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Nutritional risks after laparoscopic Sleeve Gastrectomy.

The Sleeve Gastrectomy (SG) has become the number one performed bariatric procedure worldwide. Although the incidence of micronutrient deficiencies has hardly been researched, the risk for developing deficiencies after this procedure is considered low. However, since physical changes after SG might influence the absorption of micronutrients like iron and vitamin B12, the low risk status has increasingly been questioned in the past years.

Follow-up care: multivitamin supplements after SG

To evaluate the low risk status for developing deficiencies following an SG, a prospective study was conducted among 60 SG patients. All patients were instructed to take daily multivitamin supplements (150% RDA), calcium and vitamin D. Preoperatively, and 6 and 12 months after surgery, the patients were tested for the most common micronutrient deficiencies.

Deficiencies and hypervitaminosis

In contrast to previous assumptions, this study shows that patients who have undergone an SG are at serious risk for developing micronutrient deficiencies, even when taking multivitamins. 1 out of 4 patients in this study was diagnosed with anemia. Deficiencies in iron, folic acid, vitamin B12, vitamin D and albumin were also frequently found (table 1). At the same time, nearly half of the patients had increased levels of vitamin A, and one third developed a hypervitaminosis of vitamin B1 or B6.

Table 1: Prevalence of micronutrient deficiencies or hypervitaminosis of LSG patients

% deficient % hypervitaminosis
Iron 43% (26% anemia)
Calcium 4%
PTH 39%
Vitamin D 39%
Vitamin A 4% 48%
Vitamin B1 11% 31%
Vitamin B6 30%
Folic Acid 15% 4%
Vitamin B12 9% 2%

Regular checks are essential

After an SG operation, the balance between low and high levels of micronutrients is difficult, but essential to achieve. To prevent possible complications due to deficiencies or hypervitaminosis in the long-term, supplements should be prescribed as a minimum and added or withdrawn based on regular blood testing.

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Aarts E.O., Janssen I.M.C. Berends F.J. (2011) The Gastric Sleeve: Losing Weight as Fast as Micronutrients? OBES SURG (2011) 21:207–211 DOI 10.1007/s11695-010-0316-7

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