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Obesity Surgery

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01-06-2018 | Original Contributions

Evaluation of Nutritional Status Post Laparoscopic Sleeve Gastrectomy—5-Year Outcomes

Authors: Aliaa Al-Mutawa, Salman Al-Sabah, Alfred Kojo Anderson, Mohammad Al-Mutawa

Published in: Obesity Surgery | Issue 6/2018

Abstract

Introduction

Obesity is considered a public health problem and has led to advancements in bariatric surgery. Laparoscopic sleeve gastrectomy (LSG) had become the most performed procedure worldwide; however, its consequences on nutritional status in the short and long term are of concern.

Methods

A retrospective analysis of medical records and bariatric database of patients who underwent LSG from October 2008–September 2015 at Al-Amiri Hospital, Kuwait, was performed. Data regarding nutritional status along with demographic data were collected over a 5-year follow-up period.

Results

One thousand seven hundred ninety-three patients comprising of 74% females and 26% males were included. The greatest % total body weight loss (%TBWL) was at 18 months post-LSG (33%), corresponding to a % excess weight loss (%EWL) of 73.8%. With regard to nutritional status, vitamin B1 showed a significant drop at 3–5 years post-op in comparison to pre-op value, but stayed within the normal range throughout the study. Red blood cells count, hemoglobin, and hematocrit also showed a significant drop starting from 6 months post-op until the fifth year of follow-up. On the other hand, vitamins B6 and B12 showed a significant increase at 6 months post-op and decreased afterwards, but did not reach pre-op values. Vitamin D also showed a significant increase throughout the study period from deficient value at the pre-op time, but remained insufficient. Albumin, transferrin, folate, ferritin, iron, and vitamin B2 showed no significant changes at 5 years post-LSG compared to pre-op values.

Conclusion

Little is known about the nutritional status and optimal nutritional care plan post-LSG, especially in the longer term. Nutritional deficiencies were prevalent prior and post-LSG. Some of the nutritional parameters improved and even reached the abnormal high level post-LSG. These observations highlight the importance of pre- and post-operative nutritional assessment and tailored supplementation to ensure optimal nutritional status.

World Health Organization. (2017). GHO | By category | Overweight (body mass index ≥ 25), age-standardized (%) - Global estimates. .who.int. Retrieved 3 April 2017, from http://apps.who.int/gho/data/view.main.GLOBAL2461A?lang=en.

World Health Organization. (2016). Obesity and overweight. World Health Organization. Retrieved 17 January 2017, from http://www.who.int/mediacentre/factsheets/fs311/en/.

Lehnert T, Sonntag D, Konnopka A, et al. Economic costs of overweight and obesity. Best Pract Res Clin Endocrinol Metab. 2013;27(2):105–15. https://doi.org/10.1016/j.beem.2013.01.002.

Whitlock G, Lewington S, Sherliker P, et al. Body-mass index and cause-specific mortality in 900,000 adults: collaborative analyses of 57 prospective studies. Obstet Gynecol Surv. 2009;64(9):602–4.

Renehan A, Tyson M, Egger M, et al. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. 2008;371(9612):569–78. https://doi.org/10.1016/S0140-6736(08)60269-X.

Colquitt JL, Picot J, Loveman E, et al. Surgery for obesity. Cochrane Database Syst Rev. 2009;2(2) https://doi.org/10.1002/14651858.CD003641.pub3.

Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37. https://doi.org/10.1001/jama.292.14.1724.

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

Ben-Porat T, Elazary R, Yuval J, et al. Nutritional deficiencies after sleeve gastrectomy: can they be predicted preoperatively? Surg Obes Relat Dis. 2015;11(5):1029–36. https://doi.org/10.1016/j.soard.2015.02.018.

10.

van Rutte P, Aarts E, Smulders J, et al. Nutrient deficiencies before and after sleeve gastrectomy. Obes Surg. 2014;24(10):1639–46. https://doi.org/10.1007/s11695-014-1225-y.

11.

Coupaye M, Rivière P, Breuil M, et al. Comparison of nutritional status during the first year after sleeve gastrectomy and roux-en-Y gastric bypass. Obes Surg. 2014;24(2):276–83. https://doi.org/10.1007/s11695-013-1089-6.

