Nutritional Risks in Adolescents After Bariatric Surgery
Stavra A Xanthakos, Jane C Khoury, Thomas H Inge, Todd M Jenkins, Avani C Modi, Marc P Michalsky, Mike K Chen, Anita P Courcoulas, Carroll M Harmon, Mary L Brandt, Michael A Helmrath, Heidi J Kalkwarf, Teen Longitudinal Assessment of Bariatric Surgery Consortium, Stavra A Xanthakos, Jane C Khoury, Thomas H Inge, Todd M Jenkins, Avani C Modi, Marc P Michalsky, Mike K Chen, Anita P Courcoulas, Carroll M Harmon, Mary L Brandt, Michael A Helmrath, Heidi J Kalkwarf, Teen Longitudinal Assessment of Bariatric Surgery Consortium
Abstract
Background & aims: Little is known about prevalence and risk factors for nutritional deficiencies in adolescents after metabolic bariatric surgery. We performed a 5-year prospective cohort study of these.
Methods: Adolescents who had Roux-en-Y gastric bypass (RYGB, n = 161) or vertical sleeve gastrectomy (VSG, n = 67) were enrolled at 5 tertiary-care centers from March 2007 through February 2012. The final analysis cohort included 226 participants (161 who had RYGB and 65 who had VSG). We measured serum levels of ferritin; red blood cell folate; vitamins A, D, B1, B12; and parathyroid hormone at baseline and annually for 5 years. General linear mixed models were used to examine changes over time and identify factors associated with nutritional deficiencies.
Results: The participants were 75% female and 72% white, with a mean age of 16.5 ± 1.6 years and mean body mass index of 52.7 ± 9.4 kg/m2 at surgery. Mean body mass index decreased 23% at 5 years, and did not differ significantly between procedures. After RYGB, but not VSG, serum concentrations of vitamin B12 significantly decreased whereas serum levels of transferrin and parathyroid hormone increased. Ferritin levels decreased significantly after both procedures. Hypo-ferritinemia was observed in 2.5% of patients before RYGB and 71% at 5 y after RYGB (P < .0001), and 11% of patients before VSG and 45% 5 y after VSG (P = .002). No significant changes in serum levels of folate or vitamins A, B1, or D were found between baseline and 5 y after either procedure. By 5 y, 59% of RYGB and 27% of VSG recipients had 2 or more nutritional deficiencies. Risk factors associated with specific deficiencies included surgery type, female sex, black race, supplementation intake, weight regain, and for females, pregnancy.
Conclusions: In a prospective study of adolescents who underwent RYGB or VSG, we observed nutritional deficiencies by 5 y after the procedures-particularly in iron and B12 after RYGB. Ongoing nutrient monitoring and supplementation are recommended for all patients, but surgery type, supplementation intake, sex, and race might affect risk. (Clinical trial registration: Adolescent Bariatrics: Assessing Health Benefits and Risk [also known as Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS)], NCT00474318.).
Keywords: BMI; Long-Term; Outcome; PTH.
Copyright © 2020 AGA Institute. Published by Elsevier Inc. All rights reserved.
Figures
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Figure 2:
Prevalence of abnormal values by…
Figure 2:
Prevalence of abnormal values by surgery group. * change from baseline to 5…
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- Change in gastrointestinal symptoms over the first 5 years after bariatric surgery in a multicenter cohort of adolescents.Dewberry LC, Khoury JC, Ehrlich S, Jenkins TM, Beamish AJ, Kalkwarf HJ, Xanthakos SA, Inge T. Dewberry LC, et al. J Pediatr Surg. 2019 Jun;54(6):1220-1225. doi: 10.1016/j.jpedsurg.2019.02.032. Epub 2019 Feb 28. J Pediatr Surg. 2019. PMID: 30879757 Free PMC article.
