Evolution of 29 Anthropometric, Nutritional, and Cardiometabolic Parameters Among Morbidly Obese Adolescents 2 Years Post Sleeve Gastrectomy

Abstract

BackgroundLaparoscopic sleeve gastrectomy (LSG) is a popular treatment for adolescent morbid obesity. Research on LSG outcomes among adolescents assessed a narrow range of anthropometric, nutritional, or cardiometabolic parameters, leading to an incomplete picture of these changes. We examined a wide variety of anthropometric, nutritional, and cardiometabolic parameters among adolescents before and after LSG.MethodsWe retrospectively reviewed medical charts of all obese adolescents who underwent LSG at Hamad Medical Corporation, Qatar, between January 2011 and June 2015 (N = 102). We assessed preoperative levels and postoperative changes in 4 anthropometric, 15 nutritional, and 10 cardiometabolic parameters.ResultsThe study sample comprised 79 patients with complete information (36 males, mean age 15.99 ± 1.1 years). At a mean of 24.2 months post-LSG, we observed (1) significantly reduced mean weight and body mass index by 51.82 ± 28.1 kg and 17 ± 6.24 kg/m2, respectively; (2) the highest prevalence of post-LSG deficiencies pertained to vitamin D, albumin, and ferritin (89.3, 38, and 33.3%, respectively); (3) low hemoglobin levels (29.3%) only in females; (4) trace elements were not deficient; (4) significant reductions in percentage of adolescents with elevated low-density lipoprotein (from 66.1 to 38.9%), alanine aminotransferase (from 45.3 to 10.9%), and aspartate aminotransferase (from 24.1 to 8.6%) levels; (5) 100% remission of prediabetes cases; and (6) 80% remission of type 2 diabetes cases.ConclusionsLSG achieved significant weight loss and improvement of cardiometabolic risk factors among adolescents. However, the slight worsening of preexisting nutritional deficiencies warrants careful preoperative surveillance and appropriate postoperative nutritional supplementation.

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

“…Vitamin D deficiency is common in people with severe and complex obesity 19,29,30,32,34,38,40,42–48,50,58,61–65 with reports as high as 99% of participants in one study conducted by Ben‐Porat et al 40 A raised albumin‐adjusted serum calcium in the presence of raised parathyroid hormone (PTH) may indicate primary hyperparathyroidism, and so both PTH and calcium should be measured preoperatively 66 . If primary hyperparathyroidism is suspected, advice should be sought from a specialist in this area 66…”

“…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 .…”

“…Because folic acid is absorbed in the small bowel, 95 absorption may be affected by RYGB or BPD/DS, but deficiency is also observed following SG so is more likely to be due to low dietary intake or non‐adherence with vitamin and mineral supplementation 15,18,19,32,34,40,41,47,87,100,101 …”

“…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.…”