Abstract
Background
Many patients complain of nutritional symptoms after bariatric surgery (BS), including hair loss, cramps, and paresthesia, but their link with biological alterations has been poorly studied.
Objectives
To assess in a large cohort of subjects the relationship between nutritional symptoms and biological deficits both in the short term (ST ≤ 1 year) and long term (LT ≥ 3 years) after the 2 most common procedures, Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG).
Methods
Nutritional symptoms and biological parameters (including vitamins, minerals, and protein parameters) were prospectively recorded. All subjects with complete clinical and biological assessments from 2011 to 2018 were included.
Results
After BS, 555 subjects were studied in the ST (50% RYGB) and 494 in the LT (79% RYGB); multivitamin intake was 97% and 78%, respectively. The proportion of patients with hair loss decreased from 65 (ST) to 35% (LT) (p < 0.001). In contrast, cramps increase from 7 to 32% and paresthesia from 11 to 18% (p < 0.001). No significant difference was found between SG and RYGB. In subjects with hair loss, blood parameters of protein and iron metabolism were significantly lower than in subjects without hair loss, both in the ST and LT. In contrast, neither zinc nor group B vitamin levels were significantly different. None of the nutritional parameters tested was clearly associated with cramps and paresthesia.
Conclusion
After BS, the most frequent nutritional symptom is hair loss, essentially linked to iron and protein deficiencies. The causes of other nutritional symptoms are less clear and probably more heterogeneous.
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References
Dogan K, Homan J, Aarts EO, et al. Long-term nutritional status in patients following Roux-en-Y gastric bypass surgery. Clin Nutr. 2018;37:612–7.
Ledoux S, Calabrese D, Bogard C, et al. Long-term evolution of nutritional deficiencies after gastric bypass: an assessment according to compliance to medical care. Ann Surg. 2014;259:1104–10.
Caron M, Hould FS, Lescelleur O, et al. Long-term nutritional impact of sleeve gastrectomy. Surg Obes Relat Dis. 2017;13:1664–73.
Al-Mutawa A, Al-Sabah S, Anderson AK, et al. Evaluation of nutritional status post laparoscopic sleeve gastrectomy-5-year outcomes. Obes Surg. 2018;28:1473–83.
Coupaye M, Rivière P, Breuil MC, et al. Comparison of nutritional status during the first year after sleeve gastrectomy and Roux-en-Y gastric bypass. Obes Surg. 2014;24:276–83.
Tabbara M, Carandina S, Bossi M, et al. Rare neurological complications after sleeve gastrectomy. Obes Surg. 2016;26:2843–8.
Punchai S, Hanipah ZN, Meister KM, et al. Neurologic manifestations of vitamin B deficiency after bariatric surgery. Obes Surg. 2017;27:2079–82.
Via MA, Mechanick JI. Nutritional and micronutrient care of bariatric surgery patients: current evidence update. Curr Obes Rep. 2017;6:286–96.
Katsogridaki G, Tzovaras G, Sioka E, et al. Hair loss after laparoscopic sleeve gastrectomy. Obes Surg. 2018;28:3929–34.
Ruiz-Tovar J, Oller I, Llavero C, et al. Hair loss in females after sleeve gastrectomy: predictive value of serum zinc and iron levels. Am Surg. 2014;80:466–71.
Rojas P, Gosch M, Basfi-fer K, et al. Alopecia in women with severe and morbid obesity who undergo bariatric surgery. Nutr Hosp. 2011;26:856–62.
Coupaye M, Puchaux K, Bogard C, et al. Nutritional consequences of adjustable gastric banding and gastric bypass: a 1-year prospective study. Obes Surg. 2009;19:56–65.
Ledoux S, Sami O, Breuil MC, et al. Relevance Of Self-Reported Behavioral Changes Before Bariatric Surgery To Predict Success After Surgery. Obes Surg. 2017;27:1453–9.
Pellitero S, Martínez E, Puig R, et al. Evaluation of vitamin and trace element requirements after sleeve gastrectomy at long term. Obes Surg. 2017;27:1674–82.
Tang L, Alsulaim HA, Canner JK, et al. Prevalence and predictors of postoperative thiamine deficiency after vertical sleeve gastrectomy. Surg Obes Relat Dis. 2018;14:943–50.
Mahawar KK, Bhasker AG, Bindal V, et al. Zinc deficiency after gastric bypass for morbid obesity: a systematic review. Obes Surg. 2017;27:522–9.
Ferraz ÁAB, Carvalho MRC, Siqueira LT, et al. Micronutrient deficiencies following bariatric surgery: a comparative analysis between sleeve gastrectomy and Roux-en-Y gastric bypass. Rev Col Bras Cir. 2018;45:e2016.
de Barros F, Setúbal S, Martinho JM, et al. Early endocrine and metabolic changes after bariatric surgery in grade III morbidly obese patients: a randomized clinical trial comparing sleeve gastrectomy and gastric bypass. Metab Syndr Relat Disord. 2015;13:264–71.
Johnson LM, Ikramuddin S, Leslie DB, et al. Analysis of vitamin levels and deficiencies in bariatric surgery patients: a single-institutional analysis. Surg Obes Relat Dis. 2019;15(7):1146–52.
Thereaux J, Lesuffleur T, Païta M, et al. Long-term follow-up after bariatric surgery in a national cohort. Br J Surg. 2017;104:1362–71.
Parrott J, Frank L, Rabena R, et al. American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the surgical weight loss patient 2016 update: micronutrients. Surg Obes Relat Dis. 2017;13:727–41.
Busetto L, Dicker D, Azran C, et al. Practical recommendations of the obesity management task force of the European Association for the Study of Obesity for the post-bariatric surgery medical management. Obes Facts. 2017;10:597–632.
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Ledoux, S., Flamant, M., Calabrese, D. et al. What Are the Micronutrient Deficiencies Responsible for the Most Common Nutritional Symptoms After Bariatric Surgery?. OBES SURG 30, 1891–1897 (2020). https://doi.org/10.1007/s11695-020-04412-8
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DOI: https://doi.org/10.1007/s11695-020-04412-8