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Nutritional Deficiencies in Chinese Patients Undergoing Gastric Bypass and Sleeve Gastrectomy: Prevalence and Predictors

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Abstract

Background

Nutritional deficiencies have been reported in bariatric surgery patients with inconsistent results. However, scarce data exist for Chinese patients. We aimed to assess nutritional deficiencies in Chinese patients undergoing Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), and to identify predictors of postoperative nutritional status.

Methods

A retrospective review of a prospectively collected database was conducted in the patients undergoing RYGB and SG in our hospital between June 2013 and January 2017. Anthropometric data and nutritional data were collected before surgery, at 6 and 12 months postoperatively.

Results

This study enrolled 269 patients (120 RYGB, 149 SG). Nutritional deficiencies were common in Chinese bariatric candidates, with vitamin D deficiency the most serious (78.8%), followed by vitamin B1 (39.2%), vitamin B6 (28.0%), folate (26.8%), vitamin C (18.0%) albumin (13.4%), transferrin (11.6%), and phosphorus (11.5%). Despite postoperative routine multivitamin and calcium supplements, nutritional deficiencies were still obvious for RYGB and SG patients. The prevalence of hemoglobin and vitamin B12 deficiencies increased remarkably in the RYGB group; the levels of hemoglobin, globin, vitamin B12, and ferritin decreased significantly (P < 0.05). Preoperative hemoglobin, vitamin B12, and ferritin levels were independently associated with postoperative decrease, respectively. Deficiencies of vitamin D, vitamin B1, vitamin B6, vitamin C, and albumin before surgery were predictors for deficiencies 1 year after surgery, respectively.

Conclusion

Nutritional deficiencies are common in Chinese bariatric surgery candidates. Similar deficiencies were also seen after RYGB and SG. Routine evaluation and related corrections of preoperative nutritional abnormity could contribute to postoperative nutrient balance.

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References

  1. Di Cesare M, Bentham J, Stevens GA, et al. Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet. 2016;387(10026):1377–96.

    Google Scholar 

  2. Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet. 2015;386(9997):964–73.

    Google Scholar 

  3. Peterson LA, Cheskin LJ, Furtado M, et al. Malnutrition in bariatric surgery candidates: multiple micronutrient deficiencies prior to surgery. Obes Surg. 2016;26(4):833–8.

    Google Scholar 

  4. 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.

    Google Scholar 

  5. Verger EO, Aron-Wisnewsky J, Dao MC, et al. Micronutrient and protein deficiencies after gastric bypass and sleeve gastrectomy: a 1-year follow-up. Obes Surg. 2016;26(4):785–96.

    Google Scholar 

  6. Moize 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.

    Google Scholar 

  7. 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.

    Google Scholar 

  8. Kasama K, Mui W, Lee WJ, et al. IFSO-APC consensus statements 2011. Obes Surg. 2012;22(5):677–84.

    Google Scholar 

  9. Wang C, Guan B, Yang W, et al. Prevalence of electrolyte and nutritional deficiencies in Chinese bariatric surgery candidates. Surg Obes Relat Dis. 2016;12(3):629–34.

    Google Scholar 

  10. Goldner WS, Stoner JA, Thompson J, et al. Prevalence of vitamin D insufficiency and deficiency in morbidly obese patients: a comparison with non-obese controls. Obes Surg. 2008;18(2):145–50.

    Google Scholar 

  11. van Rutte PW, Aarts EO, Smulders JF, et al. Nutrient deficiencies before and after sleeve gastrectomy. Obes Surg. 2014;24(10):1639–46.

    Google Scholar 

  12. Censani M, Stein EM, Shane E, et al. Vitamin D deficiency is prevalent in morbidly obese adolescents prior to bariatric surgery. ISRN Obes. 2013;2013:7 https://doi.org/10.1155/2013/284516.

  13. Grace C, Vincent R, Aylwin SJ. High prevalence of vitamin D insufficiency in a United Kingdom urban morbidly obese population: implications for testing and treatment. Surg Obes Relat Dis. 2014;10(2):355–60.

    Google Scholar 

  14. Alemzadeh R, Kichler J. Parathyroid hormone is associated with biomarkers of insulin resistance and inflammation, independent of vitamin D status, in obese adolescents. Metab Syndr Relat Disord. 2012;10(6):422–9.

    CAS  Google Scholar 

  15. Madan AK, Orth WS, Tichansky DS, et al. Vitamin and trace mineral levels after laparoscopic gastric bypass. Obes Surg. 2006;16(5):603–6.

    Google Scholar 

  16. Moize 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.

    Google Scholar 

  17. Harnroongroj T, Jintaridhi P, Vudhivai N, et al. B vitamins, vitamin C and hematological measurements in overweight and obese Thais in Bangkok. J Med Assoc Thail. 2002;85(1):17–25.

    Google Scholar 

  18. 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(6):517–22. discussion 22

    Google Scholar 

  19. 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(7):870–6.

