Nutritional impact of bariatric surgery: a comparative study of Roux-en-Y Gastric Bypass and Sleeve gastrectomy between patients from the public and private health systems.

Souza, Natália M. M.; Santos, Ana Célia O.; Santa-Cruz, Fernando; Guimarães, Henrique; Silva, Lucas M. L.; de-Lima, Denise Sandrelly C.; Ferraz, Álvaro A. B.; Kreimer, Flávio

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Original Article • Rev. Col. Bras. Cir. 47 • 2020 • https://doi.org/10.1590/0100-6991e-20202404 copy

Nutritional impact of bariatric surgery: a comparative study of Roux-en-Y Gastric Bypass and Sleeve gastrectomy between patients from the public and private health systems.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose:

To compare the nutritional status follow up of patients who underwent Roux-en-Y gastric bypass (BGYR) and Sleeve gastrectomy (SG) in hospitals of the private and public health systems, in Pernambuco.

Methods:

This study included patients who underwent bariatric surgery in the public and private health systems, in Pernambuco, from 2008 to 2016. Anthropometric and biochemical (hemoglobin, B12, iron and ferritin) data were evaluated in the preoperative period and at 3, 6 and 12 months after the operation.

Results:

There were no significant difference between patients seen at the two health systems regarding the levels of hemoglobin, iron, anemia and vitamin B12. Patients who underwent the RYGB, presented with iron deficiency