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Erschienen in: Obesity Surgery 3/2008

01.03.2008 | Research Article

Prevalence of Iron, Folate, and Vitamin B12 Deficiency Anemia After Laparoscopic Roux-en-Y Gastric Bypass

verfasst von: Angel G. Vargas-Ruiz, Gabriela Hernández-Rivera, Miguel F. Herrera

Erschienen in: Obesity Surgery | Ausgabe 3/2008

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Abstract

Background

One of the most common bariatric operations is the laparoscopic Roux-en-Y gastric bypass (LRYGBP) in which the gastric capacity is restricted and the absorption by the small intestine is reduced. The objective of this study was to evaluate the incidence of iron, folate, and vitamin B12 deficiency anemia in patients undergoing LRYGBP.

Patients and methods

Clinical records of 30 patients who underwent LRYGBP between July 2003 and January 2005 and had a minimum follow up of 24 months at our outpatient clinic were included. Multivitamin supplementation was prescribed to all patients. The complete blood cell count, plasma iron, total iron-binding capacity, transferrin saturation, serum folate, and cobalamin levels before surgery, 6 months, 1, 2, and 3 years after the surgery were analyzed.

Results

There were 25 women (83.4%) and five men (16.6%) with ages from 21 to 56 years. Before surgery, two patients (6.6%) presented ferropenic anemia. Iron deficiency was seen in 40 and 54.5% 2 and 3 years after surgery, respectively. Cobalamin deficiency was observed in 33.3% at 2 years and in 27.2% at 3 years. At 2-year follow-up, 46.6% of the patients had already developed anemia and 63.6% at 3 years. Folate deficiency was not observed in any patient.

