Bariatric Surgery in Adolescents: Is Routine Nutrient Supplementation Sufficient to Avoid Anemia Following Bariatric Surgery?

Abstract

Background Anemia following bariatric surgery is a known complication. To prevent nutrient deficiencies, adolescent patients require multivitamin supplementation following bariatric surgery. The purpose of this study was to investigate if routine multivitamin supplementation is sufficient to prevent anemia in adolescents undergoing bariatric surgery, particularly sleeve gastrectomy (SG), a procedure that may induce nutrient malabsorption. Methods We conducted a retrospective review of medical records of pediatric patients who underwent SG (34 patients) and laparoscopic adjustable gastric banding (LAGB) (141 patients) (1/2006–12/2013). We examined anemia marker levels (iron, ferritin, folate, B12, hemoglobin and hematocrit) at first visit, 3, 6, and 12 months post-surgery by repeated measures analysis adjusting for weight loss. Results Following SG, folate levels decreased 3 and 6 months post-surgery, however returned to baseline levels at 12 months. Furthermore, SG patients demonstrated lower folate levels compared to LAGB at 3 and 6 months. B12 levels decreased 6 months post-SG, however returned to baseline at 12 months. Following LAGB, B12 levels decreased 12 months post-surgery compared baseline. Ferritin levels decreased 3 months post-LAGB, however returned to baseline levels at 6 months. There were no changes within groups or differences between groups in iron, hemoglobin or hematocrit. Conclusions While anemia did not occur in any patients while on recommended routine supplementation, folate levels were significantly reduced following SG and were lower in SG compared to LAGB patients. Additional folate supplementation seemed to improve folate levels, which highlights the importance of ongoing surveillance by primary care providers and the need for additional folate supplementation following SG.

British Obesity and Metabolic Surgery Society Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery—2020 update

“…There is a high incidence of iron deficiency anaemia following bariatric surgery because of low dietary iron intake, reduced intestinal absorption and, for some women, menstruation 15,18,19,35–37,41,57–60,72–74,85–94 …”

“…Vitamin B12 absorption is adversely affected by SG, RYGB and BPD/DS as it requires an acidic environment and presence of intrinsic factor produced by the gastric parietal cells 95 . Many people have about 2‐year stores of vitamin B12; therefore, deficiency may present several years after surgery 15,18,19,40,41,47,57–59,65,73,86–89,92,93,96 . Vitamin B12 deficiency impacts adversely on the haematopoietic and nervous systems and may result in megaloblastic anaemia and irreversible neuropathies 95 .…”

“…However, not all have been specifically related to micronutrition, had dietetic involvement and included either primary care or patient representatives. In addition, previous guidance aimed at the management of adolescents undergoing bariatric surgery has only included general nutritional recommendations, 12–14 despite this vulnerable group being at high risk of developing nutritional deficiencies 15–19 . Until recent guidelines by Shawe et al, 11 there has been little detail included in previous guidelines on recommendations for the nutritional management of pregnancy post‐surgery.…”

Current Issues in Bariatric Surgery for Adolescents with Severe Obesity: Durability, Complications, and Timing of Intervention

“…13,16 To date, although the validity of bariatric surgical proce- Currently, surgeons tend to prefer SG, which is gaining popularity over the last 5 years due to fewer complications and similar outcomes to RYGB. 14,29,30 In a recent study, no intraoperative complications were reported, however, one case of postoperative pancreatitis occurred among adolescents with median BMI > 50 kg/m 2 who underwent SG. 31 Additional data from 108 adolescents between the ages of 5 and 21 years who received bariatric surgery showed a 4.3% rate of minor (without major) complications.…”

How I approach iron deficiency with and without anemia

“…These patients are also at increased risk of vitamin B12 deficiency, so IDA may occur without evident microcytosis. Bariatric surgery, increasingly performed in the older adolescent population, is another cause of ID due to impaired absorption, as is celiac disease . Although celiac disease can occur at any age, adolescents are more likely to present with extraintestinal symptoms, with IDA being the most common .…”