12.

Trastulli S, Desiderio J, Guarino S, et al. Laparoscopic sleeve gastrectomy compared with other bariatric surgical procedures: a systematic review of randomized trials. Surg Obes Relat Dis. 2013;9(5):816–29. https://doi.org/10.1016/j.soard.2013.05.007.

13.

Gagner M, Deitel M, Erickson A, et al. Survey on laparoscopic sleeve gastrectomy (LSG) at the Fourth International Consensus Summit on Sleeve Gastrectomy. Obes Surg. 2013;23(12):2013–7. https://doi.org/10.1007/s11695-013-1040-x.

14.

Shi X, Karmali S, Sharma A, et al. A review of laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg. 2010;20(8):1171–7. https://doi.org/10.1007/s11695-010-0145-8.

15.

Moizé V, Deulofeu R, Torres F, et al. Nutritional intake and prevalence of nutritional deficiencies prior to surgery in a Spanish morbidly obese population. Obes Surg. 2011;21(9):1382–8. https://doi.org/10.1007/s11695-011-0360-y.

16.

Saif T, Strain G, Dakin G, et al. Evaluation of nutrient status after laparoscopic sleeve gastrectomy 1, 3, and 5 years after surgery. Surg Obes Relat Dis. 2012;8(5):542–7. https://doi.org/10.1016/j.soard.2012.01.013.

17.

Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357(3):266–81. https://doi.org/10.1056/NEJMra070553.CrossRefPubMed

18.

Aarts E, Janssen I, Berends F. The gastric sleeve: losing weight as fast as micronutrients? Obes Surg. 2011;21(2):207–11. https://doi.org/10.1007/s11695-010-0316-7.CrossRefPubMed

19.

Faria S, Faria O, Buffington C, et al. Dietary protein intake and bariatric surgery patients: a review. Obes Surg. 2011;21(11):1798–805. https://doi.org/10.1007/s11695-011-0441-y.

20.

Poitou Bernert C, Ciangura C, Coupaye M, et al. Nutritional deficiency after gastric bypass: diagnosis, prevention and treatment. Diabetes Metab. 2007;33(1):13–24. https://doi.org/10.1016/j.diabet.2006.11.004.

21.

Verger E, Aron-Wisnewsky J, Dao M, et al. Micronutrient and protein deficiencies after gastric bypass and sleeve gastrectomy: a 1-year follow-up. Obes Surg. 2016;26(4):785–96. https://doi.org/10.1007/s11695-015-1803-7.

22.

Mahan L, Escott-Stump S. Krause’s food & nutrition therapy. 12th ed. St. Louis: Saunders/Elsevier; 2008. p. 84–85, 1229.

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. https://doi.org/10.1007/s11695-009-0068-4.

24.

Gastaldi G, Casirola D, Ferrari G, et al. Effect of chronic ethanol administration on thiamine transport in microvillous vesicles of rat small intestine. Alcohol Alcohol. 1989;24(2):83–9. https://doi.org/10.1093/oxfordjournals.alcalc.a044888.

25.

Alsabah A, Al Sabah S, Al-Sabah S, et al. Investigating factors involved in post laparoscopic sleeve gastrectomy (LSG) neuropathy. Obes Surg. 2016;26(10):2302–7. https://doi.org/10.1007/s11695-016-2119-y.

26.

Damms-Machado A, Friedrich A, Kramer K, et al. Pre- and postoperative nutritional deficiencies in obese patients undergoing laparoscopic sleeve gastrectomy. Obes Surg. 2012;22(6):881–9. https://doi.org/10.1007/s11695-012-0609-0.

27.

Coburn SP, Lewis DL, Fink WJ, et al. Human vitamin B-6 pools estimated through muscle biopsies. Am J Clin Nutr. 1988;48(2):291–4.

28.

Alexandrou A, Armeni E, Kouskouni E, et al. Cross-sectional long-term micronutrient deficiencies after sleeve gastrectomy versus Roux-en-Y gastric bypass: a pilot study. Surg Obes Relat Dis. 2014;10(2):262–8. https://doi.org/10.1016/j.soard.2013.07.014.

