Obesity Surgery

, Volume 24, Issue 10, pp 1639–1646 | Cite as

Nutrient Deficiencies Before and After Sleeve Gastrectomy

  • P. W. J. van Rutte
  • E. O. Aarts
  • J. F. Smulders
  • S. W. Nienhuijs
Original Contributions



Obesity is associated with nutritional deficiencies. Bariatric surgery could worsen these deficiencies. Fewer nutritional deficiencies would be seen after sleeve gastrectomy compared to the Roux-en-Y gastric bypass, but sleeve gastrectomy would also cause further deterioration of the deficiencies. The aim of this study was to determine the amount of pre-operative nutrient deficiencies in sleeve gastrectomy patients and assess the evolution of the nutritional status during the first post-operative year.


Four hundred seven sleeve gastrectomy patients were assigned to a standardized follow-up program. Data of interest were weight loss, pre-operative nutrient status and evolution of nutrient deficiencies during the first post-operative year. Deficiencies were supplemented when found.


Two hundred patients completed blood withdrawal pre-operatively and in the first post-operative year. pre-operatively, 5 % of the patients were anemic, 7 % had low serum ferritin and 24 % had low folic acid. Hypovitaminosis D was present in 81 %. Vitamin A had excessive levels in 72 %. One year post-operatively, mean excess weight loss was 70 %. Anemia was found in 6 %. Low-ferritin levels were found in 8 % of the patients. Folate deficiency decreased significantly and hypovitaminosis D was still found in 36 %.


In this study, a considerable amount of patients suffered from a deficient micronutrient status pre-operatively. One year after surgery, micronutrient deficiencies persisted or were found de novo in a considerable amount of patients, despite significant weight loss and supplementation. Significant reductions were seen only for folate and vitamin D.


