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01-02-2018 | Original Contributions

Comparison of Oral Iron Supplement Formulations for Normalization of Iron Status Following Roux-EN-y Gastric Bypass Surgery: a Randomized Trial

Authors: Renee A. Mischler, Seth M. Armah, Bruce A. Craig, Arthur D. Rosen, Ambar Banerjee, Don J. Selzer, Jennifer N. Choi, Nana Gletsu-Miller

Published in: Obesity Surgery | Issue 2/2018

Abstract

Background

The evidence behind recommendations for treatment of iron deficiency (ID) following roux-en-y gastric bypass surgery (RYGB) lacks high quality studies.

Setting

Academic, United States

Objective

The objective of the study is to compare the effectiveness of oral iron supplementation using non-heme versus heme iron for treatment of iron deficiency in RYGB patients.

Methods

In a randomized, single-blind study, women post-RYGB and iron deficient received non-heme iron (FeSO₄, 195 mg/day) or heme iron (heme-iron-polypeptide, HIP, 31.5 to 94.5 mg/day) for 8 weeks. Measures of iron status, including blood concentrations of ferritin, soluble transferrin receptor (sTfR), and hemoglobin, were assessed.

Results

At baseline, the mean ± standard deviation for age, BMI, and years since surgery of the sample was 41.5 ± 6.8 years, 34.4 ± 5.9 kg/m², and 6.9 ± 3.1 years, respectively; and there were no differences between FeSO₄ (N = 6) or HIP (N = 8) groups. Compliance was greater than 94%. The study was stopped early due to statistical and clinical differences between groups. Values before and after FeSO₄ supplementation, expressed as least square means (95% CI) were hemoglobin, 10.8 (9.8, 11.9) to 13.0 (11.9, 14.0) g/dL; sTfR, 2111 (1556, 2864) to 1270 (934, 1737) μg/L; ferritin, 4.9 (3.4, 7.2) to 15.5 (10.6, 22.6) μg/L; and sTfR:ferritin ratio, 542 (273, 1086) to 103 (51, 204); all p < 0.0001. With HIP supplementation, no change was observed in any of the iron status biomarkers (all p > 0.05).

Conclusions

In accordance with recommendations, oral supplementation using FeSO₄, but not HIP, was efficacious for treatment of iron deficiency after RYGB.

Gletsu-Miller N, Wright BN. Mineral malnutrition following bariatric surgery. Adv Nutr. 2013;4(5):506–17. doi:10.3945/an.113.004341.CrossRefPubMedPubMedCentral

American-Society-for-Metabolic-and-Bariatric-Surgery. Internet: http://s3.amazonaws.com/publicASMBS/Resources/Fact-Sheets/Metabolic-Bariatric-Surgery-Fact-Sheet-ASMBS2012.pdf. Accessed 20 May 2013.

Mercachita T, Santos Z, Limao J, et al. Anthropometric evaluation and micronutrients intake in patients submitted to laparoscopic roux-en-Y gastric bypass with a postoperative period of >/= 1 year. Obes Surg. 2014;24(1):102–8. doi:10.1007/s11695-013-1057-1.CrossRefPubMed

Moize V, Andreu A, Flores L, et al. Long-term dietary intake and nutritional deficiencies following sleeve gastrectomy or Roux-En-Y gastric bypass in a mediterranean population. J Acad Nutr Diet. 2013;113(3):400–10. doi:10.1016/j.jand.2012.11.013.CrossRefPubMed

Wright BN, Gletsu-Miller N. Iron nutrition following bariatric surgery. Bariatric Surg Pract Patient Care. 2015;10(1):3–11. doi:10.1089/bari.2014.0038.CrossRef

Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23(4):427–36. doi:10.1007/s11695-012-0864-0.CrossRefPubMed

Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366(17):1577–85.CrossRefPubMed

Sjostrom L. Review of the key results from the Swedish obese subjects (SOS) trial—a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273(3):219–34. doi:10.1111/joim.12012.CrossRefPubMed

Aarts EO, van Wageningen B, Janssen IM, et al. Prevalence of anemia and related deficiencies in the first year following laparoscopic gastric bypass for morbid obesity. J Obes. 2012;2012:193705. doi:10.1155/2012/193705.CrossRefPubMedPubMedCentral

10.

