Nutritional deficiencies after sleeve gastrectomy and Roux-en-Y gastric bypass at 10 years: secondary analysis of the SLEEVEPASS randomized clinical trial

Abstract

<p><strong>Background: </strong>Long-term data on the prevalence of nutritional deficiencies after laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in RCTs are lacking. The aim of this study was to compare nutritional deficiencies and adherence to vitamin supplements after LSG and LRYGB at 10 years.</p><p><strong>Methods: </strong>This was a predefined secondary analysis of the Finnish SLEEVEPASS (LSG versus LRYGB for severe obesity) multicentre RCT, with 10-year nutritional laboratory measurements and completed questionnaires on micronutrient supplement use, to assess the prevalence of micronutritional and macronutritional deficiencies and adherence.</p><p><strong>Results: </strong>Of 240 patients (121 LSG patients and 119 LRYGB patients), 228 were available for 10-year follow-up. Of these 228 patients, 190 (83.3%) were available for laboratory tests and 192 (84.2%) for questionnaires. There were no statistically significant differences between LSG and LRYGB in the prevalence of vitamin D insufficiency (10 of 94 (11%) versus 9 of 84 (11%) respectively; P = 0.545), the prevalence of hypocalcaemia (3 of 92 (3%) versus 1 of 83 (1%) respectively; P = 0.088), the prevalence of vitamin B12 deficiency (2 of 46 (5%) versus 0 of 45 (0%); P = 0.240), or mean vitamin B12 levels (P = 0.939). The prevalence of iron deficiency, defined by ferritin level, was statistically significantly lower after LSG compared with LRYGB (4 of 29 (14%) versus 12 of 29 (41%); P = 0.017), with a median ferritin level of 34 (interquartile range 20-54) µg/l after LSG and 20 (interquartile range 12-117) µg/l after LRYGB (P = 0.397). The LSG group had statistically significantly lower overall adherence to micronutritional supplements (70 of 99 (71%) versus 83 of 93 (89%) respectively; P = 0.002).</p><p><strong>Conclusion: </strong>Long-term micronutritional and macronutritional deficiencies were rare after both LSG and LRYGB, with similar deficiency rates. Only the prevalence of iron deficiency was more common after LRYGB compared with LSG. The overall adherence to micronutritional supplements was lower after LSG.</p>