Integrated health original article
Influence of diet and supplements on iron status after gastric bypass surgery

https://doi.org/10.1016/j.soard.2015.09.007Get rights and content

Abstract

Background

Iron deficiency is common after Roux-en-Y gastric bypass (RYGB) surgery, but there is no consensus on the optimal diet quality and quantity for restoring and preserving iron status.

Objectives

The authors explored the impact of dietary and supplemental sources of iron and absorptive factors on iron status.

Setting

Academic, United States.

Methods

In a cross-sectional cohort of individuals who underwent RYGB, nutrient intakes from food and supplements were measured using 3-day food records. Blood biomarkers of iron status, including concentrations of ferritin, total iron binding capacity, serum transferrin receptor (sTfR), and the sTfR:ferritin ratio, were assessed by a reference laboratory; iron deficiency was defined as having at least 2 abnormal measures. Associations between iron status biomarkers and dietary predictors were determined using regression analysis.

Results

Of the 36 participants, 97% were female, the mean age was 45 years (95% confidence interval, 41–48 years), and body mass index was 32 (30–35) kg/m2. Iron deficiency was found in 42% of participants. Dietary intake of heme iron, found in meats, was favorably associated with 3 iron status biomarkers (ferritin, β = .366; sTfR:ferritin ratio, β = –.459; and total iron binding capacity, β = –18.26; all P<.05), independent of obesity-induced inflammation. Intake of vitamin C from food contributed to iron status (ferritin, β = .010 and sTfR:ferritin ratio, β = –.011; P<.05). Use of supplementary non-heme iron, at doses recommended for prophylaxis (45 mg/d), was positively associated with serum ferritin (β = .964; P = .029).

Conclusions

For patients who have undergone RYGB, consuming high, but realistic amounts of heme iron in meat, vitamin C from food, and adherence to recommended iron supplements can prevent iron deficiency.

Section snippets

Participants

This was an observational, cross-sectional study in which measurements were obtained prospectively. Study participants were patients who had undergone RYGB ranging from .6 to 14.3 years previously. Participants were recruited by mailing postcards to 50,000 addresses in the 30-mile radius of Purdue University; these addresses were obtained from a marketing service (Axicom, Little Rock, AR). Thus, participants who enrolled in the study were likely to be representative of a community sample of

Characteristics of the study population

Thirty-six participants were eligible and completed all study measures. Within the participant pool,>6 different bariatric surgery centers were represented. All participants self-reported their race/ethnicity as non-Hispanic white. Most patients were female (97%), and their average age at the time of the study was 45 years (95% confidence interval, 41–48 years). Seventy-two percent of the population had not experienced menopause. The length of time since participants had undergone RYGB was 6.8

Discussion

In this study, the authors aimed to identify factors in the diet that influence iron status in patients who have undergone RYGB. The authors explored cross-sectional relationships between dietary intake of iron and iron’s absorptive factors from food and supplement sources and several biomarkers of iron status. The major findings of this study were that dietary intake of heme iron, high concentrations of which are found in meat products, was the dietary factor that was most related to iron

Disclosures

International Copper Association, Ltd. provided support to this study. The authors have no commercial associations that might be a conflict of interest in relation to this article.

Acknowledgments

The authors thank all study participants. Emily Watson provided excellent technical assistance for processing of blood samples. This material is based upon work that is supported by the National Institute of Food and Agriculture, U.S. Department of Agriculture, under award number IND030427.

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