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Anemia After Sleeve Gastrectomy and One-Anastomosis Gastric Bypass: An Investigation Based on the Tehran Obesity Treatment Study (TOTS)

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Abstract

Background

Bariatric surgery has been associated with iron, folate, and vitamin B12 deficiencies, which can lead to anemia. This study compares the incidence of anemia between sleeve gastrectomy (SG) and one-anastomosis gastric bypass (OAGB).

Methods

Patients from a prospectively collected database of patients with morbid obesity undergoing a primary bariatric procedure from April 2013 to September 2018 were included. Statistical analysis was performed using the general estimation equation. Patients were followed for 6, 12, 24, and 36 months post-surgery.

Results

The present study included 2618 patients, of whom 72.3% underwent SG and 27.6% underwent OAGB. The majority of the study population were women (75.7%), and the mean age of the participants was 39.5 ± 11.7 years. At the end of the follow-up, the excess weight loss percentage was 66.15 in the SG group and 75.41 in the OAGB group (P <  0.05). The incidence of anemia at 12-, 24-, and 36-month was 16.2, 19.7, and 24.3% in the SG group and 28.4, 37.6, and 56.5% in the OAGB group, showing significantly higher incidence in the OAGB than the SG group (\(P_{\text{between groups}}\) < 0.001). However, there was no significant difference between the SG and OAGB groups regarding the incidence of iron and vitamin B12 deficiency.

Conclusions

The patients undergoing bariatric surgery, especially OAGB, should be closely monitored post-surgery regarding the incidence of anemia, and supplementation in developing countries could be continued even after the first year.

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Availability of data and materials

The datasets used and analyzed in the current study are available from the corresponding author on reasonable request.

References

  1. Colquitt JL, Pickett K, Loveman E, Frampton GK (2018) Surgery for weight loss in adults. Cochrane Database Syst Rev, (8)

  2. Wiggins T, Guidozzi N, Welbourn R, Ahmed AR, Markar SR (2021) Association of bariatric surgery with all-cause mortality and incidence of obesity-related disease at a population level: a systematic review and meta-analysis. PLoS med 17(7):e1003206

    Article  Google Scholar 

  3. Spaniolas K, Kasten KR, Brinkley J, Sippey ME, Mozer A, Chapman WH et al (2015) The changing bariatric surgery landscape in the USA. Obes Surg 25(8):1544–1546

    Article  PubMed  Google Scholar 

  4. Qi L, Guo Y, Liu CQ, Huang ZP, Sheng Y, Zou DJ (2017) Effects of bariatric surgery on glycemic and lipid metabolism, surgical complication and quality of life in adolescents with obesity: a systematic review and meta-analysis. Surg Obes Relat Dis Off J Am Soc Bariatr Surg 13(12):2037–2055

    Article  Google Scholar 

  5. Weng TC, Chang CH, Dong YH, Chang YC, Chuang LM (2015) Anaemia and related nutrient deficiencies after Roux-en-Y gastric bypass surgery: a systematic review and meta-analysis. BMJ open 5(7):e006964

    Article  PubMed  PubMed Central  Google Scholar 

  6. Jáuregui-Lobera I (2013) Iron deficiency and bariatric surgery. Nutrients 5(5):1595–1608

    Article  PubMed  PubMed Central  Google Scholar 

  7. Angrisani L, Santonicola A, Iovino P, Vitiello A, Higa K, Himpens J et al (2018) IFSO Worldwide Survey 2016: primary, endoluminal, and revisional procedures. Obes Surg 28(12):3783–3794

    Article  PubMed  Google Scholar 

  8. DeMaria EJ (2007) Bariatric surgery for morbid obesity. N Engl J Med 356(21):2176–2183

    Article  CAS  PubMed  Google Scholar 

  9. Lewis C-A, de Jersey S, Seymour M, Hopkins G, Hickman I, Osland E (2020) Iron vitamin B 12, folate and copper deficiency after bariatric surgery and the impact on anaemia: a systematic review. Obes Surg 30:1–50

    Article  Google Scholar 

  10. Kular KS, Manchanda N, Rutledge R (2014) Analysis of the five-year outcomes of sleeve gastrectomy and mini gastric bypass: a report from the Indian sub-continent. Obes Surg 24(10):1724–1728

