable number of prescriptions (45.9%) was associated with patients with hyporexia. Among the owners who reported difficulty in the preparation (10.9%), time spent (33.3%) was the most problematic topic. When questioned in relation to changes in the prescribed formulas, 60% admitted that conducted it without recommendation. In the opinion of interviewed owners, the homemade diet did not cause changes in feces (50%) and coat (62.7%) of the animals compared to the use of a commercial food and was considered appropriate by the majority (79.0%). The homemade diets can be widely used, being especially important in dogs with diseases and/or dogs with hyporexia, since they are more easily accepted than the commercial diet; however, not all owners are able for its right use.(AU)

Reproductive behavior of crossbred dairy cows grazing an intensive silvopastoral system under tropical dry forest conditions / Comportamento reprodutivo de vacas leiteiras mestiças pastando um sistema silvipastoril intensivo em condições de floresta tropical seca

It is widely accepted that selection for high milk yield in dairy cows has negatively affected their reproductive performance. After calving, dairy cows experience a nutritional imbalance due to an asynchrony in the occurrence of the lactation and dry matter intake peaks. In the tropics, this situation is exacerbated due to poor quality and/ or availability of the diet. A study was carried out to describe the nutritional and reproductive behavior of two-to-four parturition crossbred cows (Gyr (Bos indicus) x Holstein (Bos taurus)) divided in two groups according to their calving to first service interval (CFSI): Group 1: ≤50 days CFSI, n=7; Group 2: ≥50 days CFSI, n=8. Animals were grazing in an intensive silvopastoral system (ISS) based on Leucaena leucocephala and Cynodon plectostachyus and also received protein, energy and mineral supplementation. Dry matter (DMI) and nutrient intake were individually estimated and correlations between reproductive and nutritional parameters were performed. Additionally, serum progesterone concentration was monitored. Group 2 had greater forage and total DMI and milk production than Group 1 (P<0.05). Hence, Group 2 had greater nutrient intake from forages than Group 1 (P<0.05). Group 1 had a positive nutritional balance and an optimum reproductive performance compared to Group 2, which had a negative energy balance and lengthier days with open intervals (P<0.05). It was corroborated that protein and energy are required in adequate levels, to ensure that uterus undergoes involution correctly and ovarian activity starts soon in the postpartum period.(AU)

É amplamente aceito que a seleção para alta produção de leite em vacas leiteiras tem interferido no seu desempenho reprodutivo. Depois do parto, um extraordinário desafio nutritivo é experimentado pelas vacas leiteiras, devido a uma assincronia entre a ocorrência do pico de lactação e a do pico de consumo de matéria seca. Este estudo foi realizado para descrever o comportamento reprodutivo de vacas mestiças de dois a quatro partos (Gyr (Bos indicus) x Holstein (Bos taurus)), divididos em dois grupos, de acordo com seu intervalo parto ao primeiro serviço (IPPS): grupo 1: ≤ 50 dias IPPS, n = 7; grupo 2: ≥50 IPPS dias, n = 8. Os animais pastaram em um sistema silvipastoril intensivo (SSI), com base em Leucaena leucocephala e Cynodon plectostachyus, e receberam também suplementação de proteína, energia e mineral. Matéria seca (CMS) e ingestão de nutrientes foram estimadas individualmente e correlações entre parâmetros reprodutivos e nutricionais foram realizadas. Além disso, a concentração de progesterona em soro foi monitorizada. Vacas do grupo 2 apresentaram maior ingestão de forragem, de dieta total e de produção total de leite do que vacas do grupo 1 (P<0,05). Dessa forma, vacas do grupo 2 apresentaram maior consumo de nutrientes de forrageiras do que os animais do grupo 1 (P<0,05). Vacas do grupo 1 tinham um equilíbrio nutricional positivo e um ótimo desempenho reprodutivo em relação ao grupo 2, que teve um balanço energético negativo e mais longos intervalos de dias abertos (P<0,05). Foi corroborado que a proteína e a energia são necessárias em níveis adequados, assim o útero sofre involução corretamente e a atividade ovariana começa logo no período pós-parto.(AU)

Biochemical disturbances, nutritional assessment, and interventions in patients with glycogen storage disease in a Beijing-based general hospital / 中华临床营养杂志

