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Anemia following Roux-en-Y gastric bypass for morbid obesity; a 5-year follow-up study.

Abstract

OBJECTIVES

Patients are at risk of anemia post Roux-en-Y gastric bypass (RYGB). We sought to determine the prevalence of anemia and related nutritional deficiencies 5 years after RYGB and to evaluate adherence to nutritional supplements with iron, vitamin B12, and folate.

MATERIAL AND METHODS

Patients operated with RYGB 2004-2006 were eligible for evaluation. Blood samples were collected and use of nutritional supplements was recorded preoperatively, and at outpatients' consultations 1, 2, and 5 years postoperatively. Of 203 patients operated, 184 (91%) completed the 5 year follow-up and were included in the study. Of these, 97% had valid measurements of hemoglobin both at baseline and after 5 years.

RESULTS

During the 5 years after RYGB, the prevalence of anemia increased from 4% preoperatively to 24% in females, and from 0% to 7% in males. Ferritin levels decreased gradually in both genders. Iron deficiency increased from 6% preoperatively to 42% at 5 years in females, and from 0% to 9% in males. Vitamin B12 deficiency was not altered while folate deficiency decreased from 10% preoperatively to 1% at 5 years. Five years after surgery 25% reported the use of supplements with iron, while 83% used vitamin B12 and 65% used multivitamins with folate.

CONCLUSIONS

We observed a long-term increase in anemia and iron deficiency after RYGB in both genders, but most pronounced in women. Our postoperative protocol for prevention of vitamin B12 and folate deficiencies appear acceptable. Iron status and iron supplementation seems to need stronger emphasis during follow-up after RYGB.

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  • Authors+Show Affiliations

    ,

    a Center for Morbid Obesity and Bariatric Surgery, Department of Endocrinology, Morbid Obesity and Preventive Medicine , Oslo University Hospital , Oslo , Norway. b Department of Gastrointestinal Surgery , Vestre Viken Hospital Drammen , Drammen , Norway.

    ,

    a Center for Morbid Obesity and Bariatric Surgery, Department of Endocrinology, Morbid Obesity and Preventive Medicine , Oslo University Hospital , Oslo , Norway.

    ,

    a Center for Morbid Obesity and Bariatric Surgery, Department of Endocrinology, Morbid Obesity and Preventive Medicine , Oslo University Hospital , Oslo , Norway.

    ,

    a Center for Morbid Obesity and Bariatric Surgery, Department of Endocrinology, Morbid Obesity and Preventive Medicine , Oslo University Hospital , Oslo , Norway.

    ,

    c Department of Gastroenterology , Oslo University Hospital and University of Oslo , Oslo , Norway.

    ,

    a Center for Morbid Obesity and Bariatric Surgery, Department of Endocrinology, Morbid Obesity and Preventive Medicine , Oslo University Hospital , Oslo , Norway.

    a Center for Morbid Obesity and Bariatric Surgery, Department of Endocrinology, Morbid Obesity and Preventive Medicine , Oslo University Hospital , Oslo , Norway. d Department of Gastrointestinal Surgery , Oslo University Hospital , Oslo , Norway.

    Source

    MeSH

    Adult
    Anemia, Iron-Deficiency
    Dietary Supplements
    Female
    Folic Acid
    Folic Acid Deficiency
    Follow-Up Studies
    Gastric Bypass
    Humans
    Iron
    Linear Models
    Male
    Medication Adherence
    Middle Aged
    Norway
    Obesity, Morbid
    Postoperative Period
    Sex Distribution
    Vitamin B 12
    Vitamin B 12 Deficiency

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    30231804

    Citation

    Engebretsen, K V., et al. "Anemia Following Roux-en-Y Gastric Bypass for Morbid Obesity; a 5-year Follow-up Study." Scandinavian Journal of Gastroenterology, vol. 53, no. 8, 2018, pp. 917-922.
    Engebretsen KV, Blom-Høgestøl IK, Hewitt S, et al. Anemia following Roux-en-Y gastric bypass for morbid obesity; a 5-year follow-up study. Scand J Gastroenterol. 2018;53(8):917-922.
    Engebretsen, K. V., Blom-Høgestøl, I. K., Hewitt, S., Risstad, H., Moum, B., Kristinsson, J. A., & Mala, T. (2018). Anemia following Roux-en-Y gastric bypass for morbid obesity; a 5-year follow-up study. Scandinavian Journal of Gastroenterology, 53(8), pp. 917-922. doi:10.1080/00365521.2018.1489892.
    Engebretsen KV, et al. Anemia Following Roux-en-Y Gastric Bypass for Morbid Obesity; a 5-year Follow-up Study. Scand J Gastroenterol. 2018;53(8):917-922. PubMed PMID: 30231804.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Anemia following Roux-en-Y gastric bypass for morbid obesity; a 5-year follow-up study. AU - Engebretsen,K V, AU - Blom-Høgestøl,I K, AU - Hewitt,S, AU - Risstad,H, AU - Moum,B, AU - Kristinsson,J A, AU - Mala,T, PY - 2018/9/21/entrez PY - 2018/9/21/pubmed PY - 2018/12/12/medline KW - Morbid obesity KW - Roux-en-Y gastric bypass KW - anemia KW - iron deficiency SP - 917 EP - 922 JF - Scandinavian journal of gastroenterology JO - Scand. J. Gastroenterol. VL - 53 IS - 8 N2 - OBJECTIVES: Patients are at risk of anemia post Roux-en-Y gastric bypass (RYGB). We sought to determine the prevalence of anemia and related nutritional deficiencies 5 years after RYGB and to evaluate adherence to nutritional supplements with iron, vitamin B12, and folate. MATERIAL AND METHODS: Patients operated with RYGB 2004-2006 were eligible for evaluation. Blood samples were collected and use of nutritional supplements was recorded preoperatively, and at outpatients' consultations 1, 2, and 5 years postoperatively. Of 203 patients operated, 184 (91%) completed the 5 year follow-up and were included in the study. Of these, 97% had valid measurements of hemoglobin both at baseline and after 5 years. RESULTS: During the 5 years after RYGB, the prevalence of anemia increased from 4% preoperatively to 24% in females, and from 0% to 7% in males. Ferritin levels decreased gradually in both genders. Iron deficiency increased from 6% preoperatively to 42% at 5 years in females, and from 0% to 9% in males. Vitamin B12 deficiency was not altered while folate deficiency decreased from 10% preoperatively to 1% at 5 years. Five years after surgery 25% reported the use of supplements with iron, while 83% used vitamin B12 and 65% used multivitamins with folate. CONCLUSIONS: We observed a long-term increase in anemia and iron deficiency after RYGB in both genders, but most pronounced in women. Our postoperative protocol for prevention of vitamin B12 and folate deficiencies appear acceptable. Iron status and iron supplementation seems to need stronger emphasis during follow-up after RYGB. SN - 1502-7708 UR - https://www.unboundmedicine.com/medline/citation/30231804/Anemia_following_Roux_en_Y_gastric_bypass_for_morbid_obesity L2 - http://www.tandfonline.com/doi/full/10.1080/00365521.2018.1489892 DB - PRIME DP - Unbound Medicine ER -