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Is the Current Micronutrient Supplementation Adequate in Preventing Deficiencies in Indian Patients? Short- and Mid-Term Comparison of Sleeve Gastrectomy and Roux-en-Y Gastric Bypass

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Abstract

Purpose

Bariatric procedures reduce the capacity of the gut and alter the gastrointestinal transit time predisposing to micro-nutritional deficiencies. This study analyzed and compared the micro-nutritional parameters following laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (RYGB) in the Indian population.

Materials and Methods

This is a retrospective study of patients who underwent LSG or RYGB for morbid obesity at a tertiary care center between January 2015 and December 2016. The micronutrient parameters, namely, serum ferritin, vitamin B12, ionized calcium, vitamin D3, and parathormone (PTH) in the preoperative settings and subsequently at 1, 2, and 3 years were analyzed.

Results

A total of 390 patients were studied, of which 258 (66.15%) underwent LSG while 132 (33.85%) underwent RYGB. Baseline micronutrient parameters were comparable in the two groups. Anemia (58.1% vs. 59.1%), deficiencies of ferritin (31.7% vs. 34.3%), vitamin B12 (18.8% vs. 36.4%), ionized calcium (65.1% vs. 72.7%), vitamin D3 (95.3% vs. 90.9%), and secondary hyperparathyroidism (45.5% vs. 58.1%) were seen following LSG and RYGB at the end of 3 years, respectively. There was no significant difference found between LSG and RYGB in terms of micronutrient deficiencies studied, including rising in PTH at 1, 2, and 3 years. Vitamin D3 levels were significantly lower at 2 and 3 years following RYGB (p = 0.035 and p = 0.032, respectively).

Conclusion

LSG and RYGB have comparable micronutrient deficiencies in the short- and mid-term except for vitamin D3, which is higher following RYGB. Long-term studies are needed to define optimum micronutrient supplement dosages for the Indian population.

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References

  1. Haslam DW, James WPT. Obesity. Lancet (London, England). 2005 Oct;366(9492):1197–209.

  2. Yajnik CS, Yudkin JS. The Y-Y paradox. Lancet (London, England). 2004 Jan;363(9403):163.

  3. Ovrebo B, Strommen M, Kulseng B, et al. Bariatric surgery versus lifestyle interventions for severe obesity: 5-year changes in body weight, risk factors and comorbidities. Clin Obes. 2017;7(3):183–90.

    Article  CAS  PubMed  Google Scholar 

  4. Lupoli R, Lembo E, Saldalamacchia G, et al. Bariatric surgery and long-term nutritional issues. World J Diabetes. 2017;8(11):464–74.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Shah S, Shah P, Todkar J, et al. Prospective controlled study of effect of laparoscopic sleeve gastrectomy on small bowel transit time and gastric emptying half-time in morbidly obese patients with type 2 diabetes mellitus. Surg Obes Relat Dis. 2010;6(2):152–7.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  7. Mechanick JI, Youdim A, Jones DB, et al. 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 f. Obesity (Silver Spring). 2013;21(Suppl 1):S1–27.

    Article  CAS  Google Scholar 

  8. Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA. 2014;311(1):74–86.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Maciejewski ML, Arterburn DE, Van Scoyoc L, et al. Bariatric surgery and long-term durability of weight loss. JAMA Surg. 2016 Nov;151(11):1046–55.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Sioka E, Tzovaras G, Perivoliotis K, et al. Impact of laparoscopic sleeve gastrectomy on gastrointestinal motility. Gastroenterol Res Pract. 2018;2018:4135813.

    Article  PubMed  PubMed Central  Google Scholar 

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

    Article  PubMed  Google Scholar 

  12. Miras AD, le Roux CW. Mechanisms underlying weight loss after bariatric surgery. Nat Rev Gastroenterol Hepatol. 2013;10(10):575–84.

    Article  PubMed  Google Scholar 

  13. Krzizek E-C, Brix JM, Herz CT, et al. Prevalence of micronutrient deficiency in patients with morbid obesity before bariatric surgery. Obes Surg. 2018;28(3):643–8.

    Article  Google Scholar 

  14. Skroubis G, Sakellaropoulos G, Pouggouras K, et al. Comparison of nutritional deficiencies after Roux-en-Y gastric bypass and after biliopancreatic diversion with Roux-en-Y gastric bypass. Obes Surg. 2002;12(4):551–8.

    Article  PubMed  Google Scholar 

  15. Ruz M, Carrasco F, Rojas P, et al. Iron absorption and iron status are reduced after Roux-en-Y gastric bypass. Am J Clin Nutr. 2009;90(3):527–32.

    Article  CAS  PubMed  Google Scholar 

  16. Zarshenas N, Nacher M, Loi KW, et al. Investigating nutritional deficiencies in a group of patients 3 years post laparoscopic sleeve gastrectomy. Obes Surg. 2016;26(12):2936–43.

    Article  PubMed  Google Scholar 

  17. Ferraz AAB, Carvalho MRC, Siqueira LT, et al. Micronutrient deficiencies following bariatric surgery: a comparative analysis between sleeve gastrectomy and Roux-en-Y gastric bypass. Rev Col Bras Cir. 2018;45(6):e2016.

