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Surg Obes Relat Dis. 2017 Mar 2. pii: S1550-7289(17)30105-3. doi: 10.1016/j.soard.2017.02.021. [Epub ahead of print]

Nutritional deficiencies four years after laparoscopic sleeve gastrectomy-are supplements required for a lifetime?

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Department of Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. Electronic address:
Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Department of Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Department of Nutrition, Assuta Medical Center, Tel Aviv, Israel.
Department of Human Metabolism and Nutrition, Hebrew University, Jerusalem, Israel.



Data regarding long-term nutritional deficiencies following laparoscopic sleeve gastrectomy (LSG) are scarce.


To assess the prevalence of nutritional deficiencies and supplement consumption 4 years post-LSG.


Hebrew University, Israel.


Data were collected prospectively from preoperative and 1 and 4 years postoperative including anthropometric parameters, biochemical tests, and supplement intake.


Data were available for 192, 77, and 27 patients at presurgery and 1 and 4 years post-LSG, respectively. Prevalence of nutritional deficiencies at baseline and 1 and 4 years postsurgery, respectively, were specifically for iron (44%, 41.2%, 28.6%), anemia (11.5%, 20%, 18.5%), folate (46%, 14.3%, 12.5%), vitamin B12 (7.7%, 13.6%, 15.4%), vitamin D (96.2%, 89%, 86%), and elevated parathyroid hormone (PTH) (52%, 15.4%, 60%). Vitamin D levels remained low throughout the whole period. PTH levels were 37.5 pg/mL at 1 year postsurgery and increased to 77.3 pg/mL at 4 years postsurgery (P = .009). Females had higher prevalence of elevated PTH and a tendency for higher rates of anemia, compared with males 4 years postsurgery (80% versus 20%, P = .025; and 28% versus 0%, P = .08, respectively). Of the patients, 92.6% reported taking a multivitamin and 74.1% vitamin D supplements during the first postoperative year, while after 4 years only 37% and 11.1% were still taking these supplements, respectively.


A high rate of nutritional deficiencies is common at 4 years post-LSG along with low adherence to the nutritional supplementation regimen. Long-term nutritional follow-up and supplementation maintenance are crucial for LSG patients. Future studies are needed to clarify the clinical impact of such deficiencies.


Bariatric surgery; Laparoscopic sleeve gastrectomy (LSG); Nutritional deficiencies; Supplements

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