BACKGROUND: Concerns regarding nutritional deficiencies have recently emerged after Roux-en-Y gastric bypass (RYGB). METHODS: A total of 835 subjects underwent RYGB, age 43.3 years, body mass index (BMI) 47.2 kg/m(2). Hematological and calcium metabolic variables were measured before, 6, 12, and 24 months after surgery. Daily supplement of 800 mg calcium, 800 U vitamin D, a multivitamin, and a vitamin B12 injection (1 mg) every third month was recommended. In subjects with low ferritin and decreasing hemoglobin levels, oral, or intravenous iron was administered. RESULTS: Hemoglobin concentration decreased from before surgery to month 24 for both men (9.3 ± 0.05 vs. 8.3 ± 0.08 mmol/L, p < 0.001) and women (8.4 ± 0.03 vs. 7.7 ± 0.06 mmol/L, p < 0.001). At 24 months, anemia was present in 25.8 % of women and 22.1 % of men. Predictors of anemia in both sexes were baseline hemoglobin (p < 0.001), excessive weight loss in men, and younger age in women (p < 0.001). Plasma ferritin levels decreased in both sexes (p < 0.01), whereas concentrations of folic acid and vitamin B12 increased from before surgery to 24 months after surgery (p < 0.001). Vitamin D increased from baseline to month 24 in both sexes (p < 0.01). In women, PTH increased from baseline to month 24 (p < 0.05) with no changes in calcium or magnesium. CONCLUSIONS: Supplementation of calcium and vitamin D was sufficient. Iron substitution did not prevent anemia, which especially affected premenopausal women. More attention should be given to iron substitution after RYGB.
BACKGROUND: Concerns regarding nutritional deficiencies have recently emerged after Roux-en-Y gastric bypass (RYGB). METHODS: A total of 835 subjects underwent RYGB, age 43.3 years, body mass index (BMI) 47.2 kg/m(2). Hematological and calcium metabolic variables were measured before, 6, 12, and 24 months after surgery. Daily supplement of 800 mg calcium, 800 U vitamin D, a multivitamin, and a vitamin B12 injection (1 mg) every third month was recommended. In subjects with low ferritin and decreasing hemoglobin levels, oral, or intravenous iron was administered. RESULTS: Hemoglobin concentration decreased from before surgery to month 24 for both men (9.3 ± 0.05 vs. 8.3 ± 0.08 mmol/L, p < 0.001) and women (8.4 ± 0.03 vs. 7.7 ± 0.06 mmol/L, p < 0.001). At 24 months, anemia was present in 25.8 % of women and 22.1 % of men. Predictors of anemia in both sexes were baseline hemoglobin (p < 0.001), excessive weight loss in men, and younger age in women (p < 0.001). Plasma ferritin levels decreased in both sexes (p < 0.01), whereas concentrations of folic acid and vitamin B12 increased from before surgery to 24 months after surgery (p < 0.001). Vitamin D increased from baseline to month 24 in both sexes (p < 0.01). In women, PTH increased from baseline to month 24 (p < 0.05) with no changes in calcium or magnesium. CONCLUSIONS: Supplementation of calcium and vitamin D was sufficient. Iron substitution did not prevent anemia, which especially affected premenopausal women. More attention should be given to iron substitution after RYGB.
Authors: Lars Sjöström; Anna-Karin Lindroos; Markku Peltonen; Jarl Torgerson; Claude Bouchard; Björn Carlsson; Sven Dahlgren; Bo Larsson; Kristina Narbro; Carl David Sjöström; Marianne Sullivan; Hans Wedel Journal: N Engl J Med Date: 2004-12-23 Impact factor: 91.245
Authors: Torsten Olbers; Sofia Björkman; Ak Lindroos; Almantas Maleckas; Lars Lönn; Lars Sjöström; Hans Lönroth Journal: Ann Surg Date: 2006-11 Impact factor: 12.969
Authors: Ted D Adams; Lance E Davidson; Sheldon E Litwin; Ronette L Kolotkin; Michael J LaMonte; Robert C Pendleton; Michael B Strong; Russell Vinik; Nathan A Wanner; Paul N Hopkins; Richard E Gress; James M Walker; Tom V Cloward; R Tom Nuttall; Ahmad Hammoud; Jessica L J Greenwood; Ross D Crosby; Rodrick McKinlay; Steven C Simper; Sherman C Smith; Steven C Hunt Journal: JAMA Date: 2012-09-19 Impact factor: 56.272
Authors: Annette von Drygalski; Deborah A Andris; Peter R Nuttleman; Scott Jackson; John Klein; James R Wallace Journal: Surg Obes Relat Dis Date: 2010-05-08 Impact factor: 4.734
Authors: Thorsten Schinke; Arndt F Schilling; Anke Baranowsky; Sebastian Seitz; Robert P Marshall; Tilman Linn; Michael Blaeker; Antje K Huebner; Ansgar Schulz; Ronald Simon; Matthias Gebauer; Matthias Priemel; Uwe Kornak; Sandra Perkovic; Florian Barvencik; F Timo Beil; Andrea Del Fattore; Annalisa Frattini; Thomas Streichert; Klaus Pueschel; Anna Villa; Klaus-Michael Debatin; Johannes M Rueger; Anna Teti; Jozef Zustin; Guido Sauter; Michael Amling Journal: Nat Med Date: 2009-06 Impact factor: 53.440
Authors: Ted D Adams; Robert C Pendleton; Michael B Strong; Ronette L Kolotkin; James M Walker; Sheldon E Litwin; Wael K Berjaoui; Michael J LaMonte; Tom V Cloward; Erick Avelar; Theophilus E Owan; Robert T Nuttall; Richard E Gress; Ross D Crosby; Paul N Hopkins; Eliot A Brinton; Wayne D Rosamond; Gail A Wiebke; Frank G Yanowitz; Robert J Farney; R Chad Halverson; Steven C Simper; Sherman C Smith; Steven C Hunt Journal: Obesity (Silver Spring) Date: 2009-06-04 Impact factor: 5.002
Authors: J Fleischer; E M Stein; M Bessler; M Della Badia; N Restuccia; L Olivero-Rivera; D J McMahon; S J Silverberg Journal: J Clin Endocrinol Metab Date: 2008-07-22 Impact factor: 5.958
Authors: Kamal K Mahawar; Alastair Reid; Yitka Graham; Lindes Callejas-Diaz; Chetan Parmar; William Rj Carr; Neil Jennings; Rishi Singhal; Peter K Small Journal: Obes Surg Date: 2018-07 Impact factor: 4.129
Authors: Hannes Beiglböck; Paul Fellinger; Tamara Ranzenberger-Haider; Bianca Itariu; Gerhard Prager; Alexandra Kautzky-Willer; Michael Krebs; Peter Wolf Journal: Obes Surg Date: 2020-06-13 Impact factor: 4.129