Abstract
Background
Micronutrient deficiencies are key concerns after bariatric surgery. We describe the prevalence of perioperative testing and diagnosis of micronutrient deficiencies among a cohort of insured bariatric surgery patients.
Methods
We used claims data from seven health insurers to identify bariatric surgery patients from 2002–2008. Our outcomes were perioperative claims for vitamin D, B12, folate, and iron testing and diagnosed deficiencies. We analyzed results by bariatric surgery type: Roux-en-Y gastric bypass (RYGB), restrictive, and malabsorptive. We calculated the prevalence of testing and deficiency diagnosis, and performed multivariate logistic regression to determine the association with surgery type.
Results
Of 21,345 eligible patients, 84 % underwent RYGB. The pre-surgical testing prevalence for all micronutrients was <25 %. The testing prevalence during the first 12 months after surgery varied: vitamin D (12 %), vitamin B12 (60 %), folate (47 %) and iron (49 %), and declined during 13–24 and 25–36 months. The deficiency prevalence during 0–12 months post-survey varied: vitamin D (34 %), vitamin B12 (20 %), folate (13 %), and iron (10 %). The odds of vitamin B12, folate, and iron deficiency during 0–12 months were significantly lower for restrictive as compared to RYGB, but were not different during 13–24 and 25–36 months post-surgery. The odds of vitamin D deficiency were significantly greater for malabsorptive as compared to RYGB during all post-surgical periods.
Conclusion
Many patients did not receive micronutrient testing pre- or post-surgery, yet deficiencies were relatively common among those tested. These results highlight the need for surgeons and primary care providers to test all bariatric surgery patients for micronutrient deficiencies.
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Acknowledgments
The data set used in this study was originally created for a different research project on patterns of obesity care within selected BCBS plans. The previous research project (but not the current study) was funded by unrestricted research grants from Ethicon Endo-Surgery, Inc. (a Johnson & Johnson company); Pfizer, Inc., and GlaxoSmithKline. The data and database development support and guidance were provided by the BCBS Association, BCBS of Tennessee, BCBS of Hawaii, BCBS of Michigan, BCBS of North Carolina, Highmark, Inc. of Pennsylvania, Independence Blue Cross of Pennsylvania, Wellmark BCBS of Iowa and Wellmark BCBS of South Dakota. We thank the Blue Cross and Blue Shield plans and their staff members.
Funding Sources
KAG was supported by a training grant from the Health Resources and Service Administration (T32HP10025). Creation of the database was funded by Ethicon Endo-Surgery, Inc.; GlaxoSmithKline; and Pfizer, Inc. Data and support were provided by Blue Cross Blue Shield of Michigan and Highmark. Support was provided by the Blue Cross Blue Shield Association. The supporting organizations were kept informed of the study’s progress and shared their expertise on certain aspects of the study. Also, preliminary findings were shared with them, and they were invited to review the manuscript. However, they did not have any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation or approval of the manuscript.
Disclosure Statement
KA Gudzune: no conflicts of interest.
MM Huizinga: no conflicts of interest.
HY Chang: no conflicts of interest.
V Asamoah: no conflicts of interest.
M Gadgil: no conflicts of interest.
JM Clark: no conflicts of interest.
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Gudzune, K.A., Huizinga, M.M., Chang, HY. et al. Screening and Diagnosis of Micronutrient Deficiencies Before and After Bariatric Surgery. OBES SURG 23, 1581–1589 (2013). https://doi.org/10.1007/s11695-013-0919-x
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DOI: https://doi.org/10.1007/s11695-013-0919-x