SEARCHCOHORTsurgery, clinical nutrition

cohort·surgery, clinical nutrition, micronutrients, endocrinology, observational study·PMC10630125

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

European Journal of Clinical Nutrition · 8 authors, 8 centres

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TL;DR

The study identifies specific nutrients at higher risk and highlights the important confounding role of inflammation in interpreting micronutrient status.

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877 CHARS

Researchers assessed biochemical micronutrient status, supplementation dose, inflammation, and glycaemic control pre-operatively and at 1–3, 6, and 12 months postoperatively. Results showed high preoperative deficiency rates for vitamin D, iron, and selenium. Postoperative supplementation increased but often did not meet target doses. Key findings include a higher risk of folate deficiency at 6 months after sleeve gastrectomy (OR 13) and increased deficiency rates for vitamins B1, A, and selenium within 1–3 months after gastric bypass. Inflammation was a significant independent factor associated with several micronutrient levels. The authors conclude that de novo deficiency is uncommon for most nutrients in the setting of a supportive multidisciplinary program, suggesting that rationalized, individualized monitoring and supplementation protocols may be appropriate.

STUDY TYPE

cohort

SPECIALTY

surgery

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AI pipeline

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100% · A

ORIGINAL PAPER

PMC10630125

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

European Journal of Clinical Nutrition

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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.

CITATION EXPORT

Carrie-Anne Lewis, Emma J. Osland, Susan de Jersey et al.. Monitoring for micronutrient deficiency after bariatric surgery—what is the risk?. European Journal of Clinical Nutrition. (2023). https://doi.org/10.1038/s41430-023-01318-3

AUTHORS

8 · 8 CENTRES

Carrie-Anne Lewis, Emma J. Osland, Susan de Jersey, George Hopkins, Matthew Seymour, Lindsey Webb, Mark D. Chatfield, Ingrid J. Hickman

1https://ror.org/05p52kj31grid.416100.20000 0001 0688 4634Department of Nutrition and Dietetics, Royal Brisbane and Women’s Hospital, Herston, QLD Australia
2https://ror.org/00rqy9422grid.1003.20000 0000 9320 7537The University of Queensland, Greater Brisbane Clinical School, Faculty of Medicine, Brisbane, QLD Australia
3https://ror.org/00rqy9422grid.1003.20000 0000 9320 7537The University of Queensland, School of Human Movements and Nutrition Science, Brisbane, QLD Australia
4https://ror.org/00rqy9422grid.1003.20000 0000 9320 7537The University of Queensland, Centre for Health Services Research, Faculty of Medicine, Brisbane, QLD Australia
5https://ror.org/05p52kj31grid.416100.20000 0001 0688 4634Department of Surgery, Royal Brisbane and Women’s Hospital, Brisbane, QLD Australia
6https://ror.org/05p52kj31grid.416100.20000 0001 0688 4634Department of Endocrinology, Royal Brisbane and Women’s Hospital, Brisbane, QLD Australia
7https://ror.org/04mqb0968grid.412744.00000 0004 0380 2017Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD Australia
8https://ror.org/00rqy9422grid.1003.20000 0000 9320 7537The University of Queensland, Centre for Clinical Research, Faculty of Medicine, Brisbane, Australia