Keywords
How to Cite
Abstract
RESUMO
Bariatric surgery is effective in reducing body weight and improving the clinical conditions associated with obesity. In the gastric bypass technique, mineral deficiencies can arise, with publications publishing deficiencies in the long term.Objective: To analyze the occurrence of long-term mineral deficiency in the gastric bypass technique. Methodology: Integrative review, carried out using electronic databases: PubMed, SciELO, BVS, with a search of the last 12 years of studies published in indexed journals. The following descriptors were used individually or in combination: bariatric surgery, nutritional deficiency, mineral deficiency, gastric bypass, postoperative and gastric bypass, in English, Portuguese and Spanish. We considered long-term deficiencies of all minerals (after 2 years of surgery), excluding case reports, CBTs, theses, dissertations, editorials and reviews. Results: Of the 37 studies found in the initial phase, only 19 met the exclusion and inclusion criteria and were selected for the review. The main results showed that some micronutrients are still lacking in the late postoperative period, the most frequent being: iron (5-42%), calcium (1-20%), copper (0-18.8%), zinc (8-23%), magnesium (14.8%), selenium (11-15%); as well as the presence of iron deficiency anemia (3-37.5%) and reduced ferritin (11.1 - 57%). In addition, it was observed that patients who used supplements and received nutritional monitoring had a reduced risk of deficiencies. Conclusions: The Y-de-Roux gastric bypass can cause micronutrient deficiencies, even in the long term, with particular emphasis on iron, calcium, zinc, copper, magnesium and selenium. Nutritional monitoring is necessary, with daily adherence to 2 complete multivitamin formulas with good bioavailability, as well as the addition of specific supplements when isolated deficiencies are diagnosed.
References
VASCONCELOS, Francisco de Assis Guedes de. Diffusion of scientific concepts on obesity in the global context: a historical review. Revista de Nutrição, v. 34, 2021.
CHOOI, Yu Chung; DING, Cherlyn; MAGKOS, Faidon. The epidemiology of obesity. Metabolism: clinical and experimental, v. 92, p. 6–10, 2019.
CONSEQUÊNCIAS, Obesidade e. Suas. Atlas Mundial da Obesidade 2024. Usp.br.
LOPES, Mariana Santos. Déficits nutricionais em doentes submetidos a cirurgia bariátrica: relevância da suplementação. [s.l.]: Universidade do Porto, 2019.
FERRAZ, Álvaro Antônio Bandeira; CARVALHO, Márcio R. C.; SIQUEIRA, Luciana T.; et al. Deficiências de micronutrientes após cirurgia bariátrica: análise comparativa entre gastrectomia vertical e derivação gástrica em Y de Roux. Revista do Colégio Brasileiro de Cirurgiões, v. 45, n. 6, 2018.
DOGAN, Kemal; AARTS, Edo O.; KOEHESTANIE, Parweez; et al. Optimization of vitamin suppletion after roux-en-Y gastric bypass surgery can lower postoperative deficiencies: A randomized controlled trial. Medicine, v. 93, n. 25, p. e169, 2014.
MILAGRES, Marcelle Minarini; SILVA, Laís de Paula; SARAIVA, Matheus Augusto Pereira; et al. Avanço nas técnicas cirúrgicas da cirurgia bariátrica: uma revisão da literatura. Brazilian Journal of Health Review, v. 6, n. 3, p. 8776–8788, 2023.
SOUZA, Natália M. M.; SANTOS, Ana Célia O.; SANTA-CRUZ, Fernando; et al. Impacto nutricional da cirurgia bariátrica: estudo comparativo do Bypass gástrico em Y de Roux e do Sleeve entre pacientes dos sistemas público e privado de saúde. Revista do Colégio Brasileiro de Cirurgiões, v. 47, 2020.
BARETTA, Giorgio Alfredo Pedroso; CAMBI, Maria Paula Carlini; RODRIGUES, Arieli Luz; et al. Secondary hyperparathyroidism after bariatric surgery: Treatment is with calcium carbonate or calcium citrate? Arquivos brasileiros de cirurgia digestiva [Brazilian archives of digestive surgery], vol. 28, no. suppl 1, p. 43–45, 2015.
CASTANHA, Christiane Ramos; TCBC-PE, Álvaro Antônio Bandeira Ferraz; CASTANHA, Alessandra Ramos; et al. Avaliação da qualidade de vida, perda de peso e comorbidades de pacientes submetidos à cirurgia bariátrica. Revista do Colégio Brasileiro de Cirurgiões, vol. 45, no. 3, 2018.
