Nutritional deficiencies after sleeve gastrectomy and Roux-en-Y gastric bypass at 10 years: secondary analysis of the SLEEVEPASS randomized clinical trial.

Background

Long-term data on the prevalence of nutritional deficiencies after laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in RCTs are lacking. The aim of this study was to compare nutritional deficiencies and adherence to vitamin supplements after LSG and LRYGB at 10 years.

Methods

This was a predefined secondary analysis of the Finnish SLEEVEPASS (LSG versus LRYGB for severe obesity) multicentre RCT, with 10-year nutritional laboratory measurements and completed questionnaires on micronutrient supplement use, to assess the prevalence of micronutritional and macronutritional deficiencies and adherence.

Results

Of 240 patients (121 LSG patients and 119 LRYGB patients), 228 were available for 10-year follow-up. Of these 228 patients, 190 (83.3%) were available for laboratory tests and 192 (84.2%) for questionnaires. There were no statistically significant differences between LSG and LRYGB in the prevalence of vitamin D insufficiency (10 of 94 (11%) versus 9 of 84 (11%) respectively; P = 0.545), the prevalence of hypocalcaemia (3 of 92 (3%) versus 1 of 83 (1%) respectively; P = 0.088), the prevalence of vitamin B12 deficiency (2 of 46 (5%) versus 0 of 45 (0%); P = 0.240), or mean vitamin B12 levels (P = 0.939). The prevalence of iron deficiency, defined by ferritin level, was statistically significantly lower after LSG compared with LRYGB (4 of 29 (14%) versus 12 of 29 (41%); P = 0.017), with a median ferritin level of 34 (interquartile range 20-54) µg/l after LSG and 20 (interquartile range 12-117) µg/l after LRYGB (P = 0.397). The LSG group had statistically significantly lower overall adherence to micronutritional supplements (70 of 99 (71%) versus 83 of 93 (89%) respectively; P = 0.002).

Conclusion

Long-term micronutritional and macronutritional deficiencies were rare after both LSG and LRYGB, with similar deficiency rates. Only the prevalence of iron deficiency was more common after LRYGB compared with LSG. The overall adherence to micronutritional supplements was lower after LSG.

Registration number

NCT00793143 (http://www.clinicaltrials.gov).

References:

• GBD 2015 Obesity Collaborators . Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med  2017;377:13–27
• Ikramuddin  S, Korner  J, Lee  WJ, Thomas  AJ, Connett  JE, Bantle  JP  et al.  Lifestyle intervention and medical management with vs without Roux-en-Y gastric bypass and control of hemoglobin A1c, LDL cholesterol, and systolic blood pressure at 5 years in the diabetes surgery study. JAMA  2018;319:266–278
• Adams  TD, Davidson  LE, Litwin  SE, Kim  J, Kolotkin  RL, Nanjee  MN  et al.  Weight and metabolic outcomes 12 years after gastric bypass. N Engl J Med  2017;377:1143–1155
• Peterli  R, Wölnerhanssen  BK, Peters  T, Vetter  D, Kröll  D, Borbély  Y  et al.  Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in patients with morbid obesity: the SM-BOSS randomized clinical trial. JAMA  2018;319:255–265
• Salminen  P, Grönroos  S, Helmiö  M, Hurme  S, Juuti  A, Juusela  R  et al.  Effect of laparoscopic sleeve gastrectomy vs Roux-en-Y gastric bypass on weight loss, comorbidities, and reflux at 10 years in adult patients with obesity: the SLEEVEPASS randomized clinical trial. JAMA Surg  2022;157:656–666