Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Obesity Surgery
Published in: Obesity Surgery 6/2012

01-06-2012 | Clinical Research

Pre- and Postoperative Nutritional Deficiencies in Obese Patients Undergoing Laparoscopic Sleeve Gastrectomy

Authors: Antje Damms-Machado, Asja Friedrich, Klaus Michael Kramer, Katrin Stingel, Tobias Meile, Markus A. Küper, Alfred Königsrainer, Stephan C. Bischoff

Published in: Obesity Surgery | Issue 6/2012

Login to get access

Abstract

Background

Laparoscopic sleeve gastrectomy (LSG) has been identified as an innovative surgical approach for the treatment of obesity and is increasingly applied worldwide. However, data on outcome of LSG regarding nutrient deficiencies, protein status, and body composition are scarce.

Methods

Obese subjects (54; f:m = 4:1) scheduled for LSG were included in this study. Micronutrient analysis, protein status assessment, and bioimpedance measures were performed before and 1, 3, 6, and 12 months after LSG.

Results

In 51% of the subjects, at least one micronutrient deficiency was found prior to surgery. Baseline concentrations were below normal for 25-OH vitamin D (27%), iron (29%), vitamin B6 (11%), vitamin B12 (9%), folate (6%), and potassium (7%). Frequencies of deficiencies for vitamin B12, folate, iron, and vitamin B6 tended to increase following LSG within the first year after intervention. Also, parameters of protein status (albumin, transferrin, cholinesterase, and total protein) decreased. After surgery, bioimpedance measures indicated a reduction of total body fat, but also of body cell mass.

