Evaluation of Nutritional Status Post Laparoscopic Sleeve Gastrectomy—5-Year Outcomes

Abstract

Introduction

Obesity is considered a public health problem and has led to advancements in bariatric surgery. Laparoscopic sleeve gastrectomy (LSG) had become the most performed procedure worldwide; however, its consequences on nutritional status in the short and long term are of concern.

Methods

A retrospective analysis of medical records and bariatric database of patients who underwent LSG from October 2008–September 2015 at Al-Amiri Hospital, Kuwait, was performed. Data regarding nutritional status along with demographic data were collected over a 5-year follow-up period.

Results

One thousand seven hundred ninety-three patients comprising of 74% females and 26% males were included. The greatest % total body weight loss (%TBWL) was at 18 months post-LSG (33%), corresponding to a % excess weight loss (%EWL) of 73.8%. With regard to nutritional status, vitamin B1 showed a significant drop at 3–5 years post-op in comparison to pre-op value, but stayed within the normal range throughout the study. Red blood cells count, hemoglobin, and hematocrit also showed a significant drop starting from 6 months post-op until the fifth year of follow-up. On the other hand, vitamins B6 and B12 showed a significant increase at 6 months post-op and decreased afterwards, but did not reach pre-op values. Vitamin D also showed a significant increase throughout the study period from deficient value at the pre-op time, but remained insufficient. Albumin, transferrin, folate, ferritin, iron, and vitamin B2 showed no significant changes at 5 years post-LSG compared to pre-op values.

Conclusion

Little is known about the nutritional status and optimal nutritional care plan post-LSG, especially in the longer term. Nutritional deficiencies were prevalent prior and post-LSG. Some of the nutritional parameters improved and even reached the abnormal high level post-LSG. These observations highlight the importance of pre- and post-operative nutritional assessment and tailored supplementation to ensure optimal nutritional status.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. 1.

    World Health Organization. (2017). GHO | By category | Overweight (body mass index ≥ 25), age-standardized (%) - Global estimates. .who.int. Retrieved 3 April 2017, from http://apps.who.int/gho/data/view.main.GLOBAL2461A?lang=en.

  2. 2.

    World Health Organization. (2016). Obesity and overweight. World Health Organization. Retrieved 17 January 2017, from http://www.who.int/mediacentre/factsheets/fs311/en/.

  3. 3.

    Lehnert T, Sonntag D, Konnopka A, et al. Economic costs of overweight and obesity. Best Pract Res Clin Endocrinol Metab. 2013;27(2):105–15. https://doi.org/10.1016/j.beem.2013.01.002.

  4. 4.

    Whitlock G, Lewington S, Sherliker P, et al. Body-mass index and cause-specific mortality in 900,000 adults: collaborative analyses of 57 prospective studies. Obstet Gynecol Surv. 2009;64(9):602–4.

  5. 5.

    Renehan A, Tyson M, Egger M, et al. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. 2008;371(9612):569–78. https://doi.org/10.1016/S0140-6736(08)60269-X.

  6. 6.

    Colquitt JL, Picot J, Loveman E, et al. Surgery for obesity. Cochrane Database Syst Rev. 2009;2(2) https://doi.org/10.1002/14651858.CD003641.pub3.

  7. 7.

    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37. https://doi.org/10.1001/jama.292.14.1724.

  8. 8.

    Buchwald H, Oien D. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23(4):427–36. https://doi.org/10.1007/s11695-012-0864-0.

    Article  PubMed  Google Scholar 

  9. 9.

    Ben-Porat T, Elazary R, Yuval J, et al. Nutritional deficiencies after sleeve gastrectomy: can they be predicted preoperatively? Surg Obes Relat Dis. 2015;11(5):1029–36. https://doi.org/10.1016/j.soard.2015.02.018.

  10. 10.

    van Rutte P, Aarts E, Smulders J, et al. Nutrient deficiencies before and after sleeve gastrectomy. Obes Surg. 2014;24(10):1639–46. https://doi.org/10.1007/s11695-014-1225-y.

  11. 11.

    Coupaye M, Rivière P, Breuil M, 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. https://doi.org/10.1007/s11695-013-1089-6.

