Abstract
Background
Nutritional deficiencies are common after bariatric surgery, but data are scarce after sleeve gastrectomy (SG) at long term.
Methods
We performed a prospective nutritional status evaluation before and at 2 and 5 years after SG in morbid obese patients receiving mulvitamin and mineral supplementation at a Spanish university hospital. One hundred seventy-six patients (49.3 ± 9.1 years and 46.7 ± 7.4 kg/m2) were evaluated; 51 of them were followed during 5 years. Anthropometric, compliance supplementation intake, and micronutrient evaluation were performed.
Results
Baseline concentrations were below normal values for 25(OH) vitamin D (73%), folic acid (16.5%), cobalamin (6.9%), pyridoxine (12%), thiamine (3.4%), and copper (0.5%). Anemia was found in 23%. In 49% of the subjects, at least one micronutrient deficiency was found at 2 years after SG. Vitamin D deficiency persisted at 2 and 5 years higher than 30% of patients. Frequencies of deficiencies for folic acid, B12, B6, and B1 vitamins decreased significantly after 2 years with normalization at 5 years. Copper deficiency increased between 1 and 2 years and it persisted at 5 years after SG. Vitamin supplementation compliance decreased progressively from the first year after surgery (94.8 to 81% at 2 years and to 53% 5 years after surgery).
Conclusions
Vitamin D deficiency is the most prevalent long-term nutritional deficiency after SG. About half of patients show some micronutrient deficiency at medium long term, despite supplementation. A proactive follow-up is required to ensure a personalized and adequate supplementation in all surgically treated obese patients including those in which SG has been performed.
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References
Gutiérrez-Fisac JL, Guallar-Castillón P, León-Muñoz LM, et al. Prevalence of general and abdominal obesity in the adult population of Spain, 2008-2010: the ENRICA study. Obes Rev. 2012;13(4):388–92.
Padwal R, Klarenbach S, Wiebe N, et al. Bariatric surgery: a systematic review and network meta-analysis of randomized trials. Obes Rev. 2011;12(8):602–21.
Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Endocrine society. evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(7):1911–30.
Moizé V, Deulofeu R, Torres F, et al. Nutritional intake and prevalence of nutritional deficiencies prior to surgery in a Spanish morbidly obese population. Obes Surg. 2011;21(9):1382–8.
Sánchez A, Rojas P, Basfi-Fer K, et al. Micronutrient deficiencies in morbidly obese women prior to bariatric surgery. Obes Surg. 2016;26(2):361–8.
Damms-Machado A, Friedrich A, Kramer KM, et al. Pre- and postoperative nutritional deficiencies in obese patients undergoing laparoscopic sleeve gastrectomy. Obes Surg. 2012;22(6):881–9.
Almogy G, Crookes PF, Anthone GJ. Longitudinal gastrectomy as a treatment for the high-risk super-obese patient. Obes Surg. 2004;14(4):492–7.
Sammour T, Hill AG, Singh P, et al. Laparoscopic sleeve gastrectomy as a single-stage bariatric procedure. Obes Surg. 2010;20(3):271–5.
Casella G, Soricelli E, Giannotti D, et al. Long-term results after laparoscopic sleeve gastrectomy in a large monocentric series. Surg Obes Relat Dis. 2016;12(4):757–62.
D'Hondt M, Vanneste S, Pottel H, et al. Laparoscopic sleeve gastrectomy as a single-stage procedure for the treatment of morbid obesity and the resulting quality of life, resolution of comorbidities, food tolerance, and 6-year weight loss. Surg Endosc. 2011;25(8):2498–504.
Coupaye M, Rivière P, Breuil MC, et al. Comparison of nutritional status during the first year after sleeve gastrectomy and roux-en-Y gastric bypass. Obes Surg. 2014;24(2):276–83.
Leyba JL, Llopis SN, Aulestia SN. Laparoscopic roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the treatment of morbid obesity. A prospective study with 5 years of follow-up. Obes Surg. 2014;24(12):2094–8.
Aarts EO, Janssen IM, Berends FJ. The gastric sleeve: losing weight as fast as micronutrients? Obes Surg. 2011;21(2):207–11.
Gehrer S, Kern B, Peters T, et al. Fewer nutrient deficiencies after laparoscopic sleeve gastrectomy (SG) than after laparoscopic roux-Y-gastric bypass (LRYGB)—a prospective study. Obes Surg. 2010;20(4):447–53.
Belfiore A, Cataldi M, Minichini L, et al. Short-term changes in body composition and response to micronutrient supplementation after laparoscopic sleeve gastrectomy. Obes Surg. 2015;25(12):2344–51.
Alvarez V, Cuevas A, Olivos C, et al. Micronutrient deficiencies one year after sleeve gastrectomy. Nutr Hosp. 2014;29(1):73–9.
Shankar P, Boylan M, Sriram K. Micronutrient deficiencies after bariatric surgery. Nutrition. 2010;26(11–12):1031–7.
Pech N, Meyer F, Lippert H, et al. Complications, reoperations, and nutrient deficiencies two years after sleeve gastrectomy. J Obes. 2012;828737
Saif T, Strain GW, Dakin G, et al. Evaluation of nutrient status after laparoscopic sleeve gastrectomy 1, 3, and 5 years after surgery. Surg Obes Relat Dis. 2012;8(5):542–7.