    Article  CAS  PubMed  Google Scholar 

  11. Jammu GS, Sharma R (2016) A 7-year clinical audit of 1107 cases comparing sleeve gastrectomy, Roux-En-Y gastric bypass, and mini-gastric bypass, to determine an effective and safe bariatric and metabolic procedure. Obes Surg 26(5):926–932

    Article  PubMed  Google Scholar 

  12. Barzin M, Hosseinpanah F, Motamedi MA, Shapoori P, Arian P, Daneshpour MA et al (2016) Bariatric surgery for morbid obesity: Tehran obesity treatment study (TOTS) rationale and study design. JMIR Res Protoc 5(1):e8

    Article  PubMed  PubMed Central  Google Scholar 

  13. Parrott J, Frank L, Rabena R, Craggs-Dino L, Isom KA, Greiman L (2017) American society for metabolic and bariatric surgery integrated health nutritional guidelines for the surgical weight loss patient 2016 update: micronutrients. Surg Obes Relat Dis Off J Am Soc Bariatr Surg 13(5):727–741

    Article  Google Scholar 

  14. WHO. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. World Health Organization, Geneva [Vitamin and Mineral Nutrition Information System.]. Available from: https://www.who.int/vmnis/indicators/haemoglobin.pdf

  15. Enani G, Bilgic E, Lebedeva E, Delisle M, Vergis A, Hardy K (2020) The incidence of iron deficiency anemia post-Roux-en-Y gastric bypass and sleeve gastrectomy: a systematic review. Surg Endosc 34(7):3002–3010

    Article  PubMed  Google Scholar 

  16. Baksi A, Kamtam DN, Aggarwal S, Ahuja V, Kashyap L, Shende DR (2020) Should surveillance endoscopy be routine after one anastomosis gastric bypass to detect marginal ulcers: initial outcomes in a tertiary referral centre. Obes Surg 30:1–7

    Article  Google Scholar 

  17. Robert M, Espalieu P, Pelascini E, Caiazzo R, Sterkers A, Khamphommala L et al (2019) Efficacy and safety of one anastomosis gastric bypass versus Roux-en-Y gastric bypass for obesity (YOMEGA): a multicentre, randomised, open-label, non-inferiority trial. Lancet 393(10178):1299–1309

    Article  PubMed  Google Scholar 

  18. Ludwig H, Strasser K (2001) Symptomatology of anemia. Semin Oncol 28:7–14

    Article  CAS  PubMed  Google Scholar 

  19. Aarts EO, Janssen IM, Berends FJ (2011) The gastric sleeve: losing weight as fast as micronutrients? Obes Surg 21(2):207–211

    Article  PubMed  Google Scholar 

  20. Alexandrou A, Armeni E, Kouskouni E, Tsoka E, Diamantis T, Lambrinoudaki I (2014) Cross-sectional long-term micronutrient deficiencies after sleeve gastrectomy versus Roux-en-Y gastric bypass: a pilot study. Surg Obes Relat Dis 10(2):262–268

    Article  PubMed  Google Scholar 

  21. Saif T, Strain GW, Dakin G, Gagner M, Costa R, Pomp A (2012) Evaluation of nutrient status after laparoscopic sleeve gastrectomy 1, 3, and 5 years after surgery. Surg Obes Relat Dis 8(5):542–547

    Article  PubMed  PubMed Central  Google Scholar 

  22. Moizé V, Andreu A, Flores L, Torres F, Ibarzabal A, Delgado S et al (2013) Long-term dietary intake and nutritional deficiencies following sleeve gastrectomy or Roux-En-Y gastric bypass in a mediterranean population. J Acad Nutr Diet 113(3):400–410

    Article  PubMed  Google Scholar 

  23. Hood MM, Corsica J, Bradley L, Wilson R, Chirinos DA, Vivo A (2016) Managing severe obesity: understanding and improving treatment adherence in bariatric surgery. J Behav Med 39(6):1092–1103

    Article  PubMed  Google Scholar 

  24. Behrns KE, Smith CD, Sarr MG (1994) Prospective evaluation of gastric acid secretion and cobalamin absorption following gastric bypass for clinically severe obesity. Dig Dis Sci 39(2):315–320

    Article  CAS  PubMed  Google Scholar 

  25. Spak E, Björklund P, Helander HF, Vieth M, Olbers T, Casselbrant A et al (2010) Changes in the mucosa of the Roux-limb after gastric bypass surgery. Histopathology 57(5):680–688

