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Bariatric surgery and the risk of micronutrient deficiencies


Roux-en-Y Gastric Bypass and Sleeve Gastrectomy have comparable consequences on food intakes and nutritional adequacy of the diet in the first year post surgery

Because bariatric surgery appears to be the most effective strategy to treat morbid obesity, the number of interventions has dramatically risen worldwide in the last decade. Roux-en-Y Gastric Bypass (GBP) and Sleeve Gastrectomy (SG) are the most popular procedures, and although the two surgical techniques and their mechanisms of action differ, they appear to be equally safe and both induce significant weight loss post-surgery.

Nevertheless little is known about the effect of SG on the risk of micronutrient deficiencies, and whether they are comparable to those seen after BPG. Indeed SG is viewed as less harmful than GBP. Karine Clément’s team at ICAN (Institute of Cardiometabolism And Nutrition – AP-HP/Inserm/UPMC) at the Pitié-Salpêtrière hospital in Paris, have monitored food intake, nutrient adequacy of the diet and nutritional biological parameters of 52 obese subjects during one year after both GBP and SG.

They display that both surgery induce similar food restriction effects on food intakes and nutritional adequacy of the diet in the first year post-surgery. In particular, they observed comparable consequences in terms of bioclinical evolution and micronutrient serum concentrations, suggesting that systematic multivitamin and mineral supplementation after SG prevents the risk of nutritional deficiencies in the same way as in GBP. Most importantly, protein intake decreases dramatically and remains low even after one year thus inducing mild protein depletion in more than a third of the patients one year after both types of surgery.

These results have just been published in the journal Obesity Surgery. They have important clinical and practical implications to the field of clinical nutrition and more specifically to the care of bariatric surgery patients:

  1. SG is as harmful as GBP in terms of food restriction effects ;
  2. Specific dietary advice to increase protein intake should be provided after both GBP and SG ;
  3. Daily multivitamin and mineral supplements should be prescribed after both GBP and SG.

Future studies with longer follow-up periods and larger sample size are needed to determine how poor dietary habits and nutritional deficiencies correlate with weight maintenance and body composition evolution at longer term and with the improvement or resolution of obesity related co-morbidities.

Original article

Micronutrient and Protein Deficiencies After Gastric Bypass and Sleeve Gastrectomy: a 1-year Follow-up
Verger EO, Aron-Wisnewsky J, Dao MC, Kayser BD, Oppert JM, Bouillot JL, Torcivia A, Clément K.
Obes Surg. 2015 Jul 24. [Epub ahead of print]
doi: 10.1007/s11695-015-1803-7