Moizé V, Andreu A, Flores L, et al. Long-term dietary intake and nutritional deficiencies following sleeve gastrectomy or roux-en-Y gastric bypass in a Mediterranean population. J Acad Nutr Diet. 2013;113(3):400–10.
Alexandrou A, Armeni E, Kouskouni E. Cross-sectional long-term micronutrient deficiencies after sleeve gastrectomy versus roux-en-Y gastric bypass: a pilot study. Surg Obes Relat Dis. 2014;10(2):262–8.
Rubio MA, Monereo S, Lecube A, et al. Joint position statement of the SEEN-SECO-SEEDO-SED societies on metabolic surgery for type 2 diabetes mellitus. Endocrinol Nutr. 2013;60(10):547–8.
Buse JB, Caprio S, Cefalu WT, et al. How do we define cure of diabetes? Diabetes Care. 2009;32:2133–5.
Mechanick JI, Youdim A, Jones DB, et al. American Association of Clinical Endocrinologists; Obesity Society; American Society for Metabolic & Bariatric Surgery. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring). 2013;(Suppl 1):S1–27.
Cashman KD, Dowling KG, Škrabáková Z, et al. Vitamin D deficiency in Europe: pandemic? Am J Clin Nutr. 2016;103(4):1033–44.
Serra-Planas E, Aguilera E, Granada ML, et al. High prevalence of vitamin D deficiency and lack of association with subclinical atherosclerosis in asymptomatic patients with type 1 diabetes mellitus from a Mediterranean area. Acta Diabetol. 2015;52(4):773–9.
Van Rutte PW, Aarts EO, Smulders JF, et al. Nutrient deficiencies before and after sleeve gastrectomy. Obes Surg. 2014;24(10):1639–46.
Kaidar-Person O, Person B, Szomstein S, et al. Nutritional deficiencies in morbidly obese patients: a new form of malnutrition? Part B:minerals Obes Surg. 2008;18(8):1028–34.
Malinowski SS. Nutritional and metabolic complications of bariatric surgery. Am J Med Sci. 2006;331(4):219–25.
Lanzarini E, Nogués X, Goday A, et al. High-dose vitamin D supplementation is necessary after bariatric surgery: a prospective 2-year follow-up study. Obes Surg. 2015;25(9):1633–8.
Ruiz-Tovar J, Oller I, Tomas A, et al. Mid-term effects of sleeve gastrectomy on calcium metabolism parameters, vitamin D and parathormone (PTH) in morbid obese women. Obes Surg. 2012;22(5):797–801l.
Boyce SG, Goriparthi R, Clark J, et al. Can composite nutritional supplement based on the current guidelines prevent vitamin and mineral deficiency after weight loss surgery? Obes Surg. 2016;26(5):966–71.
Muschitz C, Kocijan R, Haschka J, et al. The impact of vitamin D, calcium, protein supplementation, and physical exercise on bone metabolism after bariatric surgery: the BABS study. J Bone Miner Res. 2016;31(3):672–82.
Flores L, Moizé V, Ortega E, et al. Prospective study of individualized or high fixed doses of vitamin D supplementation after bariatric surgery. Obes Surg. 2015;25(3):470–6.
Moore CE, Sherman V. Vitamin D supplementation efficacy: sleeve gastrectomy versus gastric bypass surgery. Obes Surg. 2014;24(12):2055–60.
Fried M, Yumuk V, Oppert JM, et al. International Federation for Surgery of obesity and metabolic disorders-European chapter (IFSO-EC); European Association for the Study of Obesity (EASO); European Association for the Study of obesity obesity management task force (EASO OMTF). Interdisciplinary European guidelines on metabolic and bariatric surgery. Obes Surg. 2014;24(1):42–55.
Allen LH. Causes of vitamin B12 and folate deficiency. Food Nutr Bull. 2008;29(2 Suppl):S20–34.
Goodman JC. Neurological complications of bariatric surgery. Curr Neurol Neurosci Rep. 2015;15(12):79.
Kröll D, Laimer M, Borbély YM, et al. Wernicke encephalopathy: a future problem even after sleeve gastrectomy? A Systematic Literature Review Obes Surg. 2016;26(1):205–12.
Saab R, El Khoury M, Farhat S. Wernicke's encephalopathy three weeks after sleeve gastrectomy. Surg Obes Relat Dis. 2014;10(5):992–4.
Papamargaritis D, Aasheim ET, Sampson B, et al. Copper, selenium and zinc levels after bariatric surgery in patients recommended to take multivitamin-mineral supplementation. J Trace Elem Med Biol. 2015;31:167–72.
Dunstan MJ, Molena EJ, Ratnasingham K, et al. Variations in oral vitamin and mineral supplementation following bariatric gastric bypass surgery: a national survey. Obes Surg. 2015;25(4):648–55.
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This research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.
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An erratum to this article is available at http://dx.doi.org/10.1007/s11695-017-2654-1.
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Pellitero, S., Martínez, E., Puig, R. et al. Evaluation of Vitamin and Trace Element Requirements after Sleeve Gastrectomy at Long Term. OBES SURG 27, 1674–1682 (2017). https://doi.org/10.1007/s11695-017-2557-1
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DOI: https://doi.org/10.1007/s11695-017-2557-1