Metabolic syndrome impact on nutritional deficiencies and metabolic status 1 year after sleeve gastrectomy

Silvia Cristina de Sousa Paredes; Marta de Lurdes Fernandes Alves; Maria Ramires da Silva Lopes Pereira; Laura Virgínia Pereira Teixeira Ribeiro

doi:10.1016/j.soard.2020.03.004

Metabolic syndrome impact on nutritional deficiencies and metabolic status 1 year after sleeve gastrectomy

Surg Obes Relat Dis. 2020 Jul;16(7):844-851. doi: 10.1016/j.soard.2020.03.004. Epub 2020 Mar 18.

Authors

Silvia Cristina de Sousa Paredes¹, Marta de Lurdes Fernandes Alves², Maria Ramires da Silva Lopes Pereira², Laura Virgínia Pereira Teixeira Ribeiro³

Affiliations

¹ Endocrinology Department, Hospital de Braga, Sete Fontes, Braga, Portugal; Department of Public Health and Forensic Sciences, and Medical Education, Medical Education Unit, Faculty of Medicine of the University of Porto, Porto, Portugal. Electronic address: silvia.sparedes@gmail.com.
² Endocrinology Department, Hospital de Braga, Sete Fontes, Braga, Portugal.
³ Department of Public Health and Forensic Sciences, and Medical Education, Medical Education Unit, Faculty of Medicine of the University of Porto, Porto, Portugal.

PMID: 32334971
DOI: 10.1016/j.soard.2020.03.004

Abstract

Background: A paucity of information is available on the comparative nutritional deficiencies considering the presence of metabolic syndrome (MetS) and nutritional changes after vertical sleeve gastrectomy (SG).

Objectives: To compare the nutritional status in patients with and without MetS before and 1 year after SG and to investigate its association with metabolic status.

Setting: A tertiary referral center.

Methods: Retrospective study, including all patients submitted to SG between January 2011 and July 2015. Patients were evaluated before and 12 months after surgery. MetS presence was classified using the International Diabetes Federation/American Heart Association/National Heart, Lung, and Blood Institute 2009 definition. Univariate and multivariate analyses were applied to find associations between MetS, nutritional, anthropometric, and metabolic parameters.

Results: A total of 330 patients were included and MetS was present in 47%. Preoperatively, patients without MetS presented a higher percentage of folate deficiency (12% versus 2%, P < .001). Follow-up data were available for 202 patients. In the 1-year evaluation, MetS patients presented significantly lower body mass index and percent excess weight loss (70.96 ± 20.4 versus 79.55 ± 23.0, P < .001). These patients also presented lower homocysteine (11.76 ± 4.3 versus 13.66 ± 7.6, P = .027) and magnesium (19.41 ± 2.1 versus 20.22 ± 1.9, P = .004) levels but higher calcium (9.27 ± .3 versus 9.16 ± .4, P = .031) and vitamin B12 (396, P 312-504.5 versus 329, P 255-433, P = .002) levels comparing with those without MetS. Multiple linear regression evidenced that higher preoperative albumin and postoperative ferritin and homocysteine were predictors of a lower body mass index after surgery, and higher postoperative folate levels were associated with lower insulin-resistance.

Conclusions: The impact of SG on nutritional parameters is affected by MetS. If not treated, preoperative deficiencies can impair postoperative metabolic status and weight loss. MetS should be considered when evaluating bariatric surgery candidates, and preoperative supplementation and long-term nutritional follow-up are required to prevent further nutritional deficiencies.

Keywords: Bariatric surgery; Insulin resistance; Metabolic syndrome; Micronutrient status; Nutritional status; Sleeve gastrectomy.

MeSH terms

Gastrectomy
Humans
Malnutrition* / etiology
Metabolic Syndrome* / complications
Nutritional Status
Obesity, Morbid* / surgery
Retrospective Studies