Comparison of micronutrient deficiencies following Sleeve Gastrectomy versus Roux-en-Y Gastric Bypass

Micronutrient deficiencies are common after bariatric surgery, irrespective of the kind of procedure. To assess the need for nutritional support for Sleeve Gastrectomy (SG) patients, the prevalence of nutritional deficiencies after SG was compared with the prevalence after Roux-en-Y Gastric Bypass (RYGB). This comparative study was performed including 338 SG patients and 238 RYGB patients, who all obtained postoperative vitamin and mineral supplementation. Levels of hemoglobin, iron, ferritin, zinc and vitamin B12 were determined preoperatively and at 3, 6, 12 and 24 months after surgery.

Hemoglobin and ferritin deficiencies after SG and RYGB

Two years after surgery, the percentage of excess weight loss was statistically comparable between the two techniques, ranging from 81% (SG) to 88% (RYGB). Preoperatively, deficiencies were found for hemoglobin, iron, ferritin, zinc and vitamin B12. Over time, levels of hemoglobin and ferritin further decreased in both groups, resulting in a higher prevalence of hemoglobin and ferritin deficiencies. No statistically significant difference was found between SG and RYGB.

High deficiency rates for SG patients

This study illustrates that, despite common belief, nutritional deficiencies are highly prevalent after SG. Between groups, the prevalence of several nutritional deficiencies was comparable. Even though WLS Optimum 1.0 contained elevated doses of vitamins and minerals, the prevalence of micronutrient deficiencies remained high. WLS Optimum only significantly affected mean serum levels of folic acid, PTH and vitamin B1, and led to lower anemia rates compared to sMVS.

The need for tailored supplementation

Iron and zinc levels increased postoperatively after SG, but not after RYGB. After two years, zinc deficiencies were observed more regularly in RYGB patients (30%), compared to SG patients (6,6%). Iron and vitamin B12 deficiencies were found comparably prevalent for both patient groups. These results show that nutritional support is needed after bariatric surgery. However, since absorption and deficiency levels differ per procedure, supplementation should be tailored to the specific type of operation.

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Reference:

Ferraz, A.A.B., Carvalho, M.R.C., Siqueira, L.T. et al. (2016) Micronutrient deficiencies following bariatric surgery: a comparative analysis between sleeve gastrectomy and Roux-en-Y gastric bypass. Rev Col Bras Cir 45(6):e2016 

Link to full text: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-69912018000600155&lng=en&nrm=iso&tlng=en

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