Obesity Surgery

, Volume 19, Issue 1, pp 56–65 | Cite as

Nutritional Consequences of Adjustable Gastric Banding and Gastric Bypass: A 1-year Prospective Study

  • Muriel Coupaye
  • Karin Puchaux
  • Catherine Bogard
  • Simon Msika
  • Pauline Jouet
  • Christine Clerici
  • Etienne Larger
  • Séverine Ledoux
Research Article

Abstract

Background

Gastric bypass (GBP) is more efficient than adjustable gastric banding (AGB) on weight loss and comorbidities, but potentially induces more nutritional deficits. However, no study has compared the prevalence of nutritional deficiencies after these two bariatric procedures.

We prospectively compared

To prospectively compare the prevalence of nutritional deficiencies after AGB and GBP.

Methods

We have performed a 1-year prospective study of nutritional parameters in 70 consecutive severe obese patients, who had undergone bariatric surgery, 21 AGB and 49 GBP. After GBP, multivitamin supplements were systematically prescribed and vitamin B12 supplementation was introduced if a deficiency was observed.

Results

Patients lost more weight after GBP than after AGB (40 ± 13 vs 16 ± 8 kg, p < 0.001). Vitamins B1 and C and iron deficiencies were frequent before surgery but were not worsened by GBP. AGB only induced a slight decrease of vitamin B1 at 1 year, whereas GBP induced significant decreases of vitamins B12 and E, serum prealbumin, and creatinine concentrations, with only minor clinical consequences. Anemia was observed in 10% of the patients after bariatric surgery. Hemoglobin concentration was not correlated to vitamin B12 or folate concentrations but was related to iron status. Risk of iron deficiency anemia was better assessed by transferrin saturation than by serum ferritin concentration in this obese population.

Conclusion

Severe nutritional deficits can be avoided after bariatric surgery if patients are systematically supplemented with multivitamin and carefully monitored. However, specific care is required to avoid iron and vitamin B12 deficiencies, anemia, and protein malnutrition.

Keywords

Bariatric surgery Nutritional deficiencies Nutritional supplementation Iron status 

