Fewer Nutrient Deficiencies After Laparoscopic Sleeve Gastrectomy (LSG) than After Laparoscopic Roux-Y-Gastric Bypass (LRYGB)—a Prospective Study

Abstract

Background Deficiencies in micronutrients after bariatric operations are frequent, despite routine supplementation. Main outcome measures were pre-and postoperative frequency of nutrient deficiencies and success rate of their treatment. Between 5/2004 and 12/2006, 136 patients (m:f=0:4) with an average body mass index of 45 (35-58) kg/m 2 and age of 53 (21-66) years were prospectively analysed. Laparoscopic Roux-Y-gastric bypass (LRYGB) was performed in 86 patients and laparoscopic sleeve gastrectomy (LSG) was performed in 50 patients. The patients were examined before surgery as well as 3, 6, 12, 24, 30, and 36 months postoperatively using a standard protocol including laboratory tests. The mean follow-up time was 24.4 (12-40) months; the follow-up rate was 100%. Results Prior to surgery, 57% of the patients had at least one deficiency, 23% of whom had vitamin D 3 deficiency. Frequent postoperative deficiencies after LSG were zinc, vitamin D 3 , folic acid, iron, and vitamin B 12 ; after LRYGB, vitamin B 12 , vitamin D 3 , zinc, and secondary hyperparathyroidism. No vitamin B 1 or B 6 deficiencies were found. Calcium levels were normal in all patients. Treatment of the deficiencies was mostly successful. Conclusion Preoperatively, 57% of morbidly obese patients already had a deficiency. Postoperatively, significantly more vitamin B 12 and vitamin D deficiencies and hyperparathyroidism were found in patients who had undergone LRYGB. After LSG, folate deficiency was more frequent (but not significantly so). Calcium levels were normal in all patients; therefore, parathyroid hormone and vitamin D 3 levels are more sensitive markers for early detection of disorders of calcium metabolism. Iron deficiency anaemia is most efficiently treated by IV therapy. Methods

Alterações de parâmetros relacionados ao metabolismo ósseo em mulheres submetidas à derivação gástrica em Y de Roux

“…(19). A frequência de deficiência de 25OHD relatada nos estudos oscilou de 50% a 80% (20,22,23). As baixas concentrações de 25OHD em pacientes submetidos à DGYR podem ocorrer por sequestro no tecido adiposo, redução na hidroxilação da pré-vitamina devido à esteatose hepática, menor exposição ao sol pelo sedentarismo ou secundária à inflamação que acompanha a obesidade (12,24).…”

The link between obesity and low circulating 25-hydroxyvitamin D concentrations: considerations and implications

“…The observation that obesity is associated with below-normal serum 25-hydroxyvitamin D concentrations and/or overt deficiency is not new; however, as obesity prevalence has grown, so have the number of reports in the literature regarding this phenomenon. [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] Some of the most recent information about low vitamin D status and obesity comes from studies in bariatric surgery patients, reporting low preoperative circulating levels of 25-hydroxyvitamin D. [21][22][23][24][25][26][27][33][34][35][36][37][38] In fact, a recent systematic review of 14 studies with about 1500 patients undergoing bariatric surgical procedures confirmed that obese individuals have serum 25-hydroxyvitamin D levels below 80 nmol l À1 preoperatively. 39 Other investigators have reported that body mass index (BMI) 25,26,[40][41][42][43][44][45][46] and body fat 20,45,…”

Medication and nutritional supplement use before and after bariatric surgery

“…57,58 Such deficiencies frequent occur after bariatric surgery and relate to decreased food intake and physiological changes produced by the surgery. 59,60 Gastric bypass changes how food passes along the gastrointestinal tract and leads to poor nutrient absorption, given that food is exposed to the jejunum earlier than usual, through exclusion of part of the gastric and duodenal surface. 61 The absorbent surface area and solubility, and consequently drug bioavailability, are affected by this technique.…”