Haemoglobin and Hematinic Status Before and After Bariatric Surgery over 4 years of Follow-Up
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ORIGINAL CONTRIBUTIONS
Haemoglobin and Hematinic Status Before and After Bariatric Surgery over 4 years of Follow-Up Michael J. Shipton 1 & Nicholas J. Johal 1 & Neel Dutta 1 & Christopher Slater 1 & Zohaib Iqbal 1,2,3 & Babur Ahmed 1 & Basil J. Ammori 1,2 & Siba Senapati 1,4 & Khurshid Akhtar 1 & Lucinda K. M. Summers 1,2 & John P. New 1,2 & Handrean Soran 2,3 & Safwaan Adam 1,2,5 & Akheel A. Syed 1,2 Received: 2 March 2020 / Revised: 17 August 2020 / Accepted: 18 August 2020 # The Author(s) 2020
Abstract Purpose Bariatric surgery is associated with deficiencies of vitamins and minerals, and patients are routinely advised supplements postoperatively. We studied prevalence of vitamin B12, folate and iron deficiencies and anaemia before and after bariatric surgery over 4 years of follow-up. Materials and Methods We performed a retrospective cohort analysis of 353 people with obesity, including 257 (72.8%) women, who underwent gastric bypass (252, 71.4%) or sleeve gastrectomy (101, 28.6%) at our National Health Service bariatric centre in Northwest England. Results At baseline, mean (standard error) age was 46.0 (0.6) years, body mass index 53.1 (0.4) kg/m2, serum vitamin B12 400.2 (16.4) pg/L, folate 7.7 (0.2) μg/L, iron 12.0 (0.3) μmol/L, ferritin 118.3 (8.4) μg/L and haemoglobin 137.9 (0.8) g/L. Frequency of low vitamin B12 levels reduced from 7.5% preoperatively to 2.3% at 48 months (P < 0.038). Mean folate levels increased from baseline to 48 months by 5.3 μg/L (P < 0.001) but frequency of low folate levels increased from 4.7% preoperatively to 10.3% (P < 0.048). Ferritin levels increased from baseline to 48 months by 51.3 μg/L (P < 0.009). Frequency of low ferritin levels was greater in women (39.1%) than in men (8.9%) at baseline (P < 0.001) and throughout the study period. Haemoglobin was low in 4.6% of all patients at baseline with no significant change over the study period. Conclusion There were notable rates of haematinic insufficiencies in bariatric surgical candidates preoperatively. Our study lends further support to regular supplementation with vitamin B12, folic acid, and iron in people undergoing bariatric surgery. Keywords Obesity . Morbid . Gastric bypass . Gastrectomy . Anaemia . Iron deficiency . Vitamin B12 deficiency . Folic acid deficiency
Introduction Obesity management includes lifestyle, dietary and behavioural interventions with or without weight loss pharmacotherapy. Bariatric surgery, however, is the
* Akheel A. Syed [email protected] 1
Salford Royal NHS Foundation Trust, Salford UK
2
University of Manchester, Manchester UK
3
Manchester University NHS Foundation Trust, Manchester UK
4
Manchester Metropolitan University, Manchester UK
5
The Christie NHS Foundation Trust, Manchester UK
most effective option for achieving substantial, sustained weight loss and improving survival [1, 2]. Globally, gastric bypass (GB) and sleeve gastrectomy (SG) are the two most common types of bariatric surgery [3]. Each limits nutrient absorption by either reducing the stomach volu
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