Haemoglobin and Hematinic Status Before and After Bariatric Surgery over 4 years of Follow-Up

Michael J Shipton,Zohaib Iqbal,Christopher Slater,Siba Senapati,Safwaan Adam,Babur Ahmed,Handrean Soran,Nicholas J Johal,Lucinda K M Summers,John P New,Khurshid Akhtar,Neel Dutta,Akheel A Syed,Basil J Ammori

doi:10.1007/s11695-020-04943-0

Abstract

PurposeBariatric surgery is associated with deficiencies of vitamins and minerals, and patients are routinely advised supplements postoperatively. We studied prevalence of vitamin B12, folate and iron deficiencies and anaemia before and after bariatric surgery over 4 years of follow-up.Materials and MethodsWe performed a retrospective cohort analysis of 353 people with obesity, including 257 (72.8%) women, who underwent gastric bypass (252, 71.4%) or sleeve gastrectomy (101, 28.6%) at our National Health Service bariatric centre in Northwest England.ResultsAt baseline, mean (standard error) age was 46.0 (0.6) years, body mass index 53.1 (0.4) kg/m2, serum vitamin B12 400.2 (16.4) pg/L, folate 7.7 (0.2) μg/L, iron 12.0 (0.3) μmol/L, ferritin 118.3 (8.4) μg/L and haemoglobin 137.9 (0.8) g/L. Frequency of low vitamin B12 levels reduced from 7.5% preoperatively to 2.3% at 48 months (P < 0.038). Mean folate levels increased from baseline to 48 months by 5.3 μg/L (P < 0.001) but frequency of low folate levels increased from 4.7% preoperatively to 10.3% (P < 0.048). Ferritin levels increased from baseline to 48 months by 51.3 μg/L (P < 0.009). Frequency of low ferritin levels was greater in women (39.1%) than in men (8.9%) at baseline (P < 0.001) and throughout the study period. Haemoglobin was low in 4.6% of all patients at baseline with no significant change over the study period.ConclusionThere were notable rates of haematinic insufficiencies in bariatric surgical candidates preoperatively. Our study lends further support to regular supplementation with vitamin B12, folic acid, and iron in people undergoing bariatric surgery.

Highlights

Obesity management includes lifestyle, dietary and behavioural interventions with or without weight loss pharmacotherapy
Whilst bariatric surgical procedures are generally safe with low mortality rates and excellent efficacy in weight reduction as well as resolution or improvement of comorbidities such as type 2 diabetes [1, 2, 4,5,6,7,8], both gastric bypass (GB) and sleeve gastrectomy (SG) are frequently associated with micronutrient deficiencies as a consequence of reduced nutrient intake and absorption [9]
The mean age was 46.0 (0.56) years and body mass index (BMI) was 53.1 (0.38) kg/m2 at baseline; 129 (36.5%) patients had type 2 diabetes; 252 patients (71.4%) had undergone GB and 101 (28.6%) SG; women had significantly lower ferritin, iron and haemoglobin levels compared to men at baseline (Table 1)

Summary

Introduction

Dietary and behavioural interventions with or without weight loss pharmacotherapy. Bariatric surgery is the most effective option for achieving substantial, sustained weight loss and improving survival [1, 2]. Gastric bypass (GB) and sleeve gastrectomy (SG) are the two most common types of bariatric surgery [3]. Whilst bariatric surgical procedures are generally safe with low mortality rates and excellent efficacy in weight reduction as well as resolution or improvement of comorbidities such as type 2 diabetes [1, 2, 4,5,6,7,8], both GB and SG are frequently associated with micronutrient deficiencies as a consequence of reduced nutrient intake and absorption [9]. Deficiencies commonly include vitamin B12 (cobalamin), folate and iron [10]

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Results

Conclusion