Iron Deficiency and Bariatric Surgery

Abstract

It is estimated that the prevalence of anaemia in patients scheduled for bariatric surgery is higher than in the general population and the prevalence of iron deficiencies (with or without anaemia) may be higher as well. After surgery, iron deficiencies and anaemia may occur in a higher percentage of patients, mainly as a consequence of nutrient deficiencies. In addition, perioperative anaemia has been related with increased postoperative morbidity and mortality and poorer quality of life after bariatric surgery. The treatment of perioperative anaemia and nutrient deficiencies has been shown to improve patients’ outcomes and quality of life. All patients should undergo an appropriate nutritional evaluation, including selective micronutrient measurements (e.g., iron), before any bariatric surgical procedure. In comparison with purely restrictive procedures, more extensive perioperative nutritional evaluations are required for malabsorptive procedures due to their nutritional consequences. The aim of this study was to review the current knowledge of nutritional deficits in obese patients and those that commonly appear after bariatric surgery, specifically iron deficiencies and their consequences. As a result, some recommendations for screening and supplementation are presented.

Nutritional Deficiencies in Patients after Roux-en-Y Gastric Bypass and Sleeve Gastrectomy during 12-Month Follow-Up

“…Muñoz et al suggested that biochemical preoperative assessment in both groups of patients is necessary due to an increased risk of development of various deficiencies [13]. Jáuregui-Lobera in a review of iron status after bariatric surgery advised to correct iron deficiencies preoperatively and during follow-up in order to prevent anaemia [14]. It is worth mentioning that patients who partially lose excess weight prior to the surgery are more motivated to obey all the regimes after operation, including changes of lifestyle and habits as was reported by Gerber et al [15].…”

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

“…Although previous research has investigated nutrient deficiencies following bariatric surgery, the literature is not extensive enough for the development of standardized nutrition management guidelines 7 . It is known that adolescents with obesity are already at an increased risk for developing anemia preoperatively, likely due to obesity‐induced chronic inflammation, which causes alterations in iron homeostasis 15 – 19 . Similarly, patients included in the current study demonstrated a high prevalence of iron deficiency and anemia (defined by low Hgb levels) prior to surgery.…”

“…Iron deficiency is frequently observed following bariatric surgery, with a prevalence as high as 14% and 18% following LAGB and SG, respectively 19 . However, at least 2 other studies found a very low prevalence of iron deficiency following SG 6 , 21 .…”

Iron bioavailability from commercially available iron supplements

“…Another group that might benefit from both Spatone Apple ® and Iron Vital F ® are post-bariatric surgery patients who are at high risk of IDA [39][40][41], and in whom treatment with standard iron tablets is often ineffective [42,43]. In one study postoperative gastric bypass patients given 100 mg FeSO 4 tablets as an oral challenge absorbed inadequate amounts of iron as measured by change in serum iron concentration [44]; altered gut physiology after bariatric surgery may not allow for iron absorption from FeSO 4 tablets.…”