Iron and bariatric surgery

© 2017 Elsevier Inc. All rights reserved. This chapter focuses on iron deficiency in obese patients before and after bariatric surgery. Iron deficiency is common in obese patients due to the unbalanced Western affluent diet in combination with the obesity-associated, chronic, low-grade inflammation that induces the production of hepcidin and subsequently inhibits iron absorption and release. Bariatric surgery in these patients creates anatomical changes in the gastrointestinal tract, which influences nutrient intake and absorption, and subsequently the development of nutritional deficiencies (including iron deficiency). There are multiple factors that can contribute to the development of iron deficiency after bariatric surgery: (1) reduction of gastric acid secretion, which is required for the absorption of iron as it transforms the ferric form (Fe3+) to the absorbable ferrous form (Fe2+); (2) diminished intestinal absorption surface, especially bypassing the duodenum and proximal jejunum as the main absorption sites of iron; and (3) reduced nutrient intake, including iron-rich foods, due to increased satiety, reduced hunger, and food intolerances. Furthermore, insufficient supplementation due to nonadherence to a prescribed regimen or inadequate amounts of iron and inadequate nutritional support contribute to the development of iron deficiency. Therefore, preoperative screening and treatment of deficiencies is essential, and lifelong follow-up (including nutritional advice) after bariatric surgery is crucial.

ISBN:9780128040119

Jaar van publicatie:2016