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Udredning og behandling af jernmangelanæmi efter fedmekirurgi med gastrisk bypass
... Após procedimento de bypass gástrico em Y-de-Roux, o alimento é desviado dos locais de maior absorção do ferro e tem menor contato com ácido estomacal, prejudicando também sua conversão para sua forma absorvível -ferrosa. Ademais, os pacientes apresentam maior dificuldade no consumo de alimentos ricos em ferro, como carne e vegetais, resultando em menor fornecimento de ferro após o procedimento (Gribsholt, 2014). ...
... Outra causa importante de redução ferrosa em pacientes pós-bariátrica é o aumento da perda desse micronutriente por sangramentos, que podem ser encontrados em mulheres de idade fértil, no sangramento menstrual, em sangramentos por úlcera, geralmente localizadas em anastomose superior, ou por causas raras, como condições malignas do trato gastrintestinal que geram sangramentos ocultos (Gribsholt, 2014). ...
A obesidade pode ser considerada como o distúrbio metabólico de maior prevalência em todo o mundo e é explicada pelo desequilíbrio persistente ente o gasto energético e a ingestão calórica. Desta forma, a cirurgia bariátrica vem ganhando muito destaque como uma terapia promissora para perda de peso a longo prazo, sendo atraente para os obesos. No entanto, ela traz consigo alguns desafios, como o déficit nutricional após a cirurgia. Esta revisão aborda os principais desafios nutricionais após a realização da bariátrica e as estratégias de prevenção e intervenção para esta problemática. O presente estudo trata-se de uma revisão literária, realizada a partir de buscas nas bases de dados do PubMed e SCIELO, utilizando as palavras chaves: “cirurgia bariátrica”, “complicações pós-operatórias”, “deficiência de vitaminas” e “deficiência mineral” entre os anos de 2015 até 2024. Foram selecionados 18 artigos condizentes com a temática. Os resultados destacam que a vitamina D, cálcio, vitamina B12 e ferro são os principais micronutrientes deficitários em pacientes pós operados de cirurgia bariátrica. A prevenção e a identificação precoce dessa deficiência nutricional são fundamentais para a minimizar os danos á saúde do paciente. Suplementação adequada e acompanhamento dos níveis séricos desses nutrientes é crucial em todos os pacientes que realizaram bariátrica.
In 2012, an outstanding expert panel derived from IFSO-EC (International Federation for the Surgery of Obesity - European Chapter) and EASO (European Association for the Study of Obesity), composed by key representatives of both Societies including past and present presidents together with EASO's OMTF (Obesity Management Task Force) chair, agreed to devote the joint Medico-Surgical Workshop of both institutions to the topic of metabolic surgery as a pre-satellite of the 2013 European Congress on Obesity (ECO) to be held in Liverpool given the extraordinarily advancement made specifically in this field during the past years. It was further agreed to revise and update the 2008 Interdisciplinary European Guidelines on Surgery of Severe Obesity produced in cooperation of both Societies by focusing in particular on the evidence gathered in relation to the effects on diabetes during this lustrum and the subsequent changes that have taken place in patient eligibility criteria. The expert panel composition allowed the coverage of key disciplines in the comprehensive management of obesity and obesity-associated diseases, aimed specifically at updating the clinical guidelines to reflect current knowledge, expertise and evidence-based data on metabolic and bariatric surgery. © 2013 S. Karger GmbH, Freiburg.
The effect of bariatric surgery on iron absorption is only partially known.
The objective was to study the effects of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGBP) on heme- and nonheme-iron absorption and iron status.
Fifty-eight menstruating women were enrolled in this prospective study [mean (±SD) age: 35.9 ± 9.1 y; weight: 101.7 ± 13.5 kg; BMI (in kg/m(2)): 39.9 ± 4.4]. Anthropometric, body-composition, dietary, and hematologic indexes and heme- and nonheme-iron absorption-using a standardized meal containing 3 mg Fe-were determined before and 12 mo after surgery. Forty-three subjects completed the 12-mo follow-up. Iron supplements were strictly controlled.