Ruz M, Carrasco F, Rojas P, et al. Iron absorption and iron status are reduced after Roux-en-Y gastric bypass. Am J Nutr. 2009;90:527–32.CrossRef

11.

Gudzune KA, Huizinga MM, Chang HY, et al. Screening and diagnosis of micronutrient deficiencies before and after bariatric surgery. Obes Surg. 2013; doi:10.1007/s11695-013-0919-x.

12.

van der Beek ES, Monpellier VM, Eland I, et al. Nutritional deficiencies in gastric bypass patients; incidence, time of occurrence and implications for post-operative surveillance. Obes Surg. 2014; doi:10.1007/s11695-014-1456-y.

13.

King WC, Chen JY, Belle SH, et al. Change in pain and physical function following bariatric surgery for severe obesity. JAMA. 2016;315(13):1362–71. doi:10.1001/jama.2016.3010.CrossRefPubMedPubMedCentral

14.

Karefylakis C, Naslund I, Edholm D, et al. Prevalence of anemia and related deficiencies 10 years after gastric bypass-a retrospective study. Obes Surg. 2014; doi:10.1007/s11695-014-1500-y.

15.

Ruiz-Tovar J, Oller I, Llavero C, et al. Hair loss in females after sleeve gastrectomy: predictive value of serum zinc and iron levels. Am Surg. 2014;80(5):466–71.PubMed

16.

Kushner RF, Gleason B, Shanta-Retelny V. Reemergence of pica following gastric bypass surgery for obesity: a new presentation of an old problem. J Am Diet Assoc. 2004;104(9):1393–7. doi:10.1016/j.jada.2004.06.026.CrossRefPubMed

17.

Malone M, Alger-Mayer S, Lindstrom J, et al. Management of iron deficiency and anemia after Roux-en-Y gastric bypass surgery: an observational study. Surg Obes Relat Dis. 2013;9(6):969–74. doi:10.1016/j.soard.2013.01.019.CrossRefPubMed

18.

Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient-2013 update: cosponsored by american association of clinical endocrinologists, the obesity society, and american society for metabolic & bariatric surgery*. Obesity (Silver Spring). 2013;21(Suppl 1):S1–S27. doi:10.1002/oby.20461.CrossRef

19.

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. doi:10.1038/oby.2009.28.

20.

Brolin 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;133(7):740–4.CrossRefPubMed

21.

Rhode BM, Shustik C, Christou NV, et al. Iron absorption and therapy after gastric bypass. Obes Surg. 1999;9(1):17–21. doi:10.1381/096089299765553656.CrossRefPubMed

22.

Varma S, Baz W, Badine E, et al. Need for parenteral iron therapy after bariatric surgery. Surg Obes Relat Dis. 2008;4(6):715–9. doi:10.1016/j.soard.2008.04.015.CrossRefPubMed

23.

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(4):447–53. doi:10.1007/s11695-009-0068-4.CrossRefPubMed

24.

Vargas-Ruiz AG, Hernandez-Rivera G, Herrera MF. Prevalence of iron, folate, and vitamin B12 deficiency anemia after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2008;18:288–93.CrossRefPubMed

25.

Ruz M, Carrasco F, Rojas P, et al. Heme- and nonheme-iron absorption and iron status 12 mo after sleeve gastrectomy and roux-en-y gastric bypass in morbidly obese women. Am J Clin Nutr. 2012;96:810–7.CrossRefPubMed

26.

