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Observational Study
. 2023 Nov;77(11):1071-1083.
doi: 10.1038/s41430-023-01318-3. Epub 2023 Aug 7.

Monitoring for micronutrient deficiency after bariatric surgery-what is the risk?

Carrie-Anne Lewis  1   2 , Emma J Osland  3   4 , Susan de Jersey  3   5 , George Hopkins  6 , Matthew Seymour  7 , Lindsey Webb  8 , Mark D Chatfield  5   9 , Ingrid J Hickman  10   8
Affiliations
Observational Study

Monitoring for micronutrient deficiency after bariatric surgery-what is the risk?

Carrie-Anne Lewis et al. Eur J Clin Nutr. 2023 Nov.

Abstract

Background: Bariatric surgery may increase the risk of micronutrient deficiencies; however, confounders including preoperative deficiency, supplementation and inflammation are rarely considered.

Objective: To examine the impact of bariatric surgeries, supplementation and inflammation on micronutrient deficiency.

Setting: Two public hospitals, Australia.

Methods: Participants were recruited to an observational study monitoring biochemical micronutrient outcomes, supplementation dose, inflammation and glycaemic control, pre-operatively and at 1-3, 6 and 12 months after gastric bypass (GB; Roux-en-Y Gastric Bypass and Single Anastomosis Gastric Bypass; N = 66) or sleeve gastrectomy (SG; N = 144). Participant retention at 12 months was 81%.

Results: Pre-operative micronutrient deficiency was common, for vitamin D (29-30%), iron (13-22%) and selenium (39% GB cohort). Supplement intake increased after surgery; however, dose was <50% of target for most nutrients. After SG, folate was vulnerable to deficiency at 6 months (OR 13 [95% CI 2, 84]; p = 0.007), with folic acid supplementation being independently associated with reduced risk. Within 1-3 months of GB, three nutrients had higher deficiency rates compared to pre-operative levels; vitamin B1 (21% vs. 6%, p < 0.01), vitamin A (21% vs. 3%, p < 0.01) and selenium (59% vs. 39%, p < 0.05). Vitamin B1 deficiency was independently associated with surgery and inflammation, selenium deficiency with improved glycaemic control after surgery and inflammation, whilst vitamin A deficiency was associated with inflammation only.

Conclusion: In the setting of prophylactic post-surgical micronutrient prescription, few nutrients are at risk of de novo deficiency. Although micronutrient supplementation and monitoring remains important, rationalising high-frequency biochemical testing protocols in the first year after surgery may be warranted.

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Conflict of interest statement

GH reports personal fees from Johnson & Johnson and Medtronic, outside of this submitted work. All other authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1. Participant recruitment and retention: Sleeve Gastrectomy and Gastric Bypass.
SG sleeve gastrectomy; GB gastric bypass; n = number of participants enrolled or excluded at each stage of recruitment and follow-up data collection.
Fig. 2
Fig. 2. The proportion of participants having ‘adequate’ nutrient supplement intake.
*p < 0.05 change from preoperative intake, using the McNemar’s test.
See this image and copyright information in PMC

References

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