  12. 12.

    Trastulli S, Desiderio J, Guarino S, et al. Laparoscopic sleeve gastrectomy compared with other bariatric surgical procedures: a systematic review of randomized trials. Surg Obes Relat Dis. 2013;9(5):816–29. https://doi.org/10.1016/j.soard.2013.05.007.

  13. 13.

    Gagner M, Deitel M, Erickson A, et al. Survey on laparoscopic sleeve gastrectomy (LSG) at the Fourth International Consensus Summit on Sleeve Gastrectomy. Obes Surg. 2013;23(12):2013–7. https://doi.org/10.1007/s11695-013-1040-x.

  14. 14.

    Shi X, Karmali S, Sharma A, et al. A review of laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg. 2010;20(8):1171–7. https://doi.org/10.1007/s11695-010-0145-8.

  15. 15.

    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. https://doi.org/10.1007/s11695-011-0360-y.

  16. 16.

    Saif T, Strain G, 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. https://doi.org/10.1016/j.soard.2012.01.013.

  17. 17.

    Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357(3):266–81. https://doi.org/10.1056/NEJMra070553.

    Article  PubMed  CAS  Google Scholar 

  18. 18.

    Aarts E, Janssen I, Berends F. The gastric sleeve: losing weight as fast as micronutrients? Obes Surg. 2011;21(2):207–11. https://doi.org/10.1007/s11695-010-0316-7.

    Article  PubMed  Google Scholar 

  19. 19.

    Faria S, Faria O, Buffington C, et al. Dietary protein intake and bariatric surgery patients: a review. Obes Surg. 2011;21(11):1798–805. https://doi.org/10.1007/s11695-011-0441-y.

  20. 20.

    Poitou Bernert C, Ciangura C, Coupaye M, et al. Nutritional deficiency after gastric bypass: diagnosis, prevention and treatment. Diabetes Metab. 2007;33(1):13–24. https://doi.org/10.1016/j.diabet.2006.11.004.

  21. 21.

    Verger E, Aron-Wisnewsky J, Dao M, et al. Micronutrient and protein deficiencies after gastric bypass and sleeve gastrectomy: a 1-year follow-up. Obes Surg. 2016;26(4):785–96. https://doi.org/10.1007/s11695-015-1803-7.

  22. 22.

    Mahan L, Escott-Stump S. Krause’s food & nutrition therapy. 12th ed. St. Louis: Saunders/Elsevier; 2008. p. 84–85, 1229.

    Google Scholar 

  23. 23.

    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(4):447–53. https://doi.org/10.1007/s11695-009-0068-4.

  24. 24.

    Gastaldi G, Casirola D, Ferrari G, et al. Effect of chronic ethanol administration on thiamine transport in microvillous vesicles of rat small intestine. Alcohol Alcohol. 1989;24(2):83–9. https://doi.org/10.1093/oxfordjournals.alcalc.a044888.

  25. 25.

    Alsabah A, Al Sabah S, Al-Sabah S, et al. Investigating factors involved in post laparoscopic sleeve gastrectomy (LSG) neuropathy. Obes Surg. 2016;26(10):2302–7. https://doi.org/10.1007/s11695-016-2119-y.

  26. 26.

    Damms-Machado A, Friedrich A, Kramer K, et al. Pre- and postoperative nutritional deficiencies in obese patients undergoing laparoscopic sleeve gastrectomy. Obes Surg. 2012;22(6):881–9. https://doi.org/10.1007/s11695-012-0609-0.

  27. 27.

    Coburn SP, Lewis DL, Fink WJ, et al. Human vitamin B-6 pools estimated through muscle biopsies. Am J Clin Nutr. 1988;48(2):291–4.

  28. 28.

    Alexandrou A, Armeni E, Kouskouni E, et al. 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. https://doi.org/10.1016/j.soard.2013.07.014.

  29. 29.

    Gillon S, Jeanes Y, Andersen J, et al. Micronutrient status in morbidly obese patients prior to laparoscopic sleeve gastrectomy and micronutrient changes 5 years post-surgery. Obes Surg. 2016;27(3):606–12.

  30. 30.