Conclusions

Preoperative micronutrient deficiencies were common in morbid obese individuals scheduled for LSG. LSG had a modest effect on micronutrient status by further reducing iron, vitamin B12, vitamin B6, and folate within the first year after intervention. Our data suggest that especially obese patients with preoperative deficits require control and supplementation of micronutrients and protein in the postoperative period. ClinicalTrials.gov identifier: NCT01344525
Literature
1.
Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.PubMedCrossRef
2.
Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–52.PubMedCrossRef
3.
Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142:547–59.PubMed
4.
Shi X, Karmali S, Sharma AM, et al. A review of laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg. 2010;20:1171–7.PubMedCrossRef
5.
Aggarwal S, Kini SU, Herron DM. Laparoscopic sleeve gastrectomy for morbid obesity: a review. Surg Obes Relat Dis. 2007;3:189–94.PubMedCrossRef
6.
Davies DJ, Baxter JM, Baxter JN. Nutritional deficiencies after bariatric surgery. Obes Surg. 2007;17:1150–8.PubMedCrossRef
7.
Toh SY, Zarshenas N, Jorgensen J. Prevalence of nutrient deficiencies in bariatric patients. Nutrition. 2009;25:1150–6.PubMedCrossRef
8.
Weiner RA, Weiner S, Pomhoff I, et al. Laparoscopic sleeve gastrectomy—influence of sleeve size and resected gastric volume. Obes Surg. 2007;17:1297–305.PubMedCrossRef
9.
Papailiou J, Albanopoulos K, Toutouzas KG, et al. Morbid obesity and sleeve gastrectomy: how does it work? Obes Surg. 2010;20:1448–55.PubMedCrossRef
10.
Ariyasu H, Takaya K, Tagami T, et al. Stomach is a major source of circulating ghrelin, and feeding state determines plasma ghrelin-like immunoreactivity levels in humans. J Clin Endocrinol Metab. 2001;86:4753–8.PubMedCrossRef
11.
Langer FB, Reza Hoda MA, Bohdjalian A, et al. Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg. 2005;15:1024–9.PubMedCrossRef
12.
Melissas J, Koukouraki S, Askoxylakis J, et al. Sleeve gastrectomy: a restrictive procedure? Obes Surg. 2007;17:57–62.PubMedCrossRef
13.
Bernstine H, Tzioni-Yehoshua R, Groshar D, et al. Gastric emptying is not affected by sleeve gastrectomy—scintigraphic evaluation of gastric emptying after sleeve gastrectomy without removal of the gastric antrum. Obes Surg. 2009;19:293–8.PubMedCrossRef
14.
Braghetto I, Davanzo C, Korn O, et al. Scintigraphic evaluation of gastric emptying in obese patients submitted to sleeve gastrectomy compared to normal subjects. Obes Surg. 2009;19:1515–21.PubMedCrossRef
15.
Aasheim ET, Hofso D, Hjelmesaeth J, et al. Vitamin status in morbidly obese patients: a cross-sectional study. Am J Clin Nutr. 2008;87:362–9.PubMed
16.
Ernst B, Thurnheer M, Schmid SM, et al. Evidence for the necessity to systematically assess micronutrient status prior to bariatric surgery. Obes Surg. 2009;19:66–73.PubMedCrossRef
17.
Flancbaum L, Belsley S, Drake V, et al. Preoperative nutritional status of patients undergoing Roux-en-Y gastric bypass for morbid obesity. J Gastrointest Surg. 2006;10:1033–7.PubMedCrossRef
18.
Schweiger C, Weiss R, Berry E, et al. Nutritional deficiencies in bariatric surgery candidates. Obes Surg. 2010;20:193–7.PubMedCrossRef
19.
Runkel N, Colombo-Benkmann M, Huttl TP, et al. Bariatric surgery. Dtsch Arztebl Int. 2011;108:341–6.PubMed
20.
Kueper MA, Kramer KM, Kirschniak A, et al. Laparoscopic sleeve gastrectomy: standardized technique of a potential stand-alone bariatric procedure in morbidly obese patients. World J Surg. 2008;32:1462–5.PubMedCrossRef
21.
Dittmar M, Reber H. Validation of different bioimpedance analyzers for predicting cell mass against whole-body counting of potassium (40 K) as a reference method. Am J Hum Biol. 2004;16:697–703.PubMedCrossRef
22.
Melissas J, Daskalakis M, Koukouraki S, et al. Sleeve gastrectomy—a “food limiting” operation. Obes Surg. 2008;18:1251–6.PubMedCrossRef
23.
Gagner M. Faster gastric emptying after laparoscopic sleeve gastrectomy. Obes Surg. 2010;20:964–5. author reply 966–967.PubMedCrossRef
24.
Snyder-Marlow G, Taylor D, Lenhard MJ. Nutrition care for patients undergoing laparoscopic sleeve gastrectomy for weight loss. J Am Diet Assoc. 2010;110:600–7.PubMedCrossRef
25.
Ziegler O, Sirveaux MA, Brunaud L, et al. Medical follow up after bariatric surgery: nutritional and drug issues. General recommendations for the prevention and treatment of nutritional deficiencies. Diabetes Metab. 2009;35:544–57.PubMedCrossRef
26.
Fried M, Hainer V, Basdevant A, et al. Inter-disciplinary European guidelines on surgery of severe obesity. Int J Obes (Lond). 2007;31:569–77.
27.
Mechanick JI, Kushner RF, Sugerman HJ, et al. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Obesity (Silver Spring). 2009;17 Suppl 1:S1–70. v.
28.
Gehrer S, Kern B, Peters T, et al. Fewer nutrient deficiencies after laparoscopic sleeve gastrectomy (LSG) than after laparoscopic Roux-Y-gastric bypass (LRYGB)—a prospective study. Obes Surg. 2010;20:447–53.PubMedCrossRef
29.
Aarts EO, Janssen IM, Berends FJ. The gastric sleeve: losing weight as fast as micronutrients? Obes Surg. 2011;21:207–11.PubMedCrossRef
30.
Kimmons JE, Blanck HM, Tohill BC, et al. Associations between body mass index and the prevalence of low micronutrient levels among US adults. Med Gen Med. 2006;8:59.
31.
Kaidar-Person O, Person B, Szomstein S, et al. Nutritional deficiencies in morbidly obese patients: a new form of malnutrition? Part B: minerals. Obes Surg. 2008;18:1028–34.PubMedCrossRef
32.
