Prophylactic Iron Supplementation After Roux-en-Y Gastric Bypass

Brolin, Robert E.; Gorman, Joseph H.; Gorman, Robert C.; Petschenik, Andrew J.; Bradley, Lisa B.; Kenler, Hallis A.; Cody, Ronald P.

doi:10.1001/archsurg.133.7.740

Cited by 151 publications

(87 citation statements)

References 9 publications

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“…In case series lasting 1 to 8 years, iron deficiency developed in 20% to 49% of GBP patients; it was most likely to occur in menstruating women (114 -116). Data show that 640 mg/d of ferrous sulfate can prevent iron deficiency (117) and that the addition of vitamin C to iron supplements can improve absorption in GBP patients (118). Vitamin B 12 deficiency has been found in 25% to 75% of GBP patients after WLS.…”

Section: Micronutrientsmentioning

confidence: 99%

Criteria for Patient Selection and Multidisciplinary Evaluation and Treatment of the Weight Loss Surgery Patient

et al. 2005

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Criteria for patient selection and multidisciplinary evaluation and treatment of the weight loss surgery patient. Obes Res. 2005;13:234 -243. Objective: To provide evidence-based guidelines for patient selection and to recommend the medical and nutritional aspects of multidisciplinary care required to minimize perioperative and postoperative risks in patients with severe obesity who undergo weight loss surgery (WLS). Research Methods and Procedures: Members of the Multidisciplinary Care Task Group conducted searches of MEDLINE and PubMed for articles related to WLS in general and medical and nutritional care in particular. Pertinent abstracts and literature were reviewed for references. Multiple searches were carried out for various aspects of multidisciplinary care published between 1980 and 2004. A total of 3000 abstracts were identified; 242 were reviewed in detail. Results: We recommended multidisciplinary screening of WLS patients to ensure appropriate selection; preoperative assessment for cardiovascular, pulmonary, gastrointestinal, endocrine, and other obesity-related diseases associated with increased risk for complications or mortality; preoperative weight loss and cessation of smoking; perioperative prophylaxis for deep vein thrombosis and pulmonary embolism (PE); preoperative and postoperative education and counseling by a registered dietitian; and a well-defined postsurgical diet progression. Discussion: Obesity-related diseases are often undiagnosed before WLS, putting patients at increased risk for complications and/or early mortality. Multidisciplinary assessment and care to minimize short-and long-term risks include: comprehensive medical screening; appropriate pre-, peri-, and postoperative preparation; collaboration with multiple patient care disciplines (e.g., anesthesiology, pulmonary medicine, cardiology, and psychology); and long-term nutrition education/counseling.

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Section: Micronutrientsmentioning

confidence: 99%

Criteria for Patient Selection and Multidisciplinary Evaluation and Treatment of the Weight Loss Surgery Patient

et al. 2005

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“…With specific iron supplementation, iron deficiency anemia may be prevented (as assessed by adequacy of ferritin levels) but mild anemia can still result, despite normal vitamin levels. 51 This finding highlights the concern that some nutritional risks of gastric bypass may be usual and expected, whereas others may not necessarily fit with expected physiologic paradigms.…”

Section: Nutritional Risks Of Weight Loss Surgerymentioning

confidence: 93%

Bariatric surgery for pediatric extreme obesity: now or later?

2006

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Obesity is a multifactorial disease of epidemic and global proportions that poses the most significant threat to the health of our younger generations. Those who are the most extremely affected bear the largest burden of health problems. In the US, extreme obesity affects approximately 9 million adults and 2 million children, and is associated with both immediate health problems and later health risk, including premature mortality. Present medical and behavioral interventions for extreme obesity in adults and children rarely result in the significant, durable weight loss necessary to improve health outcomes, prompting a search for more aggressive measures. Weight loss (bariatric) surgery has been advocated as an intervention for those with extreme obesity. In adults, bariatric surgery results in prolonged weight control and improvement in serious obesity comorbidities, namely type 2 diabetes, dyslipidemias, hypertension and obstructive sleep apnea syndrome. A surge in weight loss operations for adolescents has been observed recently, with a threefold increase in case volumes nationwide from 2000 to 2003. Current evidence suggests that after bariatric surgery, adolescents lose significant weight and serious obesity-related medical conditions and psychosocial status are improved. Thus it is reasonable to propose that bariatric surgery performed in the adolescent period may be more effective treatment for childhood-onset extreme obesity than delaying surgery for extremely obese youth until adulthood. This position has been echoed by a number of groups and an independent systematic review. Finally, it is conceivable that bariatric surgery performed in adulthood for childhood onset extreme obesity may not be as effective for comorbidity treatment as surgery performed earlier during adolescence. The purpose of this review is to examine the evidence, which supports early rather than later use of bariatric surgery in the treatment of extreme obesity, and to present this information in light of the medical and surgical risks of bariatric surgery.

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“…While standard multivitamins may prevent folate and B12 depletion, Brolin, Gorman, Milgrim, and Kenler (1991) found that multivitamin supplementation did not adequately prevent iron deficiencies and anemia in post-RYGB patients (Brolin et al, 1991). In a subsequent randomized, double blind controlled trial of menstruating women who had undergone RYGB, Brolin et al (1998) found that supplementation twice daily with oral ferrous sulfate effectively prevented iron deficiency in patients adherent to taking the prescribed supplements, although 20% of this sample abandoned iron supplementation because of unpleasant gastrointestinal side effects (Brolin et al, 1998).…”

Section: Clinical Presentationmentioning

confidence: 99%

Malabsorption anemia and iron supplement induced constipation in post-Roux-en-Y gastric bypass (RYGB) patients

Sahebzamani

Berarducci

Murr

2013

Journal of the American Association of Nurse Practitioners

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Purpose Over 250,000 bariatric surgical procedures for the management of morbid obesity are performed in the United States annually. The Roux‐en‐Y gastric bypass (RYGB) is an effective bariatric procedure because of its efficacy in achieving significant weight loss, low complication rates, and outcomes in reducing cardiovascular and all cause mortality. Because food bypasses the portion of the small intestine whereby micronutrients are normally absorbed, micronutrient deficiencies following surgery may lead to iron deficiency anemia. Iron deficiency anemia is estimated to occur in 6%–50% of post‐RYGB patients. Consequently, the procedure requires lifelong behavioral change to ensure therapeutic iron supplementation. Data sources A nonsystematic literature search for clinical guidelines, review articles, and research was conducted. Conclusions Clinical recommendations include prophylactic iron supplementation with ferrous sulfate to prevent iron deficiency anemia. Ferrous sulfate is a well‐established cause of constipation possibly resulting in low patient tolerability and subsequent low adherence rates. Clinical implications Strategies for managing the side effects of iron supplementation including constipation may require a unique approach based on the anatomical and functional changes in the post‐RYGB patient and the requirement for lifelong iron supplementation.

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Prophylactic Iron Supplementation After Roux-en-Y Gastric Bypass

Cited by 151 publications

References 9 publications

Criteria for Patient Selection and Multidisciplinary Evaluation and Treatment of the Weight Loss Surgery Patient

Criteria for Patient Selection and Multidisciplinary Evaluation and Treatment of the Weight Loss Surgery Patient

Bariatric surgery for pediatric extreme obesity: now or later?

Malabsorption anemia and iron supplement induced constipation in post-Roux-en-Y gastric bypass (RYGB) patients

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