    Article  PubMed  Google Scholar 

  18. Benotti PN, Wood GC, Still CD, et al. Metabolic surgery and iron homeostasis. Obes Rev. 2019 Apr;20(4):612–20.

    Article  PubMed  Google Scholar 

  19. 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.

    Article  PubMed  Google Scholar 

  20. Vargas-Ruiz AG, Hernandez-Rivera G, Herrera MF. Prevalence of iron, folate, and vitamin B12 deficiency anemia after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2008;18(3):288–93.

    Article  PubMed  Google Scholar 

  21. Kwon Y, Kim HJ, Lo Menzo E, et al. Anemia, iron and vitamin B12 deficiencies after sleeve gastrectomy compared to Roux-en-Y gastric bypass: a meta-analysis. Surg Obes Relat Dis. 2014;10(4):589–97.

    Article  PubMed  Google Scholar 

  22. 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.

    Article  PubMed  Google Scholar 

  23. Kheniser KG, Kashyap SR, Schauer PR, et al. Prevalence of anemia in subjects randomized into Roux-en-Y gastric bypass or sleeve gastrectomy. Obes Surg. 2017;27(5):1381–6.

    Article  PubMed  Google Scholar 

  24. Corbeels K, Verlinden L, Lannoo M, et al. Thin bones: vitamin D and calcium handling after bariatric surgery. Bone reports. 2018;8:57–63.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Vimaleswaran KS, Berry DJ, Lu C, et al. Causal relationship between obesity and vitamin D status: bi-directional Mendelian randomization analysis of multiple cohorts. PLoS Med. 2013;10(2):e1001383.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Wortsman J, Matsuoka LY, Chen TC, et al. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr. 2000;72(3):690–3.

    Article  CAS  PubMed  Google Scholar 

  27. Wamberg L, Christiansen T, Paulsen SK, et al. Expression of vitamin D-metabolizing enzymes in human adipose tissue -- the effect of obesity and diet-induced weight loss. Int J Obes. 2013;37(5):651–7.

    Article  CAS  Google Scholar 

  28. Shikora SA, Kim JJ, Tarnoff ME. Nutrition and gastrointestinal complications of bariatric surgery. Nutr Clin Pract. 2007;22(1):29–40.

    Article  PubMed  Google Scholar 

  29. Fleet JC, Schoch RD. Molecular mechanisms for regulation of intestinal calcium absorption by vitamin D and other factors. Crit Rev Clin Lab Sci. 2010 Aug;47(4):181–95.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Shankar P, Boylan M, Sriram K. Micronutrient deficiencies after bariatric surgery. Nutrition. 2010;26(11–12):1031–7.

    Article  CAS  PubMed  Google Scholar 

  31. Tian Z, Fan X-T, Li S-Z, Zhai T, Dong J. Changes in bone metabolism after sleeve gastrectomy versus gastric bypass: a meta-analysis. Obes Surg 2019.

  32. Carrasco F, Basfi-Fer K, Rojas P, et al. Calcium absorption may be affected after either sleeve gastrectomy or Roux-en-Y gastric bypass in premenopausal women: a 2-y prospective study. Am J Clin Nutr. 2018;108(1):24–32.

    Article  PubMed  Google Scholar 

  33. Muhairi SJ, Mehairi AE, Khouri AA, et al. Vitamin D deficiency among healthy adolescents in Al Ain. United Arab Emirates BMC Public Health. 2013;13:33.

    Article  CAS  PubMed  Google Scholar 

  34. Nakamura KM, Haglind EGC, Clowes JA, et al. Fracture risk following bariatric surgery: a population-based study. Osteoporos Int. 2014;25(1):151–8.

    Article  CAS  PubMed  Google Scholar 

  35. Stein EM, Silverberg SJ. Bone loss after bariatric surgery: causes, consequences, and management. Lancet Diabetes Endocrinol. 2014;2(2):165–74.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Alexandrou A, Tsoka E, Armeni E, et al. Determinants of secondary hyperparathyroidism in bariatric patients after Roux-en-Y gastric bypass or sleeve gastrectomy: a pilot study. Int J Endocrinol. 2015;2015:984935.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of bariatric and metabolic surgery, GEM hospital & research center, Coimbatore, Tamil Nadu, 641045, India

    Shivanshu Misra, Shankar Balasubramanian, Usha Isaac, Menaka Srinivasan, Christinajoice Saminathan, S Saravana Kumar & P Praveen Raj

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  1. Shivanshu Misra
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  2. Shankar Balasubramanian
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Correspondence to P Praveen Raj.

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Conflict of Interest

“Shivanshu Misra, Shankar Balasubramanian, Usha Isaac, Menaka Srinivasan, Christinajoice Saminathan, S Saravana Kumar, and P Praveen Raj” have no conflicts of interest to disclose.

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The study was pursued after obtaining institutional ethics committee clearance.

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Misra, S., Balasubramanian, S., Isaac, U. et al. Is the Current Micronutrient Supplementation Adequate in Preventing Deficiencies in Indian Patients? Short- and Mid-Term Comparison of Sleeve Gastrectomy and Roux-en-Y Gastric Bypass. OBES SURG 30, 3480–3488 (2020). https://doi.org/10.1007/s11695-020-04674-2

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