Is the Current Micronutrient Supplementation Adequate in Preventing Deficiencies in Indian Patients? Short- and Mid-Term Comparison of Sleeve Gastrectomy and Roux-en-Y Gastric Bypass

Misra, Shivanshu; Balasubramanian, S.; Isaac, Usha; Srinivasan, M.; Saminathan, Christinajoice; Kumar, Saravana; Raj, Praveen

doi:10.1007/s11695-020-04674-2

Cited by 11 publications

(27 citation statements)

References 36 publications

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“…Two other studies have reported differing findings regarding the effect of surgery on haematinic status. Misra et al [45] described no significant difference in rates of anaemia or deficiencies in ferritin, vitamin B 12 or folate between GB and SG at 3 years' follow-up, a result echoed in our study. Ledoux et al [46] similarly reported no effect of type of procedure on vitamin B 12 deficiency or anaemia, although rates of anaemia increased more substantially after GB; there was a higher frequency of folate deficiency after SG compared to GB.…”

Section: Discussionsupporting

confidence: 83%

Haemoglobin and Hematinic Status Before and After Bariatric Surgery over 4 years of Follow-Up

et al. 2020

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Purpose Bariatric surgery is associated with deficiencies of vitamins and minerals, and patients are routinely advised supplements postoperatively. We studied prevalence of vitamin B 12 , folate and iron deficiencies and anaemia before and after bariatric surgery over 4 years of follow-up. Materials and Methods We performed a retrospective cohort analysis of 353 people with obesity, including 257 (72.8%) women, who underwent gastric bypass (252, 71.4%) or sleeve gastrectomy (101, 28.6%) at our National Health Service bariatric centre in Northwest England. Results At baseline, mean (standard error) age was 46.0 (0.6) years, body mass index 53.1 (0.4) kg/m 2 , serum vitamin B 12 400.2 (16.4) pg/L, folate 7.7 (0.2) μg/L, iron 12.0 (0.3) μmol/L, ferritin 118.3 (8.4) μg/L and haemoglobin 137.9 (0.8) g/L. Frequency of low vitamin B 12 levels reduced from 7.5% preoperatively to 2.3% at 48 months (P < 0.038). Mean folate levels increased from baseline to 48 months by 5.3 μg/L (P < 0.001) but frequency of low folate levels increased from 4.7% preoperatively to 10.3% (P < 0.048). Ferritin levels increased from baseline to 48 months by 51.3 μg/L (P < 0.009). Frequency of low ferritin levels was greater in women (39.1%) than in men (8.9%) at baseline (P < 0.001) and throughout the study period. Haemoglobin was low in 4.6% of all patients at baseline with no significant change over the study period. Conclusion There were notable rates of haematinic insufficiencies in bariatric surgical candidates preoperatively. Our study lends further support to regular supplementation with vitamin B 12 , folic acid, and iron in people undergoing bariatric surgery.

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Section: Discussionsupporting

confidence: 83%

Haemoglobin and Hematinic Status Before and After Bariatric Surgery over 4 years of Follow-Up

et al. 2020

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“…After the exclusion of ineligible studies, our final sample was 30 studies. 4,5,[7][8][9][10][11][14][15][16][17][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] Among them, four studies had two arms, these arms were analyzed separately in this meta-analysis 14,31,34,39 (Figure 1). The characteristics of included studies are presented in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…The study quality assessment is also displayed in this table. Of all included studies, 30 were considered inadequate for vitamin D and calcium supplementation, [7][8][9][10]14,16,17,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] and 4 were assessed as adequate supplementation 4,5,11,15 (Table 2). Of the 30 studies with inadequate supplementation, 6 reported data for ≤1 year of follow-up, 19 for >1 and ≤5 years, 3 for >5 and ≤10 years, and 2 for >10 years.…”

