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Screening and diagnosis of micronutrient deficiencies before and after bariatric surgery.
Obes Surg 2013; 23(10):1581-9OS

Abstract

BACKGROUND

Micronutrient deficiencies are key concerns after bariatric surgery. We describe the prevalence of perioperative testing and diagnosis of micronutrient deficiencies among a cohort of insured bariatric surgery patients.

METHODS

We used claims data from seven health insurers to identify bariatric surgery patients from 2002-2008. Our outcomes were perioperative claims for vitamin D, B12, folate, and iron testing and diagnosed deficiencies. We analyzed results by bariatric surgery type: Roux-en-Y gastric bypass (RYGB), restrictive, and malabsorptive. We calculated the prevalence of testing and deficiency diagnosis, and performed multivariate logistic regression to determine the association with surgery type.

RESULTS

Of 21,345 eligible patients, 84% underwent RYGB. The pre-surgical testing prevalence for all micronutrients was <25%. The testing prevalence during the first 12 months after surgery varied: vitamin D (12%), vitamin B12 (60%), folate (47%) and iron (49%), and declined during 13-24 and 25-36 months. The deficiency prevalence during 0-12 months post-survey varied: vitamin D (34%), vitamin B12 (20%), folate (13%), and iron (10%). The odds of vitamin B12, folate, and iron deficiency during 0-12 months were significantly lower for restrictive as compared to RYGB, but were not different during 13-24 and 25-36 months post-surgery. The odds of vitamin D deficiency were significantly greater for malabsorptive as compared to RYGB during all post-surgical periods.

CONCLUSION

Many patients did not receive micronutrient testing pre- or post-surgery, yet deficiencies were relatively common among those tested. These results highlight the need for surgeons and primary care providers to test all bariatric surgery patients for micronutrient deficiencies.

Authors+Show Affiliations

Division of General Internal Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, 2024 E. Monument St, Room 2-611, Baltimore, MD, 21287, USA, gudzune@jhu.edu.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Studies
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

23515975

Citation

Gudzune, Kimberly A., et al. "Screening and Diagnosis of Micronutrient Deficiencies Before and After Bariatric Surgery." Obesity Surgery, vol. 23, no. 10, 2013, pp. 1581-9.
Gudzune KA, Huizinga MM, Chang HY, et al. Screening and diagnosis of micronutrient deficiencies before and after bariatric surgery. Obes Surg. 2013;23(10):1581-9.
Gudzune, K. A., Huizinga, M. M., Chang, H. Y., Asamoah, V., Gadgil, M., & Clark, J. M. (2013). Screening and diagnosis of micronutrient deficiencies before and after bariatric surgery. Obesity Surgery, 23(10), pp. 1581-9. doi:10.1007/s11695-013-0919-x.
Gudzune KA, et al. Screening and Diagnosis of Micronutrient Deficiencies Before and After Bariatric Surgery. Obes Surg. 2013;23(10):1581-9. PubMed PMID: 23515975.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Screening and diagnosis of micronutrient deficiencies before and after bariatric surgery. AU - Gudzune,Kimberly A, AU - Huizinga,Mary M, AU - Chang,Hsien-Yen, AU - Asamoah,Vivian, AU - Gadgil,Meghana, AU - Clark,Jeanne M, PY - 2013/3/22/entrez PY - 2013/3/22/pubmed PY - 2014/5/6/medline SP - 1581 EP - 9 JF - Obesity surgery JO - Obes Surg VL - 23 IS - 10 N2 - BACKGROUND: Micronutrient deficiencies are key concerns after bariatric surgery. We describe the prevalence of perioperative testing and diagnosis of micronutrient deficiencies among a cohort of insured bariatric surgery patients. METHODS: We used claims data from seven health insurers to identify bariatric surgery patients from 2002-2008. Our outcomes were perioperative claims for vitamin D, B12, folate, and iron testing and diagnosed deficiencies. We analyzed results by bariatric surgery type: Roux-en-Y gastric bypass (RYGB), restrictive, and malabsorptive. We calculated the prevalence of testing and deficiency diagnosis, and performed multivariate logistic regression to determine the association with surgery type. RESULTS: Of 21,345 eligible patients, 84% underwent RYGB. The pre-surgical testing prevalence for all micronutrients was <25%. The testing prevalence during the first 12 months after surgery varied: vitamin D (12%), vitamin B12 (60%), folate (47%) and iron (49%), and declined during 13-24 and 25-36 months. The deficiency prevalence during 0-12 months post-survey varied: vitamin D (34%), vitamin B12 (20%), folate (13%), and iron (10%). The odds of vitamin B12, folate, and iron deficiency during 0-12 months were significantly lower for restrictive as compared to RYGB, but were not different during 13-24 and 25-36 months post-surgery. The odds of vitamin D deficiency were significantly greater for malabsorptive as compared to RYGB during all post-surgical periods. CONCLUSION: Many patients did not receive micronutrient testing pre- or post-surgery, yet deficiencies were relatively common among those tested. These results highlight the need for surgeons and primary care providers to test all bariatric surgery patients for micronutrient deficiencies. SN - 1708-0428 UR - https://www.unboundmedicine.com/medline/citation/23515975/Screening_and_diagnosis_of_micronutrient_deficiencies_before_and_after_bariatric_surgery_ L2 - https://dx.doi.org/10.1007/s11695-013-0919-x DB - PRIME DP - Unbound Medicine ER -