References

  1. 1.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.PubMedCrossRefGoogle Scholar
  2. 2.
    Maggard MA, Shugarman LR, Suttorp M, Maglione M, Sugerman HJ, Livingston EH, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142:547–59.PubMedGoogle Scholar
  3. 3.
    Busetto L, Mirabelli D, Petroni ML, Mazza M, Favretti F, Segato G, et al. Comparative long-term mortality after laparoscopic adjustable gastric banding versus nonsurgical controls. Surg Obes Relat Dis. 2007 Sep–Oct;3(5):496–502.PubMedCrossRefGoogle Scholar
  4. 4.
    Sjöström L, Narbro K, Sjöström CD, Karason K, Larsson B, Wedel H, et al. Swedish obese subjects study. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–52.PubMedCrossRefGoogle Scholar
  5. 5.
    Adams TD, Gress RE, Smith SC, Halverson RC, Simper SC, Rosamond WD, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007 Aug;357:753–61.PubMedCrossRefGoogle Scholar
  6. 6.
    Basdevant A, Paita M, Rodde-Dunet MH, Marty M, Noguès F, Slim K, et al. A nationwide survey on bariatric surgery in France: two years prospective follow-up. Obes Surg. 2007;17:39–44.PubMedCrossRefGoogle Scholar
  7. 7.
    Weber M, Muller MK, Bucher T, et al. Laparoscopic gastric bypass is superior to laparoscopic gastric banding for treatment of morbid obesity. Ann Surg. 2004;240:975–82.PubMedCrossRefGoogle Scholar
  8. 8.
    Perugini RA, Mason R, Czerniach DR, Novitsky YW, Baker S, Litwin DE, et al. Predictors of complication and suboptimal weight loss after laparoscopic Roux-en-Y gastric bypass: a series of 188 patients. Arch Surg. 2003;138:541–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Bloomberg RD, Fleishman A, Nalle JE, Herron DM, Kini S. Nutritional deficiencies following bariatric surgery: what have we learned? Obes Surg. 2005;15:145–54.PubMedCrossRefGoogle Scholar
  10. 10.
    Alvarez-Leite JI. Nutrient deficiencies secondary to bariatric surgery. Curr Opin Clin Nutr Metab Care. 2004;7:569–75.PubMedCrossRefGoogle Scholar
  11. 11.
    Ukleja A, Stone RL. Medical and gastroenterologic management of the post-bariatric surgery patient. J Clin Gastroenterol. 2004;38:312–21.PubMedCrossRefGoogle Scholar
  12. 12.
    Shah M, Simha V, Garg A. Review: long-term impact of bariatric surgery on body weight, comorbidities, and nutritional status. J Clin Endocrinol Metab. 2006;91:4223–31.PubMedCrossRefGoogle Scholar
  13. 13.
    Ledoux S, Msika S, Moussa F, Larger E, Boudou P, Salomon L, et al. Comparison of nutritional consequences of conventional therapy of obesity, adjustable gastric banding, and gastric bypass. Obes Surg. 2006, 8:1041–9.CrossRefGoogle Scholar
  14. 14.
    National Institutes of Health, National Heart Lung and Blood Institute. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: Executive summary. Am J Clin Nutr. 1998;68:899–917.Google Scholar
  15. 15.
    Basdevant A, Laville M, Ziegler O, et al. Guide pratique pour le diagnostic, la prévention, le traitement des obésités en France. Cah Nutr Diet. 1998;33:10–42.Google Scholar
  16. 16.
    Arnaud J, Fortis I, Blachier S, Kia D, Favier A. Simultaneous determination of retinol, alpha-tocopherol and beta-carotene in serum by isocratic high-performance liquid chromatography. J Chromatogr. 1991;572:103–16.PubMedCrossRefGoogle Scholar
  17. 17.
    Skroubis G, Anesidis S, Kehagias I, Mead N, Vagenas K, Kalfarentzos F. Roux-en-Y gastric bypass versus a variant of biliopancreatic diversion in a non-superobese population: prospective comparison of the efficacy and the incidence of metabolic deficiencies. Obes Surg. 2006;16:488–95.PubMedCrossRefGoogle Scholar
  18. 18.
    Brolin RE, LaMarca LB, Kenler HA, Cody RP. Malabsorptive gastric bypass in patients with superobesity. J Gastrointest Surg. 2002;6:195–203.PubMedCrossRefGoogle Scholar
  19. 19.
    Clements RH, Katasani VG, Palepu R, Leeth RR, Leath TD, Roy BP, et al. Incidence of vitamin deficiency after laparoscopic Roux-en-Y gastric bypass in a university hospital setting. Am Surg. 2006;72:1196–202.PubMedGoogle Scholar
  20. 20.
