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Gasmi A, Bjørklund G, Mujawdiya PK, Semenova Y, Peana M, Dosa A, Piscopo S, Gasmi Benahmed A, Costea DO. Micronutrients deficiences in patients after bariatric surgery. Eur J Nutr 2021; 61:55-67. [PMID: 34302218 DOI: 10.1007/s00394-021-02619-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 06/09/2021] [Indexed: 12/14/2022]
Abstract
Bariatric surgery is an effective option for managing obesity and has gained general acceptance among patients in recent years. Generally, despite the high caloric intake, a bad nutritional habit of obese people results in the deficiency of several vitamins, minerals, and trace elements essential for body metabolism and normal physiological processes. Additionally, the current bariatric surgical approaches such as sleeve gastrectomy (SG), Roux-en-Y-gastric bypass (RYGB), laparoscopic adjustable gastric banding (LAGB), and jejunoileal bypass (JIB) can cause or exacerbate these deficiencies. Based on several reports, it appears that the various bariatric surgical procedures affect nutrient absorption differently. Being purely restrictive, LAGB and SG affect the absorption of iron, selenium, and vitamin B12, while RYGB, JIB, and biliopancreatic diversion have a more profound impact on the absorption of essential vitamins, minerals, and trace elements. Nutritional deficiencies in vitamins, minerals, and trace elements may follow bariatric surgery and are associated with clinical manifestations and diseases, including anemia, ataxia, hair loss, and Wernicke encephalopathy. The present review summarizes some of the major vitamin and micronutrient deficiencies associated with bariatric surgery, particularly those presented post-surgically. To avoid any adverse consequences of vitamin and trace element deficiency, proper monitoring and tests are recommended at any stage, from pre- to post-surgery (periodical check-up), followed by specific and individual nutritional supplementation treatments and a proper healthy diet.
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Affiliation(s)
- Amin Gasmi
- Société Francophone de Nutrithérapie et de Nutrigénétique Appliquée, Villeurbanne, France
| | - Geir Bjørklund
- Council for Nutritional and Environmental Medicine (CONEM), Toften 24, 8610, Mo i Rana, Norway.
| | | | - Yuliya Semenova
- Semey Medical University, Semey, Kazakhstan
- CONEM Kazakhstan Environmental Health and Safety Research Group, Semey Medical University, Semey, Kazakhstan
| | - Massimiliano Peana
- Department of Chemistry and Pharmacy, University of Sassari, Sassari, Italy
| | - Alexandru Dosa
- Faculty of Medicine, Ovidius University of Constanta, Constanta, Romania
| | - Salva Piscopo
- Société Francophone de Nutrithérapie et de Nutrigénétique Appliquée, Villeurbanne, France
- Department of Nutritional Research and Development, Nutri-Logics SA, Weiswampach, Luxembourg
| | - Asma Gasmi Benahmed
- Académie Internationale de Médecine Dentaire Intégrative, Paris, France
- Université Claude Bernard, Lyon 1, Villeurbanne, France
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Iron deficiency following bariatric surgery: a retrospective cohort study. Blood Adv 2021; 4:3639-3647. [PMID: 32766854 DOI: 10.1182/bloodadvances.2020001880] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/29/2020] [Indexed: 02/07/2023] Open
Abstract
Iron deficiency is a common consequence of bariatric surgery and frequently leads to anemia. Our study reports the incidence and predictors of iron deficiency, iron deficiency anemia (IDA), and IV iron use after bariatric surgery. We conducted a retrospective study of all adult patients who underwent bariatric surgery from January to December 2012 at the regional bariatric surgery center in Hamilton, Ontario, Canada, and were followed for at least 6 months. Time-to-event data were presented as Kaplan-Meier curves. Cox regression analysis was used to identify outcome predictors. A total of 388 patients met the inclusion criteria. Iron deficiency, IDA, and the use of IV iron were reported in 43%, 16%, and 6% of patients, respectively, with a mean follow-up of 31 months. The cumulative incidence of iron deficiency and IDA increased with longer follow-up, and there was a significant increase in IV iron use starting 3 years after surgery. Malabsorptive procedures (hazard ratio [HR], 1.92; 95% confidence interval [CI], 1.20-3.06; P = .006) and low baseline ferritin (HR, 0.96; 95% CI, 0.95-0.97; P < .001) were associated with an increased risk of iron deficiency. Young age (HR, 0.90; 95% CI, 0.82-0.99; P = .028), baseline anemia (HR, 19.6; 95% CI, 7.85-48.9; P < .001), and low baseline ferritin (HR, 0.96; 95% CI, 0.95-0.98; P < .001) were associated with an increased risk of IDA. Our results suggest that IDA is a delayed consequence of bariatric surgery and that preoperative assessment of patient risk may be possible.