Kaidar-Person O, Person B, Szomstein S, et al. Nutritional deficiencies in morbidly obese patients: a new form of malnutrition? Part A: vitamins. Obes Surg. 2008;18:870–6.PubMedCrossRef
33.
Himpens J, Dapri G, Cadiere GB. A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg. 2006;16:1450–6.PubMedCrossRef
34.
Hakeam HA, O’Regan PJ, Salem AM, et al. Impact of laparoscopic sleeve gastrectomy on iron indices: 1 year follow-up. Obes Surg. 2009;19:1491–6.PubMedCrossRef
35.
Pfeiffer CM, Johnson CL, Jain RB, et al. Trends in blood folate and vitamin B-12 concentrations in the United States, 1988 2004. Am J Clin Nutr. 2007;86:718–27.PubMed
36.
Stabler SP, Allen RH. Vitamin B12 deficiency as a worldwide problem. Annu Rev Nutr. 2004;24:299–326.PubMedCrossRef
37.
Haynes WG. Hyperhomocysteinemia, vascular function and atherosclerosis: effects of vitamins. Cardiovasc Drugs Ther. 2002;16:391–9.PubMedCrossRef
38.
Kennedy DA, Stern SJ, Moretti M, et al. Folate intake and the risk of colorectal cancer: a systematic review and meta-analysis. Cancer Epidemiol. 2011;35:2–10.PubMedCrossRef
39.
Stanger O, Fowler B, Piertzik K, et al. Homocysteine, folate and vitamin B12 in neuropsychiatric diseases: review and treatment recommendations. Expert Rev Neurother. 2009;9:1393–412.PubMedCrossRef
40.
Malouf M, Grimley EJ, Areosa SA. Folic acid with or without vitamin B12 for cognition and dementia. Cochrane Database Syst Rev. 2003:CD004514.
41.
Allen LH. Causes of vitamin B12 and folate deficiency. Food Nutr Bull. 2008;29:S20–34. discussion S35-27.PubMed
42.
Oppenheimer SJ. Iron and its relation to immunity and infectious disease. J Nutr. 2001;131:616S–33S. discussion 633S–635S.PubMed
43.
Spinneker A, Sola R, Lemmen V, et al. Vitamin B6 status, deficiency and its consequences—an overview. Nutr Hosp. 2007;22:7–24.PubMed
44.
Mawer EB, Backhouse J, Holman CA, et al. The distribution and storage of vitamin D and its metabolites in human tissues. Clin Sci. 1972;43:413–31.PubMed
45.
Lin E, Armstrong-Moore D, Liang Z, et al. Contribution of adipose tissue to plasma 25-hydroxyvitamin D concentrations during weight loss following gastric bypass surgery. Obesity (Silver Spring). 2011;19:588–94.CrossRef
46.
Pramyothin P, Biancuzzo RM, Lu Z, et al. Vitamin D in adipose tissue and serum 25-hydroxyvitamin D after Roux-en-Y gastric bypass. Obesity (Silver Spring). 2011.
47.
Ashwell M, Stone EM, Stolte H, et al. UK Food Standards Agency Workshop Report: an investigation of the relative contributions of diet and sunlight to vitamin D status. Br J Nutr. 2010;104:603–11.PubMedCrossRef
48.
Macdonald HM, Mavroeidi A, Fraser WD, et al. Sunlight and dietary contributions to the seasonal vitamin D status of cohorts of healthy postmenopausal women living at northerly latitudes: a major cause for concern? Osteoporos Int. 2011;22:2461–72.PubMedCrossRef
49.
Gasteyger C, Suter M, Gaillard RC, et al. Nutritional deficiencies after Roux-en-Y gastric bypass for morbid obesity often cannot be prevented by standard multivitamin supplementation. Am J Clin Nutr. 2008;87:1128–33.PubMed
50.
Ledoux S, Msika S, Moussa F, et al. Comparison of nutritional consequences of conventional therapy of obesity, adjustable gastric banding, and gastric bypass. Obes Surg. 2006;16:1041–9.PubMedCrossRef
51.
McClung JP, Karl JP. Iron deficiency and obesity: the contribution of inflammation and diminished iron absorption. Nutr Rev. 2009;67:100–4.PubMedCrossRef
52.
Chaston TB, Dixon JB, O’Brien PE. Changes in fat-free mass during significant weight loss: a systematic review. Int J Obes (Lond). 2007;31:743–50.
53.
Strain GW, Gagner M, Pomp A, et al. Comparison of weight loss and body composition changes with four surgical procedures. Surg Obes Relat Dis. 2009;5:582–7.PubMedCrossRef
54.
Andreu A, Moize V, Rodriguez L, et al. Protein intake, body composition, and protein status following bariatric surgery. Obes Surg. 2010;20:1509–15.PubMedCrossRef
55.
Giusti V, Suter M, Heraief E, et al. Effects of laparoscopic gastric banding on body composition, metabolic profile and nutritional status of obese women: 12-months follow-up. Obes Surg. 2004;14:239–45.PubMedCrossRef
56.
Strauss BJ, Marks SJ, Growcott JP, et al. Body composition changes following laparoscopic gastric banding for morbid obesity. Acta Diabetol. 2003;40 Suppl 1:S266–269.PubMedCrossRef
Metadata
Title
Pre- and Postoperative Nutritional Deficiencies in Obese Patients Undergoing Laparoscopic Sleeve Gastrectomy
Authors
Antje Damms-Machado
Asja Friedrich
Klaus Michael Kramer
Katrin Stingel
Tobias Meile
Markus A. Küper
Alfred Königsrainer
Stephan C. Bischoff
Publication date
01-06-2012
Publisher
Springer-Verlag
Published in
Obesity Surgery / Issue 6/2012
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-012-0609-0

Other articles of this Issue 6/2012

Obesity Surgery 6/2012 Go to the issue

Clinical Research

Screening of Adult ADHD Among Patients Presenting for Bariatric Surgery

Invited Commentary

Functional Importance of Laparoscopic Sleeve Gastrectomy for the Lower Esophageal Sphincter in Patients with Morbid Obesity

Clinical Research

Intragastric Balloon Fundal or Antral Position Affects Weight Loss and Tolerability

Review

Optimizing Perioperative Care in Bariatric Surgery Patients

Clinical Research

Attendance at Clinical Visits Predicts Weight Loss After Gastric Bypass Surgery

Clinical Report

Classification and Management of Leaks after Gastric Bypass for Patients with Morbid Obesity: A Prospective Study of 60 Patients