    Article  PubMed  Google Scholar 

  26. Jedamzik J, Eilenberg M, Felsenreich DM, Krebs M, Ranzenberger-Haider T, Langer FB et al (2020) Impact of limb length on nutritional status in one-anastomosis gastric bypass: 3-year results. Surg Obes Relat Dis 16(4):476–484

    Article  PubMed  Google Scholar 

  27. Stabler SP (2013) Vitamin B12 deficiency. N Engl J Med 368(2):149–160

    Article  CAS  PubMed  Google Scholar 

  28. Lakhani SV, Shah HN, Alexander K, Finelli FC, Kirkpatrick JR, Koch TR (2008) Small intestinal bacterial overgrowth and thiamine deficiency after Roux-en-Y gastric bypass surgery in obese patients. Nutr Res 28(5):293–298

    Article  CAS  PubMed  Google Scholar 

  29. Majumder S, Soriano J, Cruz AL, Dasanu CA (2013) Vitamin B12 deficiency in patients undergoing bariatric surgery: preventive strategies and key recommendations. Surg Obes Relat Dis 9(6):1013–1019

    Article  PubMed  Google Scholar 

  30. Mechanick JI, Apovian C, Brethauer S, Garvey WT, Joffe AM, Kim J et al (2019) clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures-2019 update: cosponsored by american association of clinical endocrinologists/american college of endocrinology, the obesity society, american society for metabolic & bariatric surgery, obesity medicine association, and american society of anesthesiologists-executive summary. Endocr Pract Off J Am Coll Endocrinol Am Assoc Clin Endocrinol 25(12):1346–1359

    Google Scholar 

  31. Ben-Porat T, Elazary R, Goldenshluger A, Dagan SS, Mintz Y, Weiss R (2017) Nutritional deficiencies four years after laparoscopic sleeve gastrectomy—are supplements required for a lifetime? Sur Obes Relat Dis 13(7):1138–1144

    Article  Google Scholar 

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Acknowledgements

The authors would like to thank the hospital staff, assistants, and coordinators who took part in this research. Also, special thanks are due to Mohammadreza Golsibi for his assistance and support of the electronic data collection system. This article was derived from the disease registry entitled “Registration of patients in Tehran Obesity Treatment Center” and approved under the ethical code of “IR.SBMU.ENDOCRINE.REC1397.059” (date: 2018-05-08) by the local ethics committee. The study was supported by the deputy of research and technology of Shahid Beheshti University of Medical Sciences (http://dregistrysbmu.ac.ir).

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Authors and Affiliations

  1. Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Maryam Barzin, Erfan Tasdighi, Amir Ebadinejad, Maryam Mahdavi, Majid Valizadeh & Farhad Hosseinpanah

  2. Tehran Obesity Treatment Center, Department of Surgery, Faculty of Medicine, Shahed University, Tehran, Iran

    Alireza Khalaj

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  1. Maryam Barzin
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Contributions

AK contributed to the study design, performing surgical operations, and the final approval of the manuscript; ET performed the data collection, literature review, and manuscript preparation; FH helped in study design, revising, and the final approval of the manuscript; MM contributed to the data analysis, interpretation, and manuscript preparation; MV contributed to the final approval of the manuscript; AE was involved in literature review and manuscript preparation; and MB helped in study design, data collection, the coordination of patients’ issues, manuscript preparation, and the final approval of the manuscript. All authors reviewed and approved the final draft of the manuscript.

Corresponding author

Correspondence to Farhad Hosseinpanah.

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Conflict of interest

The authors declare that they have no financial or non-financial competing interests.

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Not applicable

Ethical approval and consent to participate

All the procedures performed in the study were approved by Research Ethics Committee of the Research Institute for Endocrine Sciences of Shahid Beheshti University of Medical Sciences and were in accordance with the ethical standards of the Institutional Human Research Review Committee (No. 2ECRIES 93/03/13) and the 1964 Declaration of Helsinki and its later amendments. Informed written consent was obtained from all individual participants included in the study.

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Barzin, M., Tasdighi, E., Ebadinejad, A. et al. Anemia After Sleeve Gastrectomy and One-Anastomosis Gastric Bypass: An Investigation Based on the Tehran Obesity Treatment Study (TOTS). World J Surg 46, 1713–1720 (2022). https://doi.org/10.1007/s00268-022-06528-7

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  • DOI: https://doi.org/10.1007/s00268-022-06528-7

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