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Alwasaidi TA, Alahmadi DK, Alrufayi BM, Alaofi RK, Almutairi SR. Determining the prevalence and causes of anaemia in patients after bariatric surgery in a Saudi hospital. J Taibah Univ Med Sci 2020; 15:129-135. [PMID: 32368209 PMCID: PMC7184217 DOI: 10.1016/j.jtumed.2020.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/04/2020] [Accepted: 02/07/2020] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVES Obesity is a chronic disease with high prevalence in Saudi population. Bariatric surgery is an effective method for significant weight reduction. However, various types of nutritional deficiencies occur after weight loss surgery which increase the risk of anaemia. In this study, we aimed to determine the incidence of anaemia after bariatric surgery. METHOD A retrospective descriptive study was conducted with 70 patients of both genders aged over 16 years. These patients underwent bariatric surgery between February 2016 and March 2018 and had completed 6 months or more of post-surgery follow-up. Anthropometric and laboratory data were obtained before and after surgery at standard time intervals. All patients were on postoperative vitamin supplements. RESULTS Of the total study patients, 41 were women (58.57%) and 29 were men (41.42%) with a median age of 38.5 years (range, 16-65). The median follow-up time was 8 months (6-24 months). Postoperatively, 16 patients (22.9%) developed anaemia, and interestingly, all of them were women (39%). Fifteen of these sixteen patients (93.8%) had microcytic anaemia. Two of those sixteen patients (12.5%) had Roux-en-Y gastric bypass, while fourteen (87.5%) had sleeve gastrectomy. CONCLUSION Anaemia and its related nutritional deficiencies are a common complication after bariatric surgery which exerts a major impact on health, particularly in women. Hence, a strict post-operative follow-up and appropriate supplementation are recommended to combat anaemia and its related nutritional deficiencies.
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Affiliation(s)
- Turki A. Alwasaidi
- Medicine Department, College of Medicine, Taibah University, Almadinah Almunawwarah, KSA
| | - Duha K. Alahmadi
- College of Medicine, Taibah University, Almadinah Almunawwarah, KSA
| | | | - Rawan K. Alaofi
- College of Medicine, Taibah University, Almadinah Almunawwarah, KSA
| | - Saad R. Almutairi
- Hematology Division, Medicine Department, Prince Mohammed Bin Abdulaziz Hospital, Ministry National Guard – Health Affairs, Almadinah Almunawwarah, KSA
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Bailly L, Schiavo L, Sebastianelli L, Fabre R, Pradier C, Iannelli A. Anemia and Bariatric Surgery: Results of a National French Survey on Administrative Data of 306,298 Consecutive Patients Between 2008 and 2016. Obes Surg 2019. [PMID: 29516395 DOI: 10.1007/s11695-018-3143-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Bariatric surgery (BS) has grown exponentially in France, and long-term anemia due to micronutrient deficiencies has become common. OBJECTIVES The objective of this study was to assess the long-term risk of anemia after BS and to investigate the factors associated with the occurrence of this complication. MATERIALS AND METHODS Data from the French National Health Service database on patients who had undergone gastric bypass (GB), sleeve gastrectomy (SG), or adjustable gastric banding (AGB), between 2008 and 2016 were extracted. Only patients with a primary intervention were considered. RESULTS Data from 306,298 patients (143.733 SG, 79.188 GB, and 36.413 AGB) were analyzed. Overall, 12.930 of them (5.0%) had a diagnosis of anemia due to micronutrient deficiencies as main diagnosis or related diagnosis at time of a hospital stay between 2008 and 2016. In multivariate analysis, GB surgery, female gender, age younger than 52 years, and 25-OH vitamin D deficiency were positively associated with the occurrence of anemia whereas hospital procedural volume was negatively associated. The risk to be diagnosed with anemia after BS was 13.0% after a GB, 5.6% after a SG and 4.0% after an AGB (Log-rank p < 0.0001). The hazard ratio for anemia after GB compared to SG was 2.0 (95% CI 1.9-2.1), adjusted for age and gender. CONCLUSION In France, between 2008 and 2016, 5% of patients had anemia after BS. The risk to develop anemia was 2-fold higher after a GB than after a SG. Young women should be particularly aware of this long-term risk.
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Affiliation(s)
- Laurent Bailly
- Département de Santé Publique, Centre Hospitalier Universitaire de Nice (Public Health Department University Hospital of Nice), 06202, Nice, France
- Université Côte d'Azur, LAMHESS, Nice, France
| | - Luigi Schiavo
- Department of Cardio-Thoracic and Respiratory Science, University of Campania "Luigi Vanvitelli", Naples, Italy
- IX Division of General Surgery, Vascular Surgery, and Applied Biotechnology, Naples University Polyclinic, Naples, Italy
| | - Lionel Sebastianelli
- Digestive Unit, Archet 2 Hospital, University Hospital of Nice, 06202, Nice, France
| | - Roxane Fabre
- Département de Santé Publique, Centre Hospitalier Universitaire de Nice (Public Health Department University Hospital of Nice), 06202, Nice, France
- Université Côte d'Azur, LAMHESS, Nice, France
- EA CoBTek, University of Nice Sophia-Antipolis, Nice, France
| | - Christian Pradier
- Département de Santé Publique, Centre Hospitalier Universitaire de Nice (Public Health Department University Hospital of Nice), 06202, Nice, France
- Université Côte d'Azur, LAMHESS, Nice, France
| | - Antonio Iannelli
- Digestive Unit, Archet 2 Hospital, University Hospital of Nice, 06202, Nice, France.
