Associations of Bariatric Interventions With Micronutrient and Endocrine Disturbances

• Published in: JAMA health forum 2020-06, Vol.3 (6), p.e205123-e205123
• Main Authors: Syn, Nicholas L, Lee, Phong Ching, Kovalik, Jean-Paul, Kwang Wei Tham, Ong, Hock Soo, Chan, Weng Hoong, Tan, Chuen Seng, Chin Hong Lim
• Format: Article
• Language: English
• Subjects: Gastrointestinal surgery; Generalized linear models; Nutrition, Obesity, and Exercise; Online Only; Original Investigation
• ISSN: 2574-3805; 2574-3805; 2689-0186
• DOI: 10.1001/jamanetworkopen.2020.5123

Importance Few studies have described the longitudinal trajectories of serum levels of micronutrients whose deficiencies are associated with serious sequelae following bariatric procedures, such as anemia, osteoporotic fractures, and neuropathies. Furthermore, previous studies comparing laparoscopic sleeve gastrectomy (LSG) vs Roux-en-Y gastric bypass (LRYGB) or one-anastomosis gastric bypass (OAGB) procedures may have been limited by selection and confounding biases. Objective To appraise the spectrum and temporal course of micronutrient deficiencies associated with bone metabolism and erythropoiesis after LSG vs OAGB or LRYGB procedures, using the propensity score as a balancing score. Design, Setting, and Participants This prospective, longitudinal comparative effectiveness study was conducted at a high-volume bariatric unit in Singapore from September 1, 2008, to November 30, 2017, with a cutoff date for analysis of September 2018. Patients who underwent adjustable gastric banding, biliopancreatic diversion procedures, and intragastric balloon procedures were excluded. All other patients who underwent bariatric procedures were included. Data were analyzed from September 23 to 30, 2018. Main Outcomes and Measures Serial assessment of 13 biochemical parameters at 12 time points for up to 5 years after bariatric procedure. Inverse probability-of-treatment weights were used to obtain estimates of the mean associations of variables assessed with the bariatric surgical interventions. Longitudinal trajectories were analyzed using mixed-effects generalized linear models to apportion the temporal variation of serum micronutrients into fixed-effects and random-effects components. Results A total of 688 patients were included in this study, of whom 499 underwent LSG (mean [SD] age, 41.5 [11.3] years; 318 [63.7%] women) and 189 underwent OAGB or LRYGB (mean [SD] age, 48.6 [9.4] years; 112 [59.3%] women). There were no differences during follow-up among patients who underwent LSG vs those who underwent OAGB or LRYGB in intact parathyroid hormone levels (mean difference, 7.05 [95% CI, −28.67 to 42.77] pg/mL;P = .70), serum 25-hydroxyvitamin D levels (mean difference, −0.72 [95% CI, −1.56 to 0.12] ng/mL;P = .09), or phosphate levels (mean difference, 0.006 [95% CI, −0.052 to 0.064] mg/dL;P = .83). Hemoglobin levels were a mean 0.63 (95% CI, 0.41 to 0.85) g/dL higher among patients who underwent LSG compared with those who underwent OAGB or LRYGB (P < .001), despite n