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ANZMOSS - ANZGOSA 2020 Virtual Conference
ANZMOSS – ANZGOSA 2020 Virtual Conference
ANZMOSS - ANZGOSA 2020 Virtual Conference
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Haematinic deficiency after bariatric surgery - A systematic review

Description
Bariatric surgery may increase the risk of iron, vitamin B12, folate and copper deficiencies, leading to anaemiaThis review systematically critiques literature on the incidence of haematinic deficiencies and anaemia within 12 months of surgery.  Medline, CINAHL, Embase were searched; inclusion criteria required reporting of micronutrient deficiency incidence up to 12 months after sleeve gastrectomy (SG) and/or gastric bypass (GB).  Data was extracted and analysed independently by two authors. PRISMA and MOOSE frameworks were utilised with NHMRC evidence hierarchy and the Academy of Nutrition and Dietetics assessment of bias tool to assess the quality of articles.  Sixteen studies met inclusion criteria with the majority (n=15) deemed level IV (low level) studies with neutral or negative bias and n=1 level II study in GB, which included iron status as a secondary outcome.  For SG, the risk of iron deficiency was inconsistent and the majority of studies (n=8/9) found no increased incidence of vitamin B12 or folate deficiency in the first 12 months. The one study exploring copper status found an increased risk incidence of copper deficiency after SG.  For GB, the incidence of iron and vitamin B12 deficiency was inconsistent.  The majority of studies found no increased risk of folate deficiency after GB.  The sole study assessing copper status found an increased risk of deficiency at 6 months, with no further follow up data reported.  Data on the prevalence of nutritional anaemias was lacking.  Important confounders to micronutrient deficiency prevalence were not reported, including micronutrient supplementation prescription and adherence, the impact of inflammation on iron and copper study interpretation, surgical technique and inconsistent definitions of micronutrient deficiency. Further investigation into the incidence of iron, vitamin B12, folate and copper deficiency and its impact on haemoglobin after bariatric surgery, in both the short (<12 months) and longer (>12 months) term, is needed.  
Authors
Emma Osland - Royal Brisbane and Women's Hospital, Ingrid Hickman - Princess Alexandra Hospital, George Hopkins - Royal Brisbane and Women's Hospital, Matthew Seymour - Royal Brisbane and Women's Hospital, Susan de Jersey - Royal Brisbane and Women's Hosptial, and Carrie-Anne Lewis - Royal Brisbane and Women's Hospital & University of Queensland