Screening and diagnosis of micronutrient deficiencies before and after bariatric surgery

Kimberly A Gudzune, Mary M Huizinga, Hsien-Yen Chang, Vivian Asamoah, Meghana Gadgil, Jeanne M Clark
Obesity Surgery 2013, 23 (10): 1581-9

BACKGROUND: Micronutrient deficiencies are key concerns after bariatric surgery. We describe the prevalence of perioperative testing and diagnosis of micronutrient deficiencies among a cohort of insured bariatric surgery patients.

METHODS: We used claims data from seven health insurers to identify bariatric surgery patients from 2002-2008. Our outcomes were perioperative claims for vitamin D, B12, folate, and iron testing and diagnosed deficiencies. We analyzed results by bariatric surgery type: Roux-en-Y gastric bypass (RYGB), restrictive, and malabsorptive. We calculated the prevalence of testing and deficiency diagnosis, and performed multivariate logistic regression to determine the association with surgery type.

RESULTS: Of 21,345 eligible patients, 84% underwent RYGB. The pre-surgical testing prevalence for all micronutrients was <25%. The testing prevalence during the first 12 months after surgery varied: vitamin D (12%), vitamin B12 (60%), folate (47%) and iron (49%), and declined during 13-24 and 25-36 months. The deficiency prevalence during 0-12 months post-survey varied: vitamin D (34%), vitamin B12 (20%), folate (13%), and iron (10%). The odds of vitamin B12, folate, and iron deficiency during 0-12 months were significantly lower for restrictive as compared to RYGB, but were not different during 13-24 and 25-36 months post-surgery. The odds of vitamin D deficiency were significantly greater for malabsorptive as compared to RYGB during all post-surgical periods.

CONCLUSION: Many patients did not receive micronutrient testing pre- or post-surgery, yet deficiencies were relatively common among those tested. These results highlight the need for surgeons and primary care providers to test all bariatric surgery patients for micronutrient deficiencies.

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