Supplements may not prevent long-term nutritional deficiency after bariatric surgery
In a cohort of adults who underwent bariatric surgery, 73% had at least one nutritional deficiency 5 years later even though 73% reported taking a dietary supplement, according to findings published in Bariatric Surgical Practice and Patient Care.
“We found that regardless of the extensive use of supplements, nutritional deficiencies are common in patients 5 years after bariatric surgery,” Mauro Lombardo, MD, an assistant professor in human nutrition in the department of human sciences and promotion of the quality of life at San Raffaele Roma Open University in Rome, told Endocrine Today. “If we can find out what happens to patients long after surgery, we can make sure that they have the lowest potential side effects by preventing them.”
Lombardo and colleagues analyzed nutritional supplementation use and micronutrient levels of 60 adults (mean age, 41.6 years; 80% women) who underwent either Roux-en-Y gastric bypass (n = 16), sleeve gastrectomy (n = 36) or adjustable gastric banding (n = 8) at the University Hospital Policlinico Tor Vergata in Rome. All procedures were performed between 2010 and 2012.
The researchers measured height and weight and also used blood samples to measure iron, vitamin B12, vitamin D, magnesium and calcium levels in participants every 3 months for the first 18 months following surgery and then every 6 months for the next 18 months and annually for the next 24 months. Participants self-reported use of a general multivitamin or one formulated for bariatric patients, 400 U of vitamin D3, 65 mg of iron sulfate, and B vitamins.
According to the researchers, prior to surgery, fewer than 5% of participants consumed a nutritional supplement 5 days per week, which was what the researchers used to define supplement use. At 3 years, 61% of participants used nutritional supplementation and at 5 years, 73% of participants used nutritional supplementation. Among participants who underwent Roux-en-Y gastric bypass, 79% used a nutritional supplement at 3 years and 94% used one at 5 years following surgery. Among participants who underwent sleeve gastrectomy, 54% used a nutritional supplement at 3 years and 75% used one at 5 years. Among participants who underwent adjustable gastric banding, 30% used a nutritional supplement at 3 years and 37% used one at 5 years.
While nutritional supplement intake increased, the researchers found that 49% of participants had at least one nutritional deficiency at 3 years and 73% had a nutritional deficiency at 5 years. Among those who underwent Roux-en-Y gastric bypass, the researchers observed a nutritional deficiency in 52% prior to surgery, 50% at 3 years and 87% at 5 years. Among those who underwent sleeve gastrectomy, 55% had a nutritional deficiency prior to surgery, 53% at 3 years and 70% at 5 years. Among those who underwent adjustable gastric banding, 25% had a nutritional deficiency prior to surgery, 22% at 3 years and 28% at 5 years.
“Surveillance of nutritional status is recommended in patients undergoing bariatric surgery. When weight loss begins to slow down, the risk of nutritional deficiencies increases,” Lombardo said. “Our data underline the importance of careful preoperative evaluation and frequent postoperative follow-up.” – by Phil Neuffer