- Inserm, U1065, Team 8 "Hepatic Complications of Obesity", 06204, Nice, France.
- University of Nice Sophia Antipolis, 06107, Nice, France.
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Lupoli R, Lembo E, Saldalamacchia G, Avola CK, Angrisani L, Capaldo B. Bariatric surgery and long-term nutritional issues. World J Diabetes 2017; 8:464-474. [PMID: 29204255 PMCID: PMC5700383 DOI: 10.4239/wjd.v8.i11.464] [Citation(s) in RCA: 193] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 08/11/2017] [Accepted: 09/04/2017] [Indexed: 02/05/2023] Open
Abstract
Bariatric surgery is recognized as a highly effective therapy for obesity since it accomplishes sustained weight loss, reduction of obesity-related comorbidities and mortality, and improvement of quality of life. Overall, bariatric surgery is associated with a 42% reduction of the cardiovascular risk and 30% reduction of all-cause mortality. This review focuses on some nutritional consequences that can occur in bariatric patients that could potentially hinder the clinical benefits of this therapeutic option. All bariatric procedures, to variable degrees, alter the anatomy and physiology of the gastrointestinal tract; this alteration makes these patients more susceptible to developing nutritional complications, namely, deficiencies of macro- and micro-nutrients, which could lead to disabling diseases such as anemia, osteoporosis, protein malnutrition. Of note is the evidence that most obese patients present a number of nutritional deficits already prior to surgery, the most important being vitamin D and iron deficiencies. This finding prompts the need for a complete nutritional assessment and, eventually, an adequate correction of pre-existing deficits before surgery. Another critical issue that follows bariatric surgery is post-operative weight regain, which is commonly associated with the relapse of obesity-related co-morbidities. Nu-tritional complications associated with bariatric surgery can be prevented by life-long nutritional monitoring with the administration of multi-vitamins and mineral supplements according to the patient's needs.
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Affiliation(s)
- Roberta Lupoli
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | - Erminia Lembo
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | - Gennaro Saldalamacchia
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | - Claudia Kesia Avola
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | - Luigi Angrisani
- Department of Public Health, Federico II University, 80131 Naples, Italy
| | - Brunella Capaldo
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
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Hicks LK, Rajasekhar A, Bering H, Carson KR, Kleinerman J, Kukreti V, Ma A, Mueller BU, O'Brien SH, Panepinto JA, Pasquini MC, Sarode R, Wood WA. Identifying existing Choosing Wisely recommendations of high relevance and importance to hematology. Am J Hematol 2016; 91:787-92. [PMID: 27152483 DOI: 10.1002/ajh.24412] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 04/26/2016] [Accepted: 05/03/2016] [Indexed: 01/03/2023]
Abstract
Choosing Wisely (CW) is a medical stewardship initiative led by the American Board of Internal Medicine Foundation in collaboration with professional medical societies in the United States. In an effort to learn from and leverage the work of others, the American Society of Hematology CW Task Force developed a method to identify and prioritize CW recommendations from other medical societies of high relevance and importance to patients with blood disorders and their physicians. All 380 CW recommendations were reviewed and assessed for relevance and importance. Relevance was assessed using the MORE(TM) relevance scale. Importance was assessed with regard to six guiding principles: harm avoidance, evidence, aggregate cost, relevance, frequency and impact. Harm avoidance was considered the most important principle. Ten highly relevant and important recommendations were identified from a variety of professional societies. Recommendations focused on decreasing unnecessary imaging, blood work, treatments and transfusions, as well as on increasing collaboration across disciplines and considering value when recommending treatments. Many CW recommendations have relevance beyond the society of origin. The methods developed by the ASH CW Task Force could be easily adapted by other Societies to identify additional CW recommendations of relevance and importance to their fields. Am. J. Hematol. 91:787-792, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Lisa K. Hicks
- St. Michael's Hospital; University of Toronto; Toronto Ontario Canada
| | | | - Harriet Bering
- Harvard Vanguard Medical Associates; Beverly Massachusetts
| | | | | | - Vishal Kukreti
- University of Toronto, University Health Network; Toronto Ontario
| | - Alice Ma
- University of North Carolina; Chapel Hill North Carolina
| | | | | | - Julie A. Panepinto
- Medical College of Wisconsin/Children's Hospital of Wisconsin; Milwaukee Wisconsin
| | | | - Ravi Sarode
- UT Southwestern Medical Center; Dallas Texas
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