Objective To investigate the biochemical disturbances,nutritional assessment and nutritional interventions in hospitalized patients with glycogen storage disease (GSD) in a general hospital in Beijing and provide examples of advanced nutritional management for these patients.Methods We retrospectively reviewed 22 consecutive hospitalized patients with GSD diagnosed from January 1,2013 to January 1,2016 in Peking Union Medical College Hospital and analyzed their medical data,nutritional assessments,and interventions.Results These 22 GSD patients included 2 cases with GSD-Ⅰa,3 cases with GSD-Ⅰb,and 17 cases with GSD-Ⅲ.They were composed of 21 children (including a 6-month old infant and a 7-month old infant) and one 18-yearold man.Biochemical abnormalities:hypoglycemia (5/5),hyperlactacidemia (4/5),hyperlipidemia (4/5),hyperuricemia (4/5) were common in GSD-Ⅰ patients,while hypoglycemia (17/17),hyperlactacidemia (5/17),hyperlipidemia (7/17),and hyperuricemia (3/17) were also present among patients with GSD-Ⅲ.Growth and development assessments:among 5 patients with GSD-Ⅰ,the body weight was below the 10th percentile in of 4 patients and the height was below the 3rd percentile in 5 patients;among 17 patients with GSD-Ⅲ,the body weight was below the 10th percentile in 4 patients and the height was below the 10th percentile in 9 patients.Nutritional management condition:all the patients received nutritional assessment,dietary modulation and nutritional support.Twenty children or adolescents were prescribed with raw corn starch (RCS) every 4-6 hours,with a mean initial dose of (1.58±0.28) g and (1.21±0.33) g for patients with GSD-Ⅰ and GSD-Ⅲ,respectively;the other 2 infant aged 6-month old and 7-month old were regularly administered amino acid-based enteral nutritional agents.In addition,all the patients with GSD-Ⅲ were recommended high protein intake of 3 g/(kg · d) and received dietary guidance and modulation.Follow-up condition:5 cases with GSD-Ⅰ and 2 cases with GSD-Ⅲ stayed in track after discharge from our hospital.The mean follow-up duration was (480.40±246.16) d and (373.00± 108.89) d for patients with GSD-Ⅰ and GSD-Ⅲ,respectively.All the patients reported alleviated symptom of hypoglycemia,and the examinations also indicated improved fasting blood glucose,uric acid,lipid profile,and growth status.Conelusions Hypoglycemia,metabolic disturbances,and growth retardation are prevalent in both GSD-Ⅰ and GSD-Ⅲ patients.Potential biochemical abnormalities should not be ignored in GSD-Ⅲ patients,especially in young patients.Comprehensive nutrition assessment,regular administration of RCS,sufficient protein intake,and continuous patient follow-up and surveillance can help to alleviate symptoms,correct metabolic disturbances,and improve growth status of patients with GSD.

The application of nutritional management leaded by nurses in hospitalized phthisical patients / 中华护理杂志

Objective To explore the application of nutritional management leaded by nurses in hospitalized phthisical patients.Methods We set up a safe,effective nutritional management model by establishing united nutritional management group,making nutritional management system and process and organizing nutritional management knowledge training,and this model was carried out in 50 hospitalized phthisical patients.Results The total satisfaction rate for nutritional management was 97.56％.The screening risk rate for nutrition by nurses was 100％.Dietitians were asked to assess 22 cases for nutrition risk and 12 cases received nutritional support.The supporting rate was 54.55％,and the patients' condition was improved.Conclusion The application of the nutrition management leaded by nurses in hospitalized phthisical patients improved patients' nutritional condition,increased satisfaction of patients,enforced the screening function of nurses during the process of nutrition management and promoted the process of nursing expertise.

Food Allergy Awareness and Nutritional Management by Preschooler's Faculty Members of Child Care Facilities / 대한지역사회영양학회지

OBJECTIVES: The purpose of this study was to investigate the awareness and nutritional management of food allergy (FA) by preschooler's faculty members in child care centers. METHODS: A questionnaire survey was conducted among faculty members of child care centers in Seoul. The questionnaire was designed to identify the prevalence of food allergies, requirements of food allergy support and differences in food management depending on the presence of allergic diseases. After excluding incomplete responses, the data of 171 faculties in 137 child care centers (95.0%) were used for statistical analysis. RESULTS: According to the 137 collected questionnaires, 96 child care centers asked parents about their children's allergic disease and 151 children from 66 child care centers had food allergies. A reported 89 children from 43 child care centers had food restrictions. However, 9 child care centers (21.0%) were not aware of food restriction for children with food allergies. Only 6 child care centers (14.0%) supplied substitute foods with the same amount and type of nutrients. Forty eight faculties (28.1%) received training about food allergies. Although there were some differences according to institution type, most of the faculty members wanted food allergy-related support. CONCLUSIONS: This study identified a lack of food allergy training for faculty members in child care centers. For proper management, it is necessary for faculty members of child care centers to be educated on overall food allergies. Food allergy-related support such as menus without allergenic ingredients, guidelines on emergency care for food allergies and anaphylaxis should be provided for faculty members in child care centers.

