Short-Term Changes in Body Composition and Response to Micronutrient Supplementation After Laparoscopic Sleeve Gastrectomy

Obes Surg. 2015 Dec;25(12):2344-51. doi: 10.1007/s11695-015-1700-0.


Background: We evaluated dietary intakes, body composition, micronutrient deficiency, and response to micronutrient supplementation in 47 patients before and for 6 months after laparoscopic sleeve gastrectomy (LSG).

Methods: Before, 3, and 6 months after LSG, we measured dietary intakes with food-frequency questionnaires, body composition with bioimpedance analysis (BIA) and bioelectrical vector analysis (BIVA), and plasma concentrations of iron, Zn, water-, and lipo-soluble vitamins.

Results: After LSG, energy intake significantly decreased and patients lost weight, fat mass, and free-fat mass. BIVA showed a substantial loss of soft tissue body cell mass (BCM) with no change in hydration. Before surgery, 15 % of patients were iron deficient, 30 % had low levels of zinc and/or water-soluble vitamins, and 32 % of vitamin 25(OH)-D3. We treated iron deficiency with ferrous sulfate, isolated folate deficiency with N5-methyiltetrahydrofolate-Ca-pentahydrate, and deficiencies in vitamin B1, B12, or Zn, with or without concomitant folate deficiency, with multivitamin. No supplementation was given to vitamin 25(OH)-D3 deficient patients. At first follow-up, 7 % of patients developed new deficiencies in iron, 7 % in folic acid (n = 3), and 36 % in water-soluble vitamins and/or zinc whereas no new deficit in vitamin 25(OH)-D3 occurred. At final follow-up, deficiencies were corrected in all patients treated with either iron or folate but only in 32 % of those receiving multivitamin. Vitamin 25(OH)-D3 deficiency was corrected in 73 % of patients even though these patients were not supplemented.

Conclusion: LSG-induced weight loss is accompanied by a decrease in BCM with no body fluid alterations. Deficiencies in water-soluble vitamins and Zn respond poorly to multivitamin supplementation.

Keywords: Bioimpedence analysis; Body composition; Folic acid; Iron; Laparoscopic sleeve gastrectomy; Trace metals; Vitamin A; Vitamin B1; Vitamin B12; Vitamin D; Vitamin E; Zinc.

MeSH terms

  • Adult
  • Avitaminosis / epidemiology
  • Avitaminosis / etiology
  • Avitaminosis / prevention & control
  • Body Composition / physiology*
  • Dietary Supplements*
  • Female
  • Folic Acid / blood
  • Folic Acid Deficiency / etiology
  • Gastrectomy / adverse effects
  • Humans
  • Laparoscopy / adverse effects
  • Male
  • Micronutrients / administration & dosage*
  • Micronutrients / pharmacology
  • Middle Aged
  • Nutrition Therapy
  • Obesity, Morbid / diet therapy*
  • Obesity, Morbid / epidemiology
  • Obesity, Morbid / metabolism
  • Obesity, Morbid / surgery*
  • Postoperative Complications / prevention & control
  • Postoperative Period
  • Retrospective Studies
  • Trace Elements / blood
  • Vitamins / blood
  • Young Adult


  • Micronutrients
  • Trace Elements
  • Vitamins
  • Folic Acid