Section: Resultsmentioning

confidence: 99%

Prevalence and associated factors of secondary hyperparathyroidism after Roux‐en‐Y gastric bypass: A meta‐analysis

et al. 2022

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Summary This study aimed to investigate the prevalence and factors associated with secondary hyperparathyroidism (SHPT) after Roux‐en‐Y gastric bypass (RYGB). We searched PubMed, EMBASE, and CENTRAL for relevant studies using search terms gastric bypass, RYGB and hyperparathyroidism. Thirty‐four cohort studies with 4331 patients were incorporated into the final meta‐analysis. Overall estimates of the prevalence of SHPT following RYGB were 39%. Subgroup analyses indicated the pooled prevalences of SHPT were 25%, 42%, 48%, and 54% for ≤1 year, >1 and ≤5 years, >5 and ≤10 years, and >10 years, respectively, after RYGB. Meta‐regression showed that SHPT occurred was positively related to follow‐up durations (p = 0.001). Additionally, SHPT prevalence was higher in studies in which calcium and vitamin D supplementation were considered inadequate than in those which were adequate (p = 0.002). SHPT is highly prevalent in individuals with obesity after RYGB. It seems to progress with time after surgery. Routine calcium and vitamin D supplementation post‐RYGB together with targeted treatment of vitamin D deficiency, reasonable adjustment of the doses of supplementation with regular follow‐up, and improved patient compliance, as well as long‐term screening, are necessary to prevent the development of SHPT.

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“…This increase was also observed in a recent study of 390 patients including 132 LSG, reporting increasing rates of SHPT up to 45.5% in patients post LSG 2-years post-operatively. 19 Interestingly, in a retrospective cohort study of 226 morbidly obese patients who underwent Roux-en-Y gastric bypass on vertical-banded gastroplasty, 89% of patients diagnosed with presurgical secondary normocalcemic hyperparathyroidism (SNHPT), with 24% of these patients recovered within 18 months after surgery. Even though they recovered from this disorder after surgery, their serum PTH levels were statistically significantly (p < 0.05) higher than those of other patients throughout the study follow-up period.…”

Section: Discussionmentioning

confidence: 99%

Secondary Hyperparathyroidism in Obese Patients Post Sleeve Gastrectomy

Altawil¹,

Alkofide²,

Alamri³

et al. 2021

DMSO

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Introduction Bariatric surgery provides an effective option for the management of morbid obesity. Several studies have investigated the association between bariatric surgery and secondary hyperparathyroidism (SHPT). This study aims to compare the levels of blood biomarkers, specifically, calcium (Ca), vitamin D, and phosphate (PO4), and their association with parathyroid hormone (PTH) levels pre- and post-bariatric surgery. In addition, it aims to assess the prevalence of hyperparathyroidism post-bariatric surgery in a tertiary care hospital in Saudi Arabia. Material and Methods A prospective cohort study was conducted at a large tertiary care hospital between May 2017 and April 2019. The study included adult obese patients who underwent laparoscopic sleeve gastrectomy (LSG). Patients were excluded if they were known to have any comorbidities, receiving vitamin supplements, and those who had undergone bariatric procedures previously. Routine blood tests, including PTH, vitamin D, Ca, and PO4, were collected at baseline, and post-surgery. Results A total of 143 patients who underwent LSG were included in the study. Hyperparathyroidism was observed in 15.4% of patients at baseline and in 36.4% of patients’ post-surgery (p < 0.001). Low vitamin D levels, which were highly prevalent before surgery, decreased sustainably (66.4% pre-operative and 28% at follow-up after surgery, P=0.032). Baseline hypocalcemia was observed in 20.3% of patients compared to 8.4% post-surgery (P=0.546). Hypophosphatemia was present in 60.8% of subjects at baseline, while the percentage dropped to 21.7% post-surgery. There was a significant association between PO4 and PTH levels at baseline. Post-operatively, there was a significant correlation between PTH and both vitamin D and calcium levels. Conclusion Our study showed that the higher levels of PTH post LSG can be related to vitamin D deficiency and lower calcium levels, despite patients following the provided recommendations for supplementation. This study also emphasizes the importance of routine testing for hyperparathyroidism both before and after bariatric surgery.

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Is the Current Micronutrient Supplementation Adequate in Preventing Deficiencies in Indian Patients? Short- and Mid-Term Comparison of Sleeve Gastrectomy and Roux-en-Y Gastric Bypass

Cited by 11 publications

References 36 publications

Haemoglobin and Hematinic Status Before and After Bariatric Surgery over 4 years of Follow-Up

Haemoglobin and Hematinic Status Before and After Bariatric Surgery over 4 years of Follow-Up

Prevalence and associated factors of secondary hyperparathyroidism after Roux‐en‐Y gastric bypass: A meta‐analysis

Secondary Hyperparathyroidism in Obese Patients Post Sleeve Gastrectomy

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