Abstract
Background Micronutrient deficiency is a well-known complication of bariatric surgery, and daily, lifelong multivitamin and multi-trace mineral supplementation is recommended after surgery. Risk of vitamin deficiency is known to vary by ethnicity, with several studies reporting higher incidence of deficiency of vitamins A and D and B vitamins among blacks compared to whites. We were unable to locate studies that examined risk of micronutrient deficiency after bariatric surgery among ethnic groups other than whites or blacks. The aim of this study was to determine if incidence of micronutrient deficiency after bariatric surgery differs among Asians and Pacific Islanders, compared to whites.
Methods We determined prevalence of micronutrient deficiency among 627 adults (36% white, 30% Pacific Islander, 11% Asian, 22% other/unknown) who underwent Roux-en-Y gastric bypass, gastric banding, or gastric sleeve for morbid obesity between 2002 and 2009 in Kaiser Permanente, Hawaii. Data on serum micronutrient levels, demographics, anthropometrics and comorbidities were collected from the VDW.
Results During up to 7 years follow-up after bariatric surgery, 78% (488 of 627) patients developed deficiency of at least one micronutrient, and incidence did not differ by ethnicity. Rates of deficiency of specific micronutrients were 61% vitamin A, 47% thiamine, 12% vitamin B12, 4% folate, 25% calcium, 43% iron. Procedure type (Roux-en-Y gastric bypass) and higher percentage of excess weight lost (%EWL) were associated with deficiency of several micronutrients After adjustment for age, sex, procedure type, and %EWL, ethnicity was not significantly associated with deficiency of any micronutrient after surgery.
Conclusion We found no evidence that the incidence of micronutrient deficiency after bariatric surgery differs between whites, Asians, and Pacific Islanders. The low numbers of blacks and those of other ethnicity in our cohort precludes comparison to prior studies. Despite attempts at universal prescribing of multivitamin and multimineral supplements, incidence of at least one micronutrient deficiency after bariatric surgery remains high in all ethnic groups. Results suggest the need for increased efforts to ensure patient knowledge of and compliance with lifelong supplementation.