MONACO-FERREIRA, Daniela Vicinansa and LEANDRO-MERHI, Vânia Aparecida. Status of iron metabolism 10 years after roux-en-Y gastric bypass. Obesity surgery, vol. 27, no. 8, p. 1993–1999, 2017.
NONINO, Carla Barbosa; OLIVEIRA, Bruno Affonso Parenti de; CHAVES, Raoana Cássia Paixão; et al. Is there any change in phenotypic characteristics comparing 5 to 10 years of follow-up in obese patients undergoing Roux-en-y gastric bypass? Arquivos brasileiros de cirurgia digestiva [Brazilian archives of digestive surgery], vol. 32, no. 3, 2019.
DAHLE, Marcelo; ZARPELON, Allan; FILGUEIRAS, Juan; et al. Avaliação nutricional e metabólica após bypass gástrico em Y-de-Roux há mais de dois anos / Nutritional and metabolic evaluation after two years Roux-en-Y gastric bypass. REVISTA MÉDICA DO PARANÁ, p. 31–35, 2021.
ARIAS, Pablo M.; DOMENICONI, Emiliano A.; GARCÍA, Manuel; et al. Micronutrient deficiencies after roux-en-Y gastric bypass: Long-term results. Obesity surgery, vol. 30, no. 1, p. 169–173, 2020.
XANTHAKOS, Stavra A.; KHOURY, Jane C.; INGE, Thomas H.; et al. Nutritional risks in adolescents after bariatric surgery. Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association, vol. 18, no. 5, p. 1070-1081.e5, 2020.
LEDOUX, Séverine; FLAMANT, Martin; CALABRESE, Daniela; et al. What are the micronutrient deficiencies responsible for the most common nutritional symptoms after bariatric surgery? Obesity surgery, vol. 30, no. 5, p. 1891–1897, 2020.
SANDVIK, Jorunn; HOLE, Torstein; KLÖCKNER, Christian A.; et al. Intravenous iron treatment in the prevention of iron deficiency and anaemia after Roux-en-Y gastric bypass. Obesity surgery, vol. 30, no. 5, p. 1745–1752, 2020.
DALCANALE, Lorença; OLIVEIRA, Claudia P. M. S.; FAINTUCH, Joel; et al. Long-term nutritional outcome after gastric bypass. Obesity surgery, vol. 20, no. 2, p. 181–187, 2010.
ENGEBRETSEN, K. V.; BLOM-HØGESTØL, I. K.; HEWITT, S.; et al. Anemia following Roux-en-Y gastric bypass for morbid obesity; a 5-year follow-up study. Scandinavian journal of gastroenterology, vol. 53, no. 8, p. 917–922, 2018.
HOMAN, Jens; SCHIJNS, Wendy; AARTS, Edo O.; et al. An optimized multivitamin supplement lowers the number of vitamin and mineral deficiencies three years after Roux-en-Y gastric bypass: a cohort study. Surgery for obesity and related diseases: official journal of the American Society for Bariatric Surgery, vol. 12, no. 3, p. 659–667, 2016.
BILLETER, Adrian T.; PROBST, Pascal; FISCHER, Lars; et al. Risk of malnutrition, trace metal, and vitamin deficiency post roux-en-Y gastric bypass—a prospective study of 20 patients with BMI <35 kg/m2. Obesity surgery, vol. 25, no. 11, p. 2125–2134, 2015.
NOVAIS, Patrícia Fátima Sousa; RASERA, Irineu, Jr; LEITE, Celso Vieira de Souza; et al. Food intake in women two years or more after bariatric surgery meets adequate intake requirements. Nutrition research (New York, N.Y.), vol. 32, no. 5, p. 335–341, 2012.
PAPAMARGARITIS, Dimitris; AASHEIM, Erlend T.; SAMPSON, Barry; et al. Copper, selenium and zinc levels after bariatric surgery in patients recommended to take multivitamin-mineral supplementation. Journal of trace elements in medicine and biology: organ of the Society for Minerals and Trace Elements (GMS), vol. 31, p. 167–172, 2015.
ZARSHENAS, Nazy; TAPSELL, Linda C.; BATTERHAM, Marijka; et al. Investigating the prevalence of copper and zinc abnormalities in patients pre and post bariatric surgery—an Australian experience. Obesity surgery, vol. 33, no. 11, p. 3437–3446, 2023.
GLETSU-MILLER, N.; BRODERIUS, M.; FREDIANI, J. K.; et al. Incidence and prevalence of copper deficiency following roux-en-y gastric bypass surgery. International journal of obesity (2005) , vol. 36, no. 3, p. 328–335, 2012.
