Nutritional deficiencies are common after bariatric surgery, but data are scarce after sleeve gastrectomy (SG) at long term.
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.
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).
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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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.
Conflict of interest
The authors declare that they have no conflict of interest.
This research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.
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
- Vitamins supplementation
- Nutritional deficiencies
- Bariatric surgery
- Sleeve gastrectomy