Heme-iron absorption was 23.9% before and 6.2% 12 mo after surgery (P < 0.0001). Nonheme-iron absorption decreased from 11.1% to 4.7% (P < 0.0001). No differences were observed by type of surgery. Iron intakes from all sources of supplements were 27.9 ± 6.2 mg/d in the SG group and 63.2 ± 21.1 mg/d in the RYGBP group (P < 0.001). Serum ferritin and total-body iron decreased more after RYGBP than after SG.
Iron (heme and nonheme) absorption is markedly reduced after SG and RYGBP. The magnitude of the decrease in heme-iron absorption is greater than that of nonheme iron. The amounts suggested as iron supplements may need to be increased to effectively prevent iron-status impairment. This trial was registered at controlled-trials.com as ISRCTN31937503.
Background. Anemia associated with deficiencies in iron, folic acid, and vitamin B12 are very common after Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) surgery for morbid obesity. This study was conducted to evaluate the prevalence of anemia after LRYGB. Patients and Methods. A total of 377 morbid obese patients were included in our study. All patients underwent a LRYGB. Hematologic parameters were obtained prior to and after surgery on standardized time intervals. Results. Anemia was present in 21 (P = 0.02) patients after surgery. Iron, folic acid, and vitamin B12 deficiencies were diagnosed in 66%, 15%, and 50% of patients, respectively. In 86% of patients, anemia was accompanied by one of these deficiencies. Conclusion. These results show that anemia and deficiencies for iron, folic acid deficiency, and vitamin B12 are very common within the first year after LRYGB. We advise a minimal daily intake of 65 mg of iron in male and 100 mg in female patients, 350 μg of vitamin B12, and 400 μg of folic acid. Patients undergoing LRYGB must be closely monitored for deficiencies pre- and postoperative and supplemented when deficiencies occur.
The reported prevalence of anemia after malabsorptive bariatric surgery has varied from 5% to 64% in the post-Roux-en-Y gastric bypass (RYGB) population, owing to the small study sample sizes and generally poor follow-up in surgical referral practices. The present study estimated the prevalence of anemia in the post-RYGB population and determined whether an integrated healthcare system with a shared electronic medical record could improve postoperative follow-up.
The medical records from 1009 sequential patients who had undergone RYGB from 2000 to 2005 were retrospectively analyzed. All anemia data within the healthcare system's electronic medical record were accessible.
Of the 1009 medical records, 720 contained ≥1 year of follow-up data concerning anemia. Anemia had developed or worsened in 259 patients, for a prevalence of 36% in the present sample. The anemia was moderate to severe (hemoglobin <10 g/dL) in 88 patients (12.2%.), many of whom subsequently required parenteral iron. Of the 1009 patients, the follow-up data for ≥3 years concerning anemia were available for only 357 patients (35.4%).
The results of the present study have shown that in a large population of patients undergoing RYGB, the prevalence of anemia was great enough to justify more intensive long-term screening. We hope the findings from the present report influence the national screening standards for this patient population.
Eight haematological quantities were measured in EDTA anticoagulated venous blood specimens collected from 1826 healthy male and female individuals between 18 and 90 years of age in the Nordic countries (Denmark, Finland, Iceland, Norway and Sweden). The samples, collected between November 1999 and November 2001 as part of the Nordic Reference Interval Project (NORIP), were analysed on 12 different types of modern automated haematology instruments currently in use among the 60 laboratories participating in the study. Non-parametric reference intervals (between 2.5 and 97.5 percentiles) have been calculated for B-Haemoglobin (females 117-153 g/L, males 134-170 g/L), B-Erythrocytes (females 3.94-5.16 x 10(12)/L, males 4.25-5.71 x 10(12)/L), B-EVF (females 0.348-0.459, males 0.395-0.500), B-MCV (82-98 fL), Erc-MCH (27.1-33.3 pg), Erc-MCHC (317-357 g/L), B-Trc (females 165-387 x 10(9)/L, males 145 x 348 x 10(9)/L) and B-Lkc (3.5-8.8 x 10(9)/L). Partitioning of data according to age and gender was done according to a standardized procedure. For most variables the calculated reference intervals corresponded well with older and less well-defined reference intervals. The mean concentration of B-Haemoglobin increased by 0.08 g/L per year of age in women, and decreased by 0.1 g/L per year of age in men. B-Haemoglobin increased with body mass index in both men and women. Smoking increased the mean of B-Lkc by 1.1 x 10(9)/L and regular use of alcohol increased the mean of B-MCV by 0.8 fL. The influence of these factors was small overall and did not promote specific reference intervals.