Intensive Nutrition Management in a Patient with Short Bowel Syndrome Who Underwent Bariatric Surgery

Many individuals with short bowel syndrome (SBS) require long-term parenteral nutrition (PN) to maintain adequate nutritional status. Herein, we report a successful intestinal adaptation of a patient with SBS through 13 times intensive nutritional support team (NST) managements. A thirty-five-year-old woman who could not eat due to intestinal discontinuity visited Seoul National University Hospital for reconstruction of the bowel. She received laparoscopic Roux-en-Y gastric bypass (RYGB) due to morbid obesity in Jan 2013 at a certain hospital and successfully reduced her weight from 110 kg to 68 kg. However, after a delivery of the second baby by cesarean section in Jul 2016, most of small bowel was herniated through Peterson’s defect, and emergent massive small bowel resection was performed. Thereafter, she visited our hospital for the purpose of intestinal reconstruction. In Sep 2016, she received side–to-side gastrogastrostomy and revision of double barrel enterostomy. The remaining small bowel included whole duodenum, 30 cm of proximal jejunum, and 10 cm of terminal ileum. Pylorus and ileocecal valves were intact. The patient given only PN after surgery was provided rice-based soft fluid diet after 10 day of operation. Through intensive nutritional management care, she could start solid meals, and finally stop the PN and eat only orally at 45 days postoperatively. Three nutritional interventions were conducted over 2 months after the patient was discharged. She did not require PN during this period, and maintained her weight within the normal weight range. Similar interventions could be used for other patients with malabsorption problems similar to SBS.

Needs for Development of IT-based Nutritional Management Program for Women with Gestational Diabetes Mellitus / 대한지역사회영양학회지

OBJECTIVES: The aim of this study was to examine self-management status, nutritional knowledge, barrier factors in dietary management and needs of nutritional management program for women with Gestational Diabetes Mellitus (GDM). METHODS: A total of 100 women with GDM were recruited from secondary and tertiary hospitals in Seoul. The questionnaire composed of general characteristics, status of self-management, dietary habits, nutrition knowledge, barrier factors in dietary management, needs for nutrition information contents and nutritional management programs. Data were collected by a self-administered questionnaire. All data were statistically analyzed using student's t-test and chi-square test using SAS 9.3. RESULTS: About 35% of the subjects reported that they practiced medical nutrition and exercise therapy for GDM control. The main sources of nutrition information were ‘internet (50.0%)’ and ‘expert advice (45.0%)’. More than 70% of the subjects experienced nutrition education. The mean score of nutrition knowledge was 7.5 point out of 10, and only about half of the subjects were reported to be correctly aware of some questions such as ‘the cause of ketosis’, ‘the goal of nutrition management for GDM’, ‘the importance of sugar restriction on breakfast’. The major obstructive factors in dietary management were ‘eating more than planned when dining out’, ‘finding the appropriate menu when dining out’. The preferred nutrition information contents in developing management program were ‘nutritional information of food’, ‘recommended food by major nutrients’, ‘the relationship between blood glucose and food’, ‘tips on menu selection at eating out’. The subjects reported that they need management program such as ‘example of menu by calorie prescription’, ‘recommended weight gain guide’, ‘meal recording and dietary assessment’, ‘expert recommendation’, ‘sharing know-how’. CONCLUSIONS: Based on the results of this study, it is necessary to develop a program that provide personalized information by identifying the individual characteristics of the subjects and expert feedback function through various information and nutrition information contents that can be used in real life.

Perioperative Nutritional Management of Morbid Obesity

Morbid obesity is associated with several comorbidities and increase risk of mortality. To avoid risk multifactorial intervention must be implemented. Morbid obese subjects who failed dietary and medical treatment should be considered as candidates for bariatric surgery. Although bariatric surgery is the most effective and sustainable treatment for morbidly obese patients, several nutritional deficiencies and metabolic complications can occur. Therefore, the perioperative assessment of nutritional status and education in all undergoing bariatric surgery, and encouragement of adherence to supplementation are important aspects of long term result. The patient had bariatric surgery also should understand postoperative dietary habit and component. The postoperative bariatric diet is based on modification of food texture and consistency, volume of food and liquid, frequency, and duration of meal, food intolerance and nutrients requirement for the patients. In addition, the bariatric patients need to adhere to dietary guideline to optimize long-term weight loss. Therefore structured nutrition counseling and education by qualified dietitians is essential part in the lifetime management of the patients.