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

Abstract

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.

Prevalence of anemia and related nutrient deficiencies after sleeve gastrectomy: A systematic review and meta‐analysis

“…The baseline levels of serum iron, ferritin, folate, and VB12 are shown in Table 2, and their reference range is shown in Table S3. Twenty‐one studies 24,25,29–33,35,37–49 recommended prophylactic iron supplementations, 22 studies 21,23–25,29–33,35,37,39–49 recommended prophylactic folate supplementations, and 22 studies 21,23–25,29–35,37,39–46,48,49 recommended prophylactic VB12 supplementations. According to the guidelines of the AACE‐TOS‐ASMBS, seven studies 24,29,38,42,43,46,47 were sufficient for iron supplementations, seven studies 32,42,43,46–49 were sufficient for folate supplementations, and four studies 34,42,43,46 were sufficient for VB12 supplementations.…”

“…The majority of studies 12,13,[21][22][23][24][25][26][27][28][29]31,33,35,[37][38][39][40][41][42][43][44][45][47][48][49] were conducted in Europe and Asia, with the number of patients ranging from 30 to 1942.…”

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

“…Our initial search identified a total of 5234 potentially relevant citations. Following screening, a total of 49 studies with 12,880 patients were eligible for inclusion 4,6,21–67 . Of these, five were randomized controlled trials, 33 were retrospective cohort studies, 10 were prospective cohort studies, and one was a nested case–control study.…”

Changes in the Proteome Profile of People Achieving Remission of Type 2 Diabetes after Bariatric Surgery

“…TF is a part of the innate immune system and acts as a marker of inflammation in patients with T2DM [48]. Furthermore, pre-operative deficiencies of iron and other trace elements are prevalent amongst individuals with obesity undergoing surgery and are often replaced post-surgery [49], which offers an explanation as to the maintained significant decline in this protein.…”