    Kalfarentzos F, Skroubis G, Kehagias I, Mead N, Vagenas K. A prospective comparison of vertical banded gastroplasty and Roux-en-Y gastric bypass in a non-superobese population. Obes Surg. 2006;16:151–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Aasheim ET, Hofsø D, Hjelmesæth J, Birkeland KI, Bøhmer T. Vitamin status in morbidly obese patients: a cross-sectional study. Am J Clin Nutr. 2008;87:362–9.PubMedGoogle Scholar
  22. 22.
    Flancbaum L, Belsley S, Drake V, Colarusso T, Tayler E. Preoperative nutritional status of patients undergoing Roux-en-Y gastric bypass for morbid obesity. J Gastrointest Surg. 2006;10:1033–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Ybarra J, Sanchez-Hernandez J, Gich I, et al. Unchanged hypovitaminosis D and secondary hyperparathyroidism in morbid obesity after bariatric surgery. Obes Surg. 2005;15:330–5.PubMedCrossRefGoogle Scholar
  24. 24.
    Salas-Salvado J, Garcia-Lorda P, Cuatrecasas G, et al. Wernicke’s syndrome after bariatric surgery. Clin Nutr. 2002;19:371–3.CrossRefGoogle Scholar
  25. 25.
    Yanoff LB, Menzie CM, Denkinger B, Sebring NG, McHugh T, Remaley AT, et al. Inflammation and iron deficiency in the hypoferremia of obesity. Int J Obes (Lond). 2007;31:1412–9.CrossRefGoogle Scholar
  26. 26.
    Zelber-Sagi S, Nitzan-Kaluski D, Halpern Z, Oren R. NAFLD and hyperinsulinemia are major determinants of serum ferritin levels. J Hepatol. 2007;46:700–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Bekri S, Gual P, Anty R, Luciani N, Dahman M, Ramesh B, et al. Increased adipose tissue expression of hepcidin in severe obesity is independent from diabetes and NASH. Gastroenterology. 2006;131:788–96.PubMedCrossRefGoogle Scholar
  28. 28.
    Kushner R. Managing the obese patient after bariatric surgery: a case report of severe malnutrition and review of the literature. J Parenter Enteral Nutr. 2000;24:126–32.CrossRefGoogle Scholar
  29. 29.
    Madan AK, Orth WS, Tichansky DS, Ternovits CA.Vitamin and trace mineral levels after laparoscopic gastric bypass. Obes Surg. 2006;16:603–6.PubMedCrossRefGoogle Scholar
  30. 30.
    Coates PS, Fernstrom JD, Fernstrom MH, Schauer PR, Greenspan SL. Gastric bypass surgery for morbid obesity leads to an increase in bone turnover and a decrease in bone mass. J Clin Endocrinol Metab. 2004;89:1061–5.PubMedCrossRefGoogle Scholar
  31. 31.
    von Mach MA, Stoeckli R, Bilz S, Kraenzlin M, Langer I, Keller U. Changes in bone mineral content after surgical treatment of morbid obesity. Metabolism. 2004;53:918–21.CrossRefGoogle Scholar
  32. 32.
    Fujioka K. Follow-up of nutritional and metabolic problems after bariatric surgery. Diabetes Care. 2005;28:481–4.PubMedCrossRefGoogle Scholar
  33. 33.
    Trostler N, Mann A, Zilberbush N, Charuzi II, Avinoach E. Nutrient intake following vertical banded gastroplasty or gastric bypass. Obes Surg. 1995;5:403–10.PubMedCrossRefGoogle Scholar
  34. 34.
    Brolin RE, Leung M. Survey of vitamin and mineral supplementation after gastric bypass and biliopancreatic diversion for morbid obesity. Obes Surg. 1999;9:150–4.PubMedCrossRefGoogle Scholar
  35. 35.
    Love AL, Billett HH. Obesity, bariatric surgery, and iron deficiency: true, true, true and related. Am J Hematol. 2008;83(5):403–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • Muriel Coupaye
    • 1
  • Karin Puchaux
    • 2
  • Catherine Bogard
    • 3
  • Simon Msika
    • 4
  • Pauline Jouet
    • 5
  • Christine Clerici
    • 1
  • Etienne Larger
    • 6
  • Séverine Ledoux
    • 1
  1. 1.Explorations FonctionnellesCentre de référence de l’Obésité, Hôpital Louis Mourier (AP-HP)ColombesFrance
  2. 2.Unité de DiététiqueHôpital Louis Mourier (AP-HP)ColombesFrance
  3. 3.Service de BiochimieCentre de référence de l’Obésité, Hôpital Louis Mourier (AP-HP)ColombesFrance
  4. 4.Service de ChirurgieCentre de référence de l’Obésité, Hôpital Louis Mourier (AP-HP)ColombesFrance
  5. 5.Service de Gastro-EntérologieCentre de référence de l’Obésité, Hôpital Louis Mourier (AP-HP)ColombesFrance
  6. 6.INSERM U833, Médecine Expérimentale, Collège de FranceParisFrance

Personalised recommendations