    Google Scholar 

  20. Aasheim ET, Bjorkman S, Sovik TT, et al. Vitamin status after bariatric surgery: a randomized study of gastric bypass and duodenal switch. Am J Clin Nutr. 2009;90(1):15–22.

    Google Scholar 

  21. 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(1):66–73.

    Google Scholar 

  22. de Luis DA, Pacheco D, Izaola O, et al. Micronutrient status in morbidly obese women before bariatric surgery. Surg Obes Relat Dis. 2013;9(2):323–7.

    Google Scholar 

  23. Toh SY, Zarshenas N, Jorgensen J. Prevalence of nutrient deficiencies in bariatric patients. Nutrition. 2009;25(11–12):1150–6.

    CAS  Google Scholar 

  24. Liamis G, Liberopoulos E, Barkas F, et al. Diabetes mellitus and electrolyte disorders. World J Clin Cases. 2014;2(10):488–96.

    Google Scholar 

  25. Dewey M, Heuberger R. Vitamin D and calcium status and appropriate recommendations in bariatric surgery patients. Gastroenterol Nurs. 2011;34(5):367–74.

    Google Scholar 

  26. Csendes A, Braghetto I. Changes in the anatomy and physiology of the distal esophagus and stomach after sleeve gastrectomy. J Obes Weight Loss Ther. 2016;6:297.

    Google Scholar 

  27. Fallatah B, Azizshehry A, Abdelsamad L, et al. Comparison study of gastric emptying after performing sleeve gastrectomy with two different techniques. Glob J Surg. 2013;1(4):53–6.

    Google Scholar 

  28. Via MA, Mechanick JI. Nutritional and micronutrient care of bariatric surgery patients: current evidence update. Curr Obes Rep. 2017;6(3):286–96.

    Google Scholar 

  29. Ben-Porat T, Elazary R, Yuval JB, et al. Nutritional deficiencies after sleeve gastrectomy: can they be predicted preoperatively? Surg Obes Relat Dis. 2015;11(5):1029–36.

    Google Scholar 

  30. Coupaye M, Riviere 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.

    Google Scholar 

  31. Remedios C, Bhasker AG, Dhulla N, et al. Bariatric nutrition guidelines for the Indian population. Obes Surg. 2016;26(5):1057–68.

    Google Scholar 

  32. Clements RH, Katasani VG, Palepu R, et al. Incidence of vitamin deficiency after laparoscopic Roux-en-Y gastric bypass in a university hospital setting. Am Surg. 2006;72(12):1196.

    Google Scholar 

  33. 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.

    Google Scholar 

  34. Kehagias I, Karamanakos SN, Argentou M, et al. Randomized clinical trial of laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the management of patients with BMI < 50 kg/m2. Obes Surg. 2011;21(11):1650–6.

    Google Scholar 

  35. Aron-Wisnewsky J, Verger EO, Bounaix C, et al. Nutritional and protein deficiencies in the short term following both gastric bypass and gastric banding. PLoS One. 2016;11(2):e0149588.

    Google Scholar 

  36. van der Beek ES, Monpellier VM, Eland I, et al. Nutritional deficiencies in gastric bypass patients: incidence, time of occurrence and implications for post-operative surveillance. Obes Surg. 2015;25(5):818–23.

    Google Scholar 

  37. Warde-Kamar J, Rogers M, Flancbaum L, et al. Calorie intake and meal patterns up to 4 years after Roux-en-Y gastric bypass surgery. Obes Surg. 2004;14(8):1070–9.

    Google Scholar 

  38. Gasteyger C, Suter M, Gaillard RC, et al. Nutritional deficiencies after Roux-en-Y gastric bypass for morbid obesity often cannot be prevented by standard multivitamin supplementation. Am J Clin Nutr. 2008;87(5):1128–33.

    CAS  Google Scholar 

  39. Organization WH. Serum and red blood cell folate concentrations for assessing folate status in populations. 2015.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China

    Bingsheng Guan, Jingge Yang, Wah Yang & Cunchuan Wang

  2. Department of Nursing Science, School of Nursing, Jinan University, Guangzhou, 510632, China

    Yanya Chen

Authors
  1. Bingsheng Guan
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  2. Jingge Yang
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  3. Yanya Chen
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  4. Wah Yang
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  5. Cunchuan Wang
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Correspondence to Jingge Yang or Cunchuan Wang.

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The authors declare that they have no conflict of interest.

Statement of Informed Consent

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

Statement of Ethical Approval

As a retrospective study, ethnic approval was not necessary due to the local ethics committee.

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Guan, B., Yang, J., Chen, Y. et al. Nutritional Deficiencies in Chinese Patients Undergoing Gastric Bypass and Sleeve Gastrectomy: Prevalence and Predictors. OBES SURG 28, 2727–2736 (2018). https://doi.org/10.1007/s11695-018-3225-9

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