Iron, Vitamin B12, Folate and Copper Deficiency After Bariatric Surgery and the Impact on Anaemia: a Systematic Review

Lewis, Carrie‐Anne; Jersey, Susan de; Seymour, Matthew; Hopkins, George; Hickman, Ingrid; Osland, Emma

doi:10.1007/s11695-020-04872-y

Cited by 53 publications

(45 citation statements)

References 76 publications

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“…The authors did state that deficiencies are correctable by regular supplementation. Another review by Lewis et al [ 24 ] found reports on folate deficiency after SG, with eight studies reporting no significant change in prevalence at 12 months compared to baseline and one study reporting a decrease in deficiencies. The same review reported on five studies comparing folate deficiencies over 12 months after RYGB: four of these found no significant difference compared to baseline and one study reported a decrease in deficiency prevalence.…”

Section: Folate Malabsorption After Bariatric Surgery: Pathogenesis and Prevalencementioning

confidence: 99%

Periconceptional Folate Supplementation in Women after Bariatric Surgery—A Narrative Review

Vynckier¹,

Ceulemans

Vanheule³

et al. 2021

Nutrients

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The prevalence of obesity is increasing globally, and along with it, there is a growing number of patients opting to undergo bariatric surgery to treat this condition. Whilst it has many advantages, bariatric surgery is known to induce micronutrient deficiency, with possible deleterious effects on overall health. This topic becomes even more relevant during pregnancy, where deficiencies can also affect the developing fetus, possibly being the cause of an increase in congenital anomalies. Most notably amongst these micronutrients is folate, or vitamin B9, which plays an essential role in development, gene expression and genomic stability. As insufficient levels of folate are associated with neural tube defects in the fetus, preventing and treating folate deficiencies during pregnancies after bariatric surgery is a relevant issue. Unfortunately, folate supplementation recommendations for bariatric patients who wish to become pregnant are not clear. In this narrative review, we discuss whether the recommendations for the general population are still valid for bariatric patients. Furthermore, we discuss the role of folate in the human body, folate status in both non-bariatric and bariatric patients, the various types of folate that are available for substitution and the risk associated with over-supplementation.

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Section: Folate Malabsorption After Bariatric Surgery: Pathogenesis and Prevalencementioning

confidence: 99%

Periconceptional Folate Supplementation in Women after Bariatric Surgery—A Narrative Review

Vynckier¹,

Ceulemans

Vanheule³

et al. 2021

Nutrients

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“…Anemia and iron deficiency: Micronutrient deficiency is common among candidates of metabolic surgery and worsens further during follow-up[ 201 , 202 ]. The prevalence of anemia and iron deficiency ranges from 6.1%-22% and 5.7%-24% respectively, in metabolic surgery candidates[ 203 - 207 ].…”

Section: Nutritional Assessment and Optimizationmentioning

confidence: 99%

“…VDD: Systematic reviews and meta-analyses have suggested that VDD is common in obese individuals and candidates of metabolic surgery[ 229 - 232 ]. Most guidelines recommend routine measurement of serum calcium and 25(OH)D before surgery[ 33 , 201 , 223 , 224 ]. Estimation of serum PTH, serum or urinary N-telopeptide, bone-specific alkaline phosphatase, and bone mineral density can be considered if osteoporosis is suspected (especially in postmenopausal women)[ 224 , 233 ].…”

Section: Nutritional Assessment and Optimizationmentioning

confidence: 99%

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Expert opinion on the preoperative medical optimization of adults with diabetes undergoing metabolic surgery