- Risk of Operative and Nonoperative Interventions Up to 4 Years After Roux-en-Y Gastric Bypass vs Vertical Sleeve Gastrectomy in a Nationwide US Commercial Insurance Claims Database.Lewis KH, Arterburn DE, Callaway K, Zhang F, Argetsinger S, Wallace J, Fernandez A, Ross-Degnan D, Wharam JF. Lewis KH, et al. JAMA Netw Open. 2019 Dec 2;2(12):e1917603. doi: 10.1001/jamanetworkopen.2019.17603. JAMA Netw Open. 2019. PMID: 31851344 Free PMC article.
- Postoperative Osteoporosis in Subjects with Morbid Obesity Undergoing Bariatric Surgery with Gastric Bypass or Sleeve Gastrectomy.Aaseth JO, Alexander J. Aaseth JO, et al. Nutrients. 2023 Mar 7;15(6):1302. doi: 10.3390/nu15061302. Nutrients. 2023. PMID: 36986032 Free PMC article. Review.
- Vitamin B Complex Deficiency After Roux-en-Y Gastric Bypass and Sleeve Gastrectomy-a Systematic Review and Meta-Analysis.Nunes R, Santos-Sousa H, Vieira S, Nogueiro J, Bouça-Machado R, Pereira A, Carneiro S, Costa-Pinho A, Lima-da-Costa E, Preto J, Group CRI. Nunes R, et al. Obes Surg. 2022 Mar;32(3):873-891. doi: 10.1007/s11695-021-05783-2. Epub 2022 Jan 4. Obes Surg. 2022. PMID: 34982396 Review.
- Metabolic and hormonal changes after laparoscopic sleeve gastrectomy in pediatric population: An observational study.Alghamdi H, Asiri A, Alzahrani F, Alamri Z, AbdelQadir YH, Shah J. Alghamdi H, et al. Front Surg. 2022 Nov 23;9:1056458. doi: 10.3389/fsurg.2022.1056458. eCollection 2022. Front Surg. 2022. PMID: 36504572 Free PMC article.
- Bariatric surgery in the management of childhood and adolescence obesity.Herouvi D, Soldatou A, Paschou SA, Kalpia C, Karanasios S, Karavanaki K. Herouvi D, et al. Endocrine. 2023 Mar;79(3):411-419. doi: 10.1007/s12020-022-03210-9. Epub 2022 Oct 4. Endocrine. 2023. PMID: 36194346 Review.
- Bariatric Surgery in Adolescents: To Do or Not to Do?Calcaterra V, Cena H, Pelizzo G, Porri D, Regalbuto C, Vinci F, Destro F, Vestri E, Verduci E, Bosetti A, Zuccotti G, Stanford FC. Calcaterra V, et al. Children (Basel). 2021 May 27;8(6):453. doi: 10.3390/children8060453. Children (Basel). 2021. PMID: 34072065 Free PMC article. Review.
- Periconceptional Folate Supplementation in Women after Bariatric Surgery-A Narrative Review.Vynckier AK, Ceulemans D, Vanheule G, De Mulder P, Van Den Driessche M, Devlieger R. Vynckier AK, et al. Nutrients. 2021 May 5;13(5):1557. doi: 10.3390/nu13051557. Nutrients. 2021. PMID: 34063091 Free PMC article. Review.
- Durability of Cardiometabolic Outcomes Among Adolescents After Sleeve Gastrectomy: First Study with 9-Year Follow-up.Elhag W, El Ansari W. Elhag W, et al. Obes Surg. 2021 Jul;31(7):2869-2877. doi: 10.1007/s11695-021-05364-3. Epub 2021 Apr 10. Obes Surg. 2021. PMID: 33840011 Free PMC article.
- Research Support, N.I.H., Extramural
- Adolescent
- Bariatric Surgery* / adverse effects
- Female
- Gastrectomy
- Gastric Bypass* / adverse effects
- Humans
- Male
- Obesity, Morbid* / surgery
- Prospective Studies
- ClinicalTrials.gov/NCT00474318
- Full Text Sources
- Medical
- Research Materials
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Source: PubMed