LEVINSON, Radmila; SILVERMAN, Jon B.; CATELLA, Jennifer G.; et al. Pharmacotherapy prevention and management of nutritional deficiencies post roux-en-Y gastric bypass. Obesity surgery, vol. 23, no. 7, p. 992–1000, 2013.
BAL, Bikram S.; FINELLI, Frederick C.; SHOPE, Timothy R.; et al. Nutritional deficiencies after bariatric surgery. Nature reviews. Endocrinology, vol. 8, no. 9, p. 544–556, 2012.
MADAN, Atul; ORTH, Whitney; TICHANSKY, David; et al. Vitamin and trace mineral levels after laparoscopic gastric bypass. Obesity surgery, vol. 16, no. 5, p. 603–606, 2006.
SCHIJNS, Wendy; SCHUURMAN, Lisanne T.; MELSE-BOONSTRA, Alida; et al. Do specialized bariatric multivitamins lower deficiencies after RYGB? Surgery for obesity and related diseases: official journal of the American Society for Bariatric Surgery, vol. 14, no. 7, p. 1005–1012, 2018.
POITOU BERNERT, C.; CIANGURA, C.; COUPAYE, M.; et al. Nutritional deficiency after gastric bypass: diagnosis, prevention and treatment. Diabetes & metabolism, vol. 33, no. 1, p. 13–24, 2007.
lEONG, Kelly; ARDILA-GATAS, Jessica; YANG, Jie; et al. Bone mineral density changes after bariatric surgery. Surgical endoscopy, vol. 35, no. 8, p. 4763–4770, 2021.
CARRASCO, Fernando; ROJAS, Pamela; CSENDES, Attila; et al. Changes in ghrelin concentrations one year after resective and non-resective gastric bypass: Associations with weight loss and energy and macronutrient intakes. Nutrition (Burbank, Los Angeles County, Calif.), vol. 28, no. 7–8, p. 757–761, 2012.
STEIN, J.; STIER, C.; RAAB, H.; et al. Review article: the nutritional and pharmacological consequences of obesity surgery. Alimentary pharmacology & therapeutics, vol. 40, no. 6, p. 582–609, 2014.
NICOLETTI, Carolina F.; LIMA, Tatiana P.; DONADELLI, Simara P.; et al. New look at nutritional care for obese patient candidates for bariatric surgery. Surgery for obesity and related diseases: official journal of the American Society for Bariatric Surgery, vol. 9, no. 4, p. 520–525, 2013.
LUK, Chee Phun; PARSONS, Richard; LEE, Ya Ping; et al. Proton pump inhibitor–associated hypomagnesemia: What do FDA data tell us? The annals of pharmacotherapy, vol. 47, no. 6, p. 773–780, 2013.
HESS, M. W.; HOENDEROP, J. G. J.; BINDELS, R. J. M.; et al. Systematic review: hypomagnesaemia induced by proton pump inhibition. Alimentary pharmacology & therapeutics, vol. 36, no. 5, p. 405–413, 2012.
NIRUJOGI, V. L.; ZOPFI, K. Nutritional considerations for plastic surgery in post-bariatric surgery patients. Revista Brasileira de Cirurgia Plástica, v. 30, n. 2, 2015.
ROBINSON, Sara D.; COOPER, Barry and LEDAY, Temekka V. Copper deficiency (hypocupremia) and pancytopenia late after gastric bypass surgery. Proceedings (Baylor University. Medical Center), vol. 26, no. 4, p. 382–386, 2013.
RUZ, Manuel; CARRASCO, Fernando; ROJAS, Pamela; et al. Zinc absorption and zinc status are reduced after Roux-en-Y gastric bypass: a randomized study using 2 supplements. The American journal of clinical nutrition, vol. 94, no. 4, p. 1004–1011, 2011.
HAKEAM, Hakeam A.; O’REGAN, Patrick J.; SALEM, Abdulrahman M.; et al. Impact of laparoscopic sleeve gastrectomy on iron indices: 1 year follow-up. Obesity surgery, vol. 19, no. 11, p. 1491–1496, 2009.
BLOOMBERG, Richard D.; FLEISHMAN, Amy; NALLE, Jennifer E.; et al. Nutritional deficiencies following bariatric surgery: What have we learned? Obesity surgery, vol. 15, no. 2, p. 145–154, 2005.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2024 Natália Oliveira, Maria Goretti Pessoa de Araújo Burgos