Bhattacharya¹,

Kalra²,

Kapoor³

et al. 2021

WJD

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Diabetes mellitus (DM) and obesity are interrelated in a complex manner, and their coexistence predisposes patients to a plethora of medical problems. Metabolic surgery has evolved as a promising therapeutic option for both conditions. It is recommended that patients, particularly those of Asian origin, maintain a lower body mass index threshold in the presence of uncontrolled DM. However, several comorbidities often accompany these chronic diseases and need to be addressed for successful surgical outcome. Laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are the most commonly used bariatric procedures worldwide. The bariatric benefits of RYGB and LSG are similar, but emerging evidence indicates that RYGB is more effective than LSG in improving glycemic control and induces higher rates of long-term DM remission. Several scoring systems have been formulated that are utilized to predict the chances of remission. A glycemic target of glycated hemoglobin < 7% is a reasonable goal before surgery. Cardiovascular, pulmonary, gastrointestinal, hepatic, renal, endocrine, nutritional, and psychological optimization of surgical candidates improves perioperative and long-term outcomes. Various guidelines for preoperative care of individuals with obesity have been formulated, but very few specifically focus on the concerns arising from the presence of concomitant DM. It is hoped that this statement will lead to the standardization of presurgical management of individuals with DM undergoing metabolic surgery.

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“…Anemia caused by iron deficiency is a commonly reported long-term complication from Roux-en-Y gastric bypass (RYGB) and other bariatric surgery methods, as these procedures alter the gastrointestinal absorption of iron and other minerals ( 1 – 3 ). However, anemia first occurs at a late stage in the process of decreasing iron stores, and iron deficiency without anemia might be an important cause of impaired health in patients who have undergone bariatric surgery ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

Iron Deficiency and Anemia 10 Years After Roux-en-Y Gastric Bypass for Severe Obesity

et al. 2021

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Iron deficiency with or without anemia is a well-known long-term complication after Roux-en-Y, gastric bypass (RYGB) as the procedure alters the gastrointestinal absorption of iron. Iron is essential for hemoglobin synthesis and a number of cellular processes in muscles, neurons, and other organs. Ferritin is the best marker of iron status, and in a patient without inflammation, iron deficiency occurs when ferritin levels are below 15 µg/L, while iron insufficiency occurs when ferritin levels are below 50 µg/L. Lifelong regular blood tests are recommended after RYGB, but the clinical relevance of iron deficiency and iron insufficiency might be misjudged as long as the hemoglobin levels are normal. The aim of this study was to explore the frequency of iron deficiency and iron deficiency anemia one decade or more after RYGB, the use of per oral iron supplements, and the frequency of intravenous iron treatment. Nine hundred and thirty patients who underwent RYGB for severe obesity at three public hospitals in Norway in the period 2003–2009 were invited to a follow-up visit 10–15 years later. Results from blood tests and survey data on the use of oral iron supplements and intravenous iron treatment were analyzed. Ferritin and hemoglobin levels more than 10 years after RYGB were available on 530 patients [423 (79.8%) women]. Median (IQR) ferritin was 33 (16–63) µg/L, and mean (SD) hemoglobin was 13.4 (1.3) g/dl. Iron deficiency (ferritin ≤ 15 µg/L) was seen in 125 (23.6%) patients; in addition, iron insufficiency (ferritin 16–50 µg/L) occurred in 233 (44%) patients. Mean (SD) hemoglobin levels were 12.5 (1.4) g/dl in patients with iron deficiency, 13.5 (1.2) g/dl in patients with iron insufficiency, 13.8 (1.3) g/dl in the 111 (21%) patients with ferritin 51–100 µg/L, and 13.8 (1.2) g/dl in the 55 (10%) patients with ferritin >100 µg/L. Two hundred and seventy-five (56%) patients reported taking oral iron supplements, and 138 (27.5%) had received intravenous iron treatment after the RYGB procedure. Iron deficiency or iron insufficiency occurred in two-thirds of the patients 10 years after RYGB, although more than half of them reported taking oral iron supplements.

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Iron, Vitamin B12, Folate and Copper Deficiency After Bariatric Surgery and the Impact on Anaemia: a Systematic Review

Cited by 53 publications

References 76 publications

Periconceptional Folate Supplementation in Women after Bariatric Surgery—A Narrative Review

Periconceptional Folate Supplementation in Women after Bariatric Surgery—A Narrative Review

Expert opinion on the preoperative medical optimization of adults with diabetes undergoing metabolic surgery

Iron Deficiency and Anemia 10 Years After Roux-en-Y Gastric Bypass for Severe Obesity

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