Iron supplementation following bariatric surgery: A systematic review of current strategies

Abstract

Summary Iron deficiency (ID) and iron deficiency anemia (IDA) are common following bariatric surgery; however, there are limited standardized treatment recommendations for their management. The purpose of this study was to review the current strategies for iron supplementation following bariatric surgery and assess their relative efficacy in managing ID and IDA. MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were searched to January 2021. Primary outcomes of interest were prevention or improvement in ID or IDA with iron supplementation. Forty‐nine studies with 12,880 patients were included. Most patients underwent Roux‐en‐Y gastric bypass (61.9%). Iron supplementation was most commonly administered orally for prevention of ID/IDA and was effective in 52% of studies. Both IV and oral iron were given for treatment of ID/IDA. Fifty percent (3/6) of the oral and 100% (3/3) of the IV supplementation strategies were effective at treating ID. Iron supplementation strategies employed following bariatric surgery are highly variable, and many do not provide sufficient iron to prevent the development of ID and IDA, potentially due to poor patient adherence. Further high‐quality prospective trials, particularly comparing intravenous and oral iron, are warranted in order to determine the ideal dosage, route, and duration of iron supplementation.

Iron Deficiency Anemia in Pregnancy after Bariatric Surgery: Etiology, Risk Factors, and How to Manage It

“…Although women after bariatric surgery had not been previously analyzed, it has been demonstrated that all iron salts seem effective to prevent and treat iron deficiency after bariatric surgery and iron deficiency in pregnancy, and, as concluded by our study, iron deficiency in pregnant women after bariatric surgery. 8,10,[13][14][15] Like other studies, vitamin B12 and folate anemia were not relevant. For folic acid, this is a result of mainly two factors: first, Brazilian food is enhanced with folate, which decreases the necessity of folic acid, and that pregnant women are advised to take 1 pill of 5 mg daily of folic acid, which is a much higher dosage than required daily.…”

“…Although women after bariatric surgery had not been previously analyzed, it has been demonstrated that all iron salts seem effective to prevent and treat iron deficiency after bariatric surgery and iron deficiency in pregnancy, and, as concluded by our study, iron deficiency in pregnant women after bariatric surgery. 8 10 13 14 15…”

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

“…Whether this results from only patients with low iron stores being recommended supplements, or whether per oral iron supplements had little effect, remains to be explored. A recently published systematic review reveals a high variation in current strategies on iron supplementation following bariatric surgery; many of them do not prevent development of iron deficiency and iron deficiency anemia (27). In a non-bariatric population, per oral iron supplements once or twice a day have been reported to decrease iron absorption due to temporally increased levels of hepcidin, and iron supplements in lower doses or alternate days might be more effective (36).…”

“…So far, no ideal program for iron supplementation following bariatric surgery is agreed upon (27). International guidelines recommend per oral iron supplementation either as continuous or intermittent treatment for all patients undergoing RYGB to avoid iron deficiency (28)(29)(30).…”