Sleeve gastrectomy Vitamin D Bariatric surgery Micronutrient deficiency 


Conflicts of Interest



  1. 1.
    Aasheim ET, Hofso D, Hjelmesaeth J, et al. Vitamin status in morbidly obese patients: a cross-sectional study. Am J Clin Nutr. 2008;87:362–9.PubMedGoogle Scholar
  2. 2.
    Boza C, Salinas J, Salgado N, et al. Laparoscopic sleeve gastrectomy as a stand-alone procedure for morbid obesity: report of 1,000 cases and 3-year follow-up. Obes Surg. 2012;22:866–71.PubMedCrossRefGoogle Scholar
  3. 3.
    Brethauer SA, Hammel JP, Schauer PR. Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Relat Dis. 2009;5:469–75.PubMedCrossRefGoogle Scholar
  4. 4.
    Deitel M, Gagner M, Erickson AL, et al. Third international summit: current status of sleeve gastrectomy. Surg Obes Relat Dis. 2011;7:749–59.PubMedCrossRefGoogle Scholar
  5. 5.
    Shi X, Karmali S, Sharma AM, et al. A review of laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg. 2010;20:1171–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Ernst B, Thurnheer M, Schmid SM, et al. Evidence for the necessity to systematically assess micronutrient status prior to bariatric surgery. Obes Surg. 2009;19:66–73.PubMedCrossRefGoogle Scholar
  7. 7.
    Kaidar-Person O, Person B, Szomstein S, et al. Nutritional deficiencies in morbidly obese patients: a new form of malnutrition? Part A: vitamins. Obes Surg. 2008;18:870–6.PubMedCrossRefGoogle Scholar
  8. 8.
    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;18:1028–34.PubMedCrossRefGoogle Scholar
  9. 9.
    Damms-Machado A, Friedrich A, Kramer KM, et al. Pre- and postoperative nutritional deficiencies in obese patients undergoing laparoscopic sleeve gastrectomy. Obes Surg. 2012;22:881–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Schweiger C, Weiss R, Berry E, et al. Nutritional deficiencies in bariatric surgery candidates. Obes Surg. 2010;20:193–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Davies DJ, Baxter JM, Baxter JN. Nutritional deficiencies after bariatric surgery. Obes Surg. 2007;17:1150–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Malinowski SS. Nutritional and metabolic complications of bariatric surgery. Am J Med Sci. 2006;331:219–25.PubMedCrossRefGoogle Scholar
  13. 13.
    Toh SY, Zarshenas N, Jorgensen J. Prevalence of nutrient deficiencies in bariatric patients. Nutrition. 2009;25:1150–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Gehrer S, Kern B, Peters T, et al. Fewer nutrient deficiencies after laparoscopic sleeve gastrectomy (LSG) than after laparoscopic Roux-Y-gastric bypass (LRYGB)-a prospective study. Obes Surg. 2010;20:447–53.PubMedCrossRefGoogle Scholar
  15. 15.
    Aarts EO, Janssen IM, Berends FJ. The gastric sleeve: losing weight as fast as micronutrients? Obes Surg. 2011;21:207–11.PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Pech N, Meyer F, Lippert H, et al. Complications, reoperations, and nutrient deficiencies two years after sleeve gastrectomy. J Obes. 2012;2012:828737.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    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;22:797–801.PubMedCrossRefGoogle Scholar
  18. 18.
    Chiu S, Birch DW, Shi X, et al. Effect of sleeve gastrectomy on gastroesophageal reflux disease: a systematic review. Surg Obes Relat Dis. 2011;7:510–5.PubMedCrossRefGoogle Scholar
  19. 19.
    Aarts EO, van Wageningen B, Janssen IM, et al. Prevalence of anemia and related deficiencies in the first year following laparoscopic gastric bypass for morbid obesity. J Obes. 2012;2012:193705. doi: 10.1155/2012/193705.PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Flancbaum L, Belsley S, Drake V, et al. Preoperative nutritional status of patients undergoing Roux-en-Y gastric bypass for morbid obesity. J Gastrointest Surg. 2006;10:1033–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Muñoz M, Botella-Romero F, Gómez-Ramírez S, et al. Iron deficiency and anaemia in bariatric surgical patients: causes, diagnosis and prope management. Nutr Hosp. 2009;24(6):640–54.PubMedGoogle Scholar
  22. 22.
    von Drygalski A, Andris DA, Nuttleman PR, et al. Anemia after bariatric surgery cannot be explained by iron deficiency alone: results of a large cohort study. Surg Obes Relat Dis. 2011;7(2):151–6. doi: 10.1016/j.soard.2010.04.008.CrossRefGoogle Scholar
  23. 23.
    Vargas-Ruiz AG, Hernandez-Rivera G, Herrera MF. Prevalence of iron, folate, and vitamin B12 deficiency anemia after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2008;18:288–93.PubMedCrossRefGoogle Scholar
  24. 24.
    Ten Broeke R, Bravenboer B, Smulders FJ. Iron deficiency before and after bariatric surgery: the need for iron supplementation. Neth J Med. 2013;71(8):412–7.PubMedGoogle Scholar
  25. 25.
    Hakeam HA, O'Regan PJ, Salem AM, et al. Impact of laparoscopic sleeve gastrectomy on iron indices: 1 year follow-up. Obes Surg. 2009;19:1491–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Mittinty MN, Golley RK, Smithers LG, et al. A preference based measure of complementary feeding quality: application to the avon longitudinal study of parents and children. PLoS One. 2013;8(10):e76111. doi: 10.1371/journal.pone.0076111.PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Carlin AM, Rao DS, Yager KM, et al. Effect of gastric bypass surgery on vitamin D nutritional status. Surg Obes Relat Dis. 2006;2:638–42.PubMedCrossRefGoogle Scholar
  28. 28.
    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
  29. 29.
    Ybarra J, Sanchez-Hernandez J, Perez A. Hypovitaminosis D and morbid obesity. Nurs Clin N Am. 2007;42:19–27.CrossRefGoogle Scholar
  30. 30.
    Blum M, Dolnikowski G, Seyoum E, et al. Vitamin D(3) in fat tissue. Endocrine. 2008;33:90–4.PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Holick MF. Vitamin D, deficiency. N Engl J Med. 2007;357:266–81.PubMedCrossRefGoogle Scholar
  32. 32.
    Grune T, Lietz G, Palou A, et al. Beta-carotene is an important vitamin A source for humans. J Nutr. 2010;140(12):2268S–85S. doi: 10.3945/jn.109.119024.PubMedCentralPubMedCrossRefGoogle Scholar
  33. 33.
    Carrodeguas L, Kaidar-Person O, Szomstein S, et al. Preoperative thiamine deficiency in obese population undergoing laparoscopic bariatric surgery. Surg Obes Relat Dis. 2005;1:517–22.PubMedCrossRefGoogle Scholar
  34. 34.
    Mason ME, Jalagani H, Vinik AI. Metabolic complications of bariatric surgery: diagnosis and management issues. Gastroenterol Clin N Am. 2005;34:25–33.CrossRefGoogle Scholar
  35. 35.
    Singh S, Kumar A. Wernicke encephalopathy after obesity surgery: a systematic review. Neurology. 2007;68:807–11.PubMedCrossRefGoogle Scholar
  36. 36.
    Allen LH. Causes of vitamin B12 and folate deficiency. Food Nutr Bull. 2008;29:S20–34.PubMedGoogle Scholar
  37. 37.
    Madan AK, Orth WS, Tichansky DS, et al. Vitamin and trace mineral levels after laparoscopic gastric bypass. Obes Surg. 2006;16:603–6.PubMedCrossRefGoogle Scholar
  38. 38.
    Barbagallo M, Dominguez LJ, Resnick LM. Magnesium metabolism in hypertension and type 2 diabetes mellitus. Am J Ther. 2007;14:375–85.PubMedCrossRefGoogle Scholar
  39. 39.
    Barbagallo M, Dominguez LJ. Magnesium metabolism in type 2 diabetes mellitus, metabolic syndrome and insulin resistance. Arch Biochem Biophys. 2007;458:40–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • P. W. J. van Rutte
    • 1
  • E. O. Aarts
    • 2
  • J. F. Smulders
    • 1
  • S. W. Nienhuijs
    • 1
  1. 1.Department of SurgeryCatharina HospitalEindhovenThe Netherlands
  2. 2.Department of SurgeryRijnstate HospitalArnhemThe Netherlands

Personalised recommendations