    Zarshenas N, Nacher M, Loi K, et al. Investigating nutritional deficiencies in a group of patients 3 years post laparoscopic sleeve gastrectomy. Obes Surg. 2016;26(12):2936–43. https://doi.org/10.1007/s11695-016-2211-3.

  31. 31.

    Brolin R, Gorman J, Gorman R, et al. Prophylactic iron supplementation after Roux-en-Y gastric bypass. Arch Surg. 1998;133(7):740–4. https://doi.org/10.1001/archsurg.133.7.740.

  32. 32.

    Shane B, Stokstad E. Vitamin B12-folate interrelationships. Annu Rev Nutr. 1985;5(1):115–41. https://doi.org/10.1146/annurev.nu.05.070185.000555.

    Article  PubMed  CAS  Google Scholar 

  33. 33.

    Gjessing H, Nielsen H, Mellgren G, et al. Energy intake, nutritional status and weight reduction in patients one year after laparoscopic sleeve gastrectomy. Spring. 2013;2(1):352. https://doi.org/10.1186/2193-1801-2-352.

  34. 34.

    Al-Mulhim A. Laparoscopic sleeve gastrectomy and nutrient deficiencies. Surg Laparosc Endosc Percutan Tech. 2016;26(3):208–11. https://doi.org/10.1097/SLE.0000000000000270.

    Article  PubMed  Google Scholar 

  35. 35.

    Alvarez-Leite J. Nutrient deficiencies secondary to bariatric surgery. Curr Opin Clin Nutr Metab Care. 2004;7(5):569–75. https://doi.org/10.1097/00075197-200409000-00010.

    Article  PubMed  Google Scholar 

  36. 36.

    Elliot K. Nutritional considerations after bariatric surgery. Crit Care Nurs Q. 2003;26(2):133–8. https://doi.org/10.1097/00002727-200304000-00007.

    Article  PubMed  Google Scholar 

  37. 37.

    Long A, Atwell C, Yoo W, et al. Vitamin B12 deficiency associated with concomitant metformin and proton pump inhibitor use. Diabetes Care. 2012;35(12):e84–4. https://doi.org/10.2337/dc12-0980.

  38. 38.

    Lin E, Armstrong-Moore D, Liang Z, et al. Contribution of adipose tissue to plasma 25-hydroxyvitamin D concentrations during weight loss following gastric bypass surgery. Obesity. 2011;19(3):588–94. https://doi.org/10.1038/oby.2010.239.

  39. 39.

    Blum M, Dolnikowski G, Seyoum E, et al. Vitamin D3 in fat tissue. Endocrine. 2008;33(1):90–4. https://doi.org/10.1007/s12020-008-9051-4.

  40. 40.

    Hakeam H, O’Regan P, Salem A, et al. Impact of laparoscopic sleeve gastrectomy on iron indices: 1 year follow-up. Obes Surg. 2009;19(11):1491–6. https://doi.org/10.1007/s11695-009-9919-2.

  41. 41.

    Melissas J, Koukouraki S, Askoxylakis J, et al. Sleeve gastrectomy—a restrictive procedure? Obes Surg. 2007;17(1):57–62. https://doi.org/10.1007/s11695-007-9006-5.

  42. 42.

    Stein J, Stier C, Raab H, et al. Review article: the nutritional and pharmacological consequences of obesity surgery. Aliment Pharmacol Ther. 2014;40(6):582–609. https://doi.org/10.1111/apt.12872.

  43. 43.

    Aasheim E. Wernicke encephalopathy after bariatric surgery: a systematic review. Ann Surg. 2008;248(5):714–20. https://doi.org/10.1097/SLA.0b013e3181884308.

    PubMed  CAS  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Salman Al-Sabah.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Additional information

The original article has been revised to correct the order of the author names.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Al-Mutawa, A., Al-Sabah, S., Anderson, A.K. et al. Evaluation of Nutritional Status Post Laparoscopic Sleeve Gastrectomy—5-Year Outcomes. OBES SURG 28, 1473–1483 (2018). https://doi.org/10.1007/s11695-017-3041-7

Download citation

Keywords

  • Nutritional status
  • Sleeve gastrectomy
  • Bariatric surgery