Preoperative micronutrient repletion strategies in metabolic and bariatric surgery: A systematic review

Xueying Tang*, Dianne P Reidlinger, Megan Crichton, Lillian Craggs-Dino, Flavia Fayet-Moore, Skye Marshall

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

Abstract

BACKGROUND: Evidence is lacking to inform how micronutrient deficiencies should be prevented and treated before metabolic-bariatric surgery to optimize patient outcomes.

OBJECTIVE: This systematic review aimed to examine the effect of preoperative repletion strategies for micronutrient deficiencies on micronutrient biochemistry, quality of life, and complication rates among candidates for metabolic and bariatric surgery, compared to usual care, alternate strategies, or no treatment.

METHODS: PubMed, Embase, CINAHL, and CENTRAL was searched in April 2024. A grey literature search was updated in April 2024 via Google search. Eligible observational and interventional studies were those that provided micronutrient repletion prior to the surgery and measured micronutrient status pre- and/or post-surgery. Studies with participants who were pregnant, lactating, or elected jejunocolic bypass, jejunoileal bypass, vertical banded gastroplasty, and biliopancreatic diversion were excluded. Risk of bias was assessed using the Academy of Nutrition and Dietetics Quality Criteria Checklist. Findings were narratively synthesized, and the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) was adopted when applicable. Twenty studies (n=27 groups) were included (n=15 observational; n=5 interventional).

RESULTS: Strategies targeted vitamins A, D, E, B6, B12, C, thiamin, folate, calcium, iron, selenium, and zinc, including chronic dosing of oral supplements and multivitamins (n=21), mega-doses of oral supplements (n=1), intramuscular injection (n=1), intravenous infusion (n=1), and a mix of injection and oral supplements (n=3). Preoperative repletion strategies varied in efficacy. Chronic dosing of oral supplements increased vitamin D levels (n=4 interventional studies; GRADE rating: moderate). Multivitamins did not improve vitamin B12 status but improved status of vitamin B6, vitamin C, and folate. Iron infusion (n=1) increased ferritin levels despite small sample size and low adherence rate, whereas oral iron supplementation resulted in unchanged (n=4) or decreased (n=1) ferritin levels.

CONCLUSIONS: Proactive and personalized micronutrient repletion schedules may decrease the risk of preoperative and early postoperative deficiency.

Original languageEnglish
Pages (from-to)1-47
Number of pages47
JournalJournal of the Academy of Nutrition and Dietetics
DOIs
Publication statusAccepted/In press - 19 Sept 2024

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