Conclusion

Our routine scheme of vitamin supplementation is not sufficient to prevent iron and vitamin B12 deficiencies in most patients.
Literatur
1.
Zurück zum Zitat Virji A, Murr MM. Caring for patients after bariatric surgery. Am Fam Phys. 2006;73:1403–8. Virji A, Murr MM. Caring for patients after bariatric surgery. Am Fam Phys. 2006;73:1403–8.
2.
Zurück zum Zitat Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.PubMedCrossRef Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.PubMedCrossRef
3.
Zurück zum Zitat Sjostrom L, Lindroos A, Peltonen M, et al. Lifestyle, diabetes and cardiovascular risk factors 10 years alter bariatric surgery. N Engl J Med. 2004;351:2683–93.PubMedCrossRef Sjostrom L, Lindroos A, Peltonen M, et al. Lifestyle, diabetes and cardiovascular risk factors 10 years alter bariatric surgery. N Engl J Med. 2004;351:2683–93.PubMedCrossRef
4.
Zurück zum Zitat Alvarez-Leite JI. Nutrient deficiencies secondary to bariatric surgery. Curr Opin Clin Nutr Metab Care. 2004;7:569–75.PubMedCrossRef Alvarez-Leite JI. Nutrient deficiencies secondary to bariatric surgery. Curr Opin Clin Nutr Metab Care. 2004;7:569–75.PubMedCrossRef
5.
Zurück zum Zitat Parkes E. Nutritional management of patients after bariatric surgery. Am J Med Sci. 2006;331(4):207–13.PubMedCrossRef Parkes E. Nutritional management of patients after bariatric surgery. Am J Med Sci. 2006;331(4):207–13.PubMedCrossRef
6.
Zurück zum Zitat Piedras Ros J, Reyes Devesa S, et al. Limites de referencia de serie roja obtenidos en Equipo Coulter S plus STK R en adultos sanos residentes a 2240 metros sobre nivel del mar. Rev Invest Clin. 1991;43:174–8.PubMed Piedras Ros J, Reyes Devesa S, et al. Limites de referencia de serie roja obtenidos en Equipo Coulter S plus STK R en adultos sanos residentes a 2240 metros sobre nivel del mar. Rev Invest Clin. 1991;43:174–8.PubMed
7.
Zurück zum Zitat Guerrero Mayares P, Halabe Cherem J. Diagnóstico de las anemias. Med Int Mex. 2004;20:124–9. Guerrero Mayares P, Halabe Cherem J. Diagnóstico de las anemias. Med Int Mex. 2004;20:124–9.
8.
Zurück zum Zitat Malindowski SS. Nutritional and metabolic complications of bariatric surgery. Am J Med Sci. 2006;33(14):219–25.CrossRef Malindowski SS. Nutritional and metabolic complications of bariatric surgery. Am J Med Sci. 2006;33(14):219–25.CrossRef
9.
Zurück zum Zitat Mott T. How effective is gastric bypass for weight loss? J Fam Pract. 2004;53(11):914–7.PubMed Mott T. How effective is gastric bypass for weight loss? J Fam Pract. 2004;53(11):914–7.PubMed
10.
Zurück zum Zitat Crowley LV, Seay J, Mullin G. Late effects of gastric bypass for morbid obesity. Am J Gastroenterol. 1984;79:850–60.PubMed Crowley LV, Seay J, Mullin G. Late effects of gastric bypass for morbid obesity. Am J Gastroenterol. 1984;79:850–60.PubMed
11.
Zurück zum Zitat Mason ME, Jalagani H, Vinik AI. Metabolic complications of bariatric surgery: diagnosis and management issues. Gastroenterol Clin North Am. 2005;34:25–33.PubMedCrossRef Mason ME, Jalagani H, Vinik AI. Metabolic complications of bariatric surgery: diagnosis and management issues. Gastroenterol Clin North Am. 2005;34:25–33.PubMedCrossRef
12.
13.
Zurück zum Zitat Kaplan LM. Gastrointestinal management of the bariatric surgery patient. Gastroenterol Clin North Am. 2005;34:105–25.PubMedCrossRef Kaplan LM. Gastrointestinal management of the bariatric surgery patient. Gastroenterol Clin North Am. 2005;34:105–25.PubMedCrossRef
14.
Zurück zum Zitat Brehrns KE, Smith CD, Sarr MG. Prospective evaluation of gastric acid secretion and cobalamin absorption following gastric bypass for clinically severe obesity. Dig Dis Sci. 1994;39(2):315–20.CrossRef Brehrns KE, Smith CD, Sarr MG. Prospective evaluation of gastric acid secretion and cobalamin absorption following gastric bypass for clinically severe obesity. Dig Dis Sci. 1994;39(2):315–20.CrossRef
15.
Zurück zum Zitat Ponsky TA, Brody F, Pucci E. Alterations in gastrointestinal physiology after Roux-en-Y gastric bypass. J Am Coll Surg. 2005;201(1):125–31.PubMedCrossRef Ponsky TA, Brody F, Pucci E. Alterations in gastrointestinal physiology after Roux-en-Y gastric bypass. J Am Coll Surg. 2005;201(1):125–31.PubMedCrossRef
16.
Zurück zum Zitat Halverson JD, Zuckerman, GR Koheler RE, et al. Gastric bypass for morbid obesity. A medical–surgical assessment. Ann Surg. 1981;194:152–60.PubMedCrossRef Halverson JD, Zuckerman, GR Koheler RE, et al. Gastric bypass for morbid obesity. A medical–surgical assessment. Ann Surg. 1981;194:152–60.PubMedCrossRef
17.
Zurück zum Zitat Amaral JF, Thompson WR, Caldwell MD, et al. Prospective hematologic evaluation of gastric exclusion surgery for morbid obesity. Ann Surg. 1985;201:186–93.PubMedCrossRef Amaral JF, Thompson WR, Caldwell MD, et al. Prospective hematologic evaluation of gastric exclusion surgery for morbid obesity. Ann Surg. 1985;201:186–93.PubMedCrossRef