We sought to identify the frequency and mechanisms of anemia after bariatric surgery in a bariatric surgery program at the Medical College of Wisconsin, (Milwaukee, WI). Anemia after bariatric surgery has often been attributed to iron deficiency, although an inflammatory component might be present, making the anemia after surgery mechanistically complex.
The body mass index and hemoglobin (Hb), vitamin B(12), folate, iron, and ferritin levels were extracted from the records of 1125 patients for ≤4 years after Roux-en-Y gastric bypass. Anemia was defined using the World Health Organization criteria.
The mean body mass index, Hb, and ferritin decreased after surgery. The body mass index decreased from 50.1 kg/m(2) (95% confidence interval [CI] 49.6-50.6) at baseline to 33.0 kg/m(2) (95% CI 32.3-33.6) at 12 months and remained unchanged thereafter. The Hb level decreased from 13.4 g/dL (95% CI 13.3-13.5) to 12.8 (95% CI 12.6-13.1) and ferritin from 87.5 ng/mL (95% CI 75.2-99.7) to 55.4 (95% CI 42.9-68.0) at 24-48 months, and serum iron increased from 68.4 μg/dL (95% CI 66.8-70.0) to 82.8 (95% CI 76.4-88.7); all P values were <.01. Anemia was present in 12% (95% CI 10-14%) of patients at baseline and had increased to 23% (95% CI 16-30%) at 24-48 months. The changes in ferritin, Hb, and the percentage of patients with anemia were most pronounced in premenopausal women. Vitamin B(12) and folate levels were unaffected.
The baseline incidence of anemia was greater than expected and increased significantly after surgery. The percentage of those with anemia and low ferritin was most significant in premenopausal women; however, the overall iron bioavailability improved significantly with pronounced weight loss, suggesting a reduction in inflammation. These findings indicate that anemia after bariatric surgery cannot be explained on the basis of iron availability and suggest that other mechanisms, currently undefined, contribute to the development of anemia in these patients.
Morbid obesity is a significant problem in the Western world. Recently, there has been an increase in the number of patients undergoing surgical weight loss procedures. Currently, the most widely performed procedure is the Roux-en-Y gastric bypass operation which combines restriction of food intake with malabsorption of calories and various nutrients, resulting in weight loss and nutritional deficiencies, respectively. Various types of anemia may complicate Roux-en-Y and commonly include deficiencies of iron, folate, and vitamin B12. Iron deficiency is particularly common and may result from many mechanisms including poor intake, malabsorption, and mucosal bleeding from marginal ulceration. However, less appreciated etiologies of nutritional anemia include deficiencies of B-complex vitamins, ascorbic acid, and copper. Replacement of the missing or decreased constituent usually reverses the anemia. Since physicians of various medical and surgical specialties are often involved with the postoperative care of bariatric patients, a review of anemia in this patient population is warranted.
To evaluate the long-term weight loss maintenance after 2 to 4 years in severely obese subjects after a lifestyle intervention at a weight loss camp in Denmark.
In a retrospective follow-up study, we assessed weight loss after 21 weeks of treatment at a weight loss camp, weight loss maintenance after 2 to 4 years, and numbers of subjects with a weight loss maintenance of > or = 10% of a total number of 435 severely obese adults participating in an intensive lifestyle intervention with a primary focus on physical activity.
We obtained follow-up data of 249 subjects (180 women and 69 men) with an initial body weight of 142 +/- 32 kg. After 21 weeks at the camp, the subjects had reduced their body weight with a mean of 21.9 +/- 13 kg (corresponding to a 15% weight loss). The average weight loss maintenance was 5.3% at a follow-up after 2 to 4 years, and 28.3% had maintained a weight loss above 10% after 4 years of follow-up.
Weight loss camps are a relatively new commercial approach in treating severely obese subjects. However, the results demonstrate that even with a multidisciplinary intensive setting with focus on diet, exercise, and psychological counseling, only 28% had maintained a weight loss above 10% after 4 years. This emphasizes that obesity is a chronic condition that needs additional strategies after a weight loss intervention in the efforts to maintain a sufficient weight loss.