Anemia and Related Deficiencies in Bariatric Surgery


Nutrients

Country

Males

Females

Iron (mg/day)

RDA* (India) (53)

RDA* (US) (54)

RNI** (UK) (55)

NRV*** (Australia/New Zealand) (56)

17

8

8.7

8

21

18

14.8

18

Folate (mcg/day)

RDA* (India) (53)

RDA* (US) (54)

RNI** (UK) (55)

NRV*** (Australia/New Zealand) (56)

200

400

200

400

200

400

200

400

Vitamin B12 (mcg/day)

RDA* (India) (53)

RDA* (US) (54)

RNI** (UK) (55)

NRV*** (Australia/New Zealand) (56)

1.0

2.4

1.5

2.4

1.0

2.4

1.5

2.4


RDA* recommended dietary allowances, RNI** reference nutrient intake, NRV*** nutrient reference value




Recommendations





  • Preoperative existing deficiency of iron, folic acid and vitamin B12 is the major factor predicting post-operative deficiency and secondary anemia.


  • Iron supplementation should be five times the RDA.


  • Vitamin B12 and folic acid supplementation can be given as part of a multivitamin preparation.


  • Similar replacements have to be considered after sleeve gastrectomy.


  • Even with regular supplementation intense follow up and management of deficiencies is necessary.


  • Total iron binding capacity or serum transferring receptor are better measures of iron deficiency than serum iron or ferritin


  • Elevated methylmalonic acid and total homocysteine concentrations are better measures of vitamin B12 deficiency than vitamin B12 levels.


  • With iron deficiency IV iron supplements restore the lost iron status more rapidly and reliably than oral iron supplements.


  • Asymptomatic vitamin B12 deficiency can be treated with oral or intranasal vitamin B12 reserving parenteral supplementation for symptomatic or severe deficiencies.



References



1.

Aisen P, Enns C, Wessling-Resnick M. Chemistry and biology of eukaryotic iron metabolism. Int J Biochem Cell Biol. 2001;33(10):940–59.CrossRefPubMed


2.

Reynolds E. Vitamin B12, folic acid, and the nervous system. Lancet Neurol. 2006;5(11):949–60.CrossRefPubMed


3.

Tamura T, Picciano MF. Folate and human reproduction. Am J Clin Nutr. 2006;83(5):993–1016.PubMed


4.

Crider KS, Bailey LB, Berry RJ. Folic acid food fortification-its history, effect, concerns, and future directions. Nutrients. 2011;3(3):370–84.CrossRefPubMedPubMedCentral


5.

McNulty H, Pentieva K. Folate bioavailability. Proc Nutr Soc. 2004;63(4):529–36.CrossRefPubMed


6.

Salgado W, Modotti C, Nonino CB, Ceneviva R. Anemia and iron deficiency before and after bariatric surgery. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2014;10(1):49–54.CrossRef

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Nov 18, 2017 | Posted by in ENDOCRINOLOGY | Comments Off on Anemia and Related Deficiencies in Bariatric Surgery

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