Gesquiere I, Lannoo M, Augustijns P, et al. Iron deficiency after Roux-en-Y gastric bypass: insufficient iron absorption from oral iron supplements. Obes Surg. 2014;24(1):56–61. doi:10.1007/s11695-013-1042-8.CrossRefPubMed

27.

Edholm D, Svensson F, Naslund I, et al. Long-term results 11 years after primary gastric bypass in 384 patients. Surg Obes Relat Dis. 2013;9(5):708–13. doi:10.1016/j.soard.2012.02.011.CrossRefPubMed

28.

Dalcanale L, Oliveira CP, Faintuch J, et al. Long-term nutritional outcome after gastric bypass. Obes Surg. 2010;20(2):181–7. doi:10.1007/s11695-009-9916-5.CrossRefPubMed

29.

Sahebzamani FM, Berarducci A, Murr MM. Malabsorption anemia and iron supplement induced constipation in post-Roux-en-Y gastric bypass (RYGB) patients. J Am Assoc Nurse Pract. 2013;25(12):634–40. doi:10.1002/2327-6924.12079.PubMed

30.

Mischler RA, Armah SM, Wright BN, et al. Influence of diet and supplements on iron status after gastric bypass surgery. Surg Obes Relat Dis. 2016;12(3):651–8. doi:10.1016/j.soard.2015.09.007.CrossRefPubMed

31.

Seligman PA, Moore GM, Schleicher RB. Clinical studies of HIP: an oral heme-iron product. Nutr Res. 2000;20:1279–86.CrossRef

32.

Dull RB, Davis E. Heme iron polypeptide for the management of anaemia of chronic kidney disease. J Clin Pharm Ther. 2015;40(4):386–90. doi:10.1111/jcpt.12281.CrossRefPubMed

33.

Clark SF. Iron deficiency anemia: diagnosis and management. Curr Opin Gasteroenterol. 2009;25:122–8.CrossRef

34.

Iron W-RM. Edtion ed. In: Ross AC, Caballero B, Cousins RJ, Tucker KL, Ziegler TR, editors. Modern nutrition in health and disease. Baltimore: Lippincott Williams & Wilkins; 2014. p. 176–88.

35.

Serfass RE, Reddy MB. Breast milk fractions solubilize Fe(III) and enhance iron flux across Caco-2 cells. J Nutr. 2003;133(2):449–55.CrossRefPubMed

36.

Anonymous. Internet: https://www.consumerlab.com/results/hometest.asp. Accessed 12 Sept 2016.

37.

Janssen CA, Scholten PC, Heintz AP. A simple visual assessment technique to discriminate between menorrhagia and normal menstrual blood loss. Obstet Gynecol. 1995;85(6):977–82. doi:10.1016/0029-7844(95)00062-v.CrossRefPubMed

38.

R-Core-Team. Internet: http://www.R-project.org/. Accessed 26 May 2015.

39.

Tolkien Z, Stecher L, Mander AP, et al. Ferrous sulfate supplementation causes significant gastrointestinal side-effects in adults: a systematic review and meta-analysis. PLoS One. 2015;10(2):e0117383. doi:10.1371/journal.pone.0117383.CrossRefPubMedPubMedCentral

Title: Comparison of Oral Iron Supplement Formulations for Normalization of Iron Status Following Roux-EN-y Gastric Bypass Surgery: a Randomized Trial
Authors: Renee A. Mischler
Seth M. Armah
Bruce A. Craig
Arthur D. Rosen
Ambar Banerjee
Don J. Selzer
Jennifer N. Choi
Nana Gletsu-Miller
Publication date: 01-02-2018
Publisher: Springer US
Published in: Obesity Surgery / Issue 2/2018
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-017-2858-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Comparison of Oral Iron Supplement Formulations for Normalization of Iron Status Following Roux-EN-y Gastric Bypass Surgery: a Randomized Trial

Abstract

Background

Setting

Objective

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Setting

Objective

Methods

Results

Conclusions

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