18.
Zurück zum Zitat Borlin RE, Gorman JH, Gorman RC, et al. Are vitamin B12 and folate deficiency clinically important after Roux-en-Y gastric bypass? J Gastrointest Surg. 1998;2:436–42.CrossRef Borlin RE, Gorman JH, Gorman RC, et al. Are vitamin B12 and folate deficiency clinically important after Roux-en-Y gastric bypass? J Gastrointest Surg. 1998;2:436–42.CrossRef
19.
Zurück zum Zitat Skroubis G, Sakellaropoulos G, Pouggouras K, et al. Comparison of nutritional deficiencies after Roux-en-Y gastric bypass and after biliopancreatic diversion with Roux-en-Y gastric bypass. Obes Surg. 2002;12:551–8.PubMedCrossRef Skroubis G, Sakellaropoulos G, Pouggouras K, et al. Comparison of nutritional deficiencies after Roux-en-Y gastric bypass and after biliopancreatic diversion with Roux-en-Y gastric bypass. Obes Surg. 2002;12:551–8.PubMedCrossRef
20.
Zurück zum Zitat Rhode BM, Shustick C, Christou NV, et al. Iron absorption and therapy after gastric bypass. Obes Surg. 1999;9:17–21.PubMedCrossRef Rhode BM, Shustick C, Christou NV, et al. Iron absorption and therapy after gastric bypass. Obes Surg. 1999;9:17–21.PubMedCrossRef
21.
Zurück zum Zitat Stocker DJ. Management of the bariatric surgery patient. Endocrinol Metab Clin North Am. 2003;32:437–57.PubMedCrossRef Stocker DJ. Management of the bariatric surgery patient. Endocrinol Metab Clin North Am. 2003;32:437–57.PubMedCrossRef
22.
Zurück zum Zitat Fujioka K. Follow-up of nutritional and metabolic problems after bariatric surgery. Diabetes Care. 2005;28:481–4.PubMedCrossRef Fujioka K. Follow-up of nutritional and metabolic problems after bariatric surgery. Diabetes Care. 2005;28:481–4.PubMedCrossRef
23.
Zurück zum Zitat Brolin RE, Leung M. Survey of vitamin and mineral supplementation alter gastric bypass and biliopancreatic diversion for morbid obesity. Obes Surg. 1999;9:150–4.PubMedCrossRef Brolin RE, Leung M. Survey of vitamin and mineral supplementation alter gastric bypass and biliopancreatic diversion for morbid obesity. Obes Surg. 1999;9:150–4.PubMedCrossRef
24.
Zurück zum Zitat Borlin RE, Gorman JH, Gorman RC, et al. Prophylactic iron supplementation after Roux-en-Y gastric bypass: a prospective, double-blind, randomized study. Arch Surg. 1998;122:740–4. Borlin RE, Gorman JH, Gorman RC, et al. Prophylactic iron supplementation after Roux-en-Y gastric bypass: a prospective, double-blind, randomized study. Arch Surg. 1998;122:740–4.
25.
Zurück zum Zitat Mallory GN, Macgregor AM. Folate status following gastric bypass surgery (the great folate mystery). Obes Surg. 1991;1:69–72.PubMedCrossRef Mallory GN, Macgregor AM. Folate status following gastric bypass surgery (the great folate mystery). Obes Surg. 1991;1:69–72.PubMedCrossRef
26.
Zurück zum Zitat Xanthakos SA, Inge TH. Nutritional consequences of bariatric surgery. Curr Opin Clin Nutr Metab Care. 2006;9:489–96.PubMedCrossRef Xanthakos SA, Inge TH. Nutritional consequences of bariatric surgery. Curr Opin Clin Nutr Metab Care. 2006;9:489–96.PubMedCrossRef
27.
Zurück zum Zitat Dunlevy LP, Chitty LS, Burren KA. Abnormal folate metabolism in foetuses affected by neural tube defects. Brain. 2007;130:1043–9.PubMedCrossRef Dunlevy LP, Chitty LS, Burren KA. Abnormal folate metabolism in foetuses affected by neural tube defects. Brain. 2007;130:1043–9.PubMedCrossRef
28.
Zurück zum Zitat Czeizel AE, Dudas I. Prevention of the first occurrence of neural tube defects by periconceptional vitamin supplementation. N Engl J Med. 1992;327;1832–5.PubMedCrossRef Czeizel AE, Dudas I. Prevention of the first occurrence of neural tube defects by periconceptional vitamin supplementation. N Engl J Med. 1992;327;1832–5.PubMedCrossRef
29.
Zurück zum Zitat Woodard CB. Pregnancy following bariatric surgery. J Perinat Neonatal Nurs. 2004;18:329–40.PubMed Woodard CB. Pregnancy following bariatric surgery. J Perinat Neonatal Nurs. 2004;18:329–40.PubMed
30.
Zurück zum Zitat Decker GA, Swain JM, Crowell MD. Gastrointestinal and nutritional complications after bariatric surgery. Am J Gastroenterol. 2007;102:1–10.CrossRef Decker GA, Swain JM, Crowell MD. Gastrointestinal and nutritional complications after bariatric surgery. Am J Gastroenterol. 2007;102:1–10.CrossRef
Metadaten
Titel
Prevalence of Iron, Folate, and Vitamin B12 Deficiency Anemia After Laparoscopic Roux-en-Y Gastric Bypass
verfasst von
Angel G. Vargas-Ruiz
Gabriela Hernández-Rivera
Miguel F. Herrera
Publikationsdatum
01.03.2008
Verlag
Springer-Verlag
Erschienen in
Obesity Surgery / Ausgabe 3/2008
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-007-9310-0

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