29.

Gillon S, Jeanes Y, Andersen J, et al. Micronutrient status in morbidly obese patients prior to laparoscopic sleeve gastrectomy and micronutrient changes 5 years post-surgery. Obes Surg. 2016;27(3):606–12.

30.

Zarshenas N, Nacher M, Loi K, et al. Investigating nutritional deficiencies in a group of patients 3 years post laparoscopic sleeve gastrectomy. Obes Surg. 2016;26(12):2936–43. https://doi.org/10.1007/s11695-016-2211-3.

31.

Brolin R, Gorman J, Gorman R, et al. Prophylactic iron supplementation after Roux-en-Y gastric bypass. Arch Surg. 1998;133(7):740–4. https://doi.org/10.1001/archsurg.133.7.740.

32.

Shane B, Stokstad E. Vitamin B12-folate interrelationships. Annu Rev Nutr. 1985;5(1):115–41. https://doi.org/10.1146/annurev.nu.05.070185.000555.CrossRefPubMed

33.

Gjessing H, Nielsen H, Mellgren G, et al. Energy intake, nutritional status and weight reduction in patients one year after laparoscopic sleeve gastrectomy. Spring. 2013;2(1):352. https://doi.org/10.1186/2193-1801-2-352.

34.

Al-Mulhim A. Laparoscopic sleeve gastrectomy and nutrient deficiencies. Surg Laparosc Endosc Percutan Tech. 2016;26(3):208–11. https://doi.org/10.1097/SLE.0000000000000270.CrossRefPubMed

35.

Alvarez-Leite J. Nutrient deficiencies secondary to bariatric surgery. Curr Opin Clin Nutr Metab Care. 2004;7(5):569–75. https://doi.org/10.1097/00075197-200409000-00010.CrossRefPubMed

36.

Elliot K. Nutritional considerations after bariatric surgery. Crit Care Nurs Q. 2003;26(2):133–8. https://doi.org/10.1097/00002727-200304000-00007.CrossRefPubMed

37.

Long A, Atwell C, Yoo W, et al. Vitamin B12 deficiency associated with concomitant metformin and proton pump inhibitor use. Diabetes Care. 2012;35(12):e84–4. https://doi.org/10.2337/dc12-0980.

38.

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. 2011;19(3):588–94. https://doi.org/10.1038/oby.2010.239.

39.

Blum M, Dolnikowski G, Seyoum E, et al. Vitamin D3 in fat tissue. Endocrine. 2008;33(1):90–4. https://doi.org/10.1007/s12020-008-9051-4.

40.

Hakeam H, O’Regan P, Salem A, et al. Impact of laparoscopic sleeve gastrectomy on iron indices: 1 year follow-up. Obes Surg. 2009;19(11):1491–6. https://doi.org/10.1007/s11695-009-9919-2.

41.

Melissas J, Koukouraki S, Askoxylakis J, et al. Sleeve gastrectomy—a restrictive procedure? Obes Surg. 2007;17(1):57–62. https://doi.org/10.1007/s11695-007-9006-5.

42.

Stein J, Stier C, Raab H, et al. Review article: the nutritional and pharmacological consequences of obesity surgery. Aliment Pharmacol Ther. 2014;40(6):582–609. https://doi.org/10.1111/apt.12872.

43.

Aasheim E. Wernicke encephalopathy after bariatric surgery: a systematic review. Ann Surg. 2008;248(5):714–20. https://doi.org/10.1097/SLA.0b013e3181884308.PubMedCrossRef

Title: Evaluation of Nutritional Status Post Laparoscopic Sleeve Gastrectomy—5-Year Outcomes
Authors: Aliaa Al-Mutawa
Salman Al-Sabah
Alfred Kojo Anderson
Mohammad Al-Mutawa
Publication date: 01-06-2018
Publisher: Springer US
Published in: Obesity Surgery / Issue 6/2018
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-017-3041-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Evaluation of Nutritional Status Post Laparoscopic Sleeve Gastrectomy—5-Year Outcomes

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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