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Behavior of Iron and Ferritin After Bariatric Surgery in Patients With and Without Hepatic Steatosis

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Abstract

Background

Iron deficiency and hepatic steatosis are common in bariatric surgery patients. Steatosis can falsely elevate ferritin values even in presence of iron deficiency. This study aims to assess the influence of hepatic steatosis on iron deficiency and replacement therapy after bariatric surgery.

Methods

Seventy-nine individuals undergoing gastric bypass have been studied at 4 time points (preoperative and 1, 3, and 6 months after surgery). Weight, body mass index (BMI), iron, ferritin, vitamin B12, folate, hemoglobin, gamma-glutamyl transferase (GGT), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and use of iron replacement were recorded.

Results

Forty-two individuals (53%) had moderate/severe steatosis assessed by ultrasound. No differences were seen in iron profile and replacement therapy features compared to individuals with no/mild steatosis both in the preoperative and postoperative periods. Mixed model analysis showed ferritin levels to be higher in the moderate/severe steatosis group than in no/mild steatosis at the 6th month (139 ± 131 vs. 60.9 ± 49.8, p < 0.05). Values in both groups were lower than baseline, with p < 0.0001. The same was observed with serum iron (92.1 ± 39.6 moderate/severe steatosis vs. 68.6 ± 33.4 no/mild steatosis, p < 0.001; p from baseline < 0.01 for both). GGT was higher in moderate/severe steatosis in the 3rd month (38.8 ± 40.5 vs. 28.8 ± 20.8, p < 0.05; p from baseline < 0.0001 for both).

Conclusions

Ferritin levels were consistently higher in individuals with steatosis in the follow-up of bariatric surgery, but no apparent implication on the diagnosis of iron deficiency and in the prescription of replacement therapy was demonstrated at 6 months of follow-up. Longer studies are probably necessary to investigate this matter.

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Authors and Affiliations

  1. Departamento de Ciências da Vida, Universidade do Estado da Bahia - UNEB, Rua Silveira Martins, 2555, Cabula, Salvador, BA, CEP: 41.150-000, Brazil

    Gerson da Costa Leite Junior & Fernando M. A. Giuffrida

  2. Faculdade de Tecnologia e Ciências – UNIFTC, Salvador, BA, Brazil

    Mille Dantas Lacerda & Thalita Arraes Lopes Barreira Alencar

  3. IMC Obesity Center, Hospital Aliança, Salvador, BA, Brazil

    Marcio Café

Authors
  1. Gerson da Costa Leite Junior
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  2. Mille Dantas Lacerda
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  3. Thalita Arraes Lopes Barreira Alencar
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  4. Marcio Café
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  5. Fernando M. A. Giuffrida
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Corresponding author

Correspondence to Fernando M. A. Giuffrida.

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Since this is a retrospective study of medical records, no formal consent was required.

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The authors declare no competing interests.

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Key Points

• Iron deficiency is a common complication after Roux-en-Y gastric bypass (RYGB), but hepatic steatosis can falsely elevate ferritin levels.

• Ferritin levels were lower after RYGB, but significantly higher in individuals with established steatosis.

• Mild anemia was seen in all individuals postoperatively, but no interaction with steatosis was demonstrated.

• No apparent implication of this finding was seen in the prescription of iron replacement therapy.

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da Costa Leite Junior, G., Lacerda, M.D., Alencar, T.A.L.B. et al. Behavior of Iron and Ferritin After Bariatric Surgery in Patients With and Without Hepatic Steatosis. OBES SURG 31, 4761–4766 (2021). https://doi.org/10.1007/s11695-021-05629-x

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  • DOI: https://doi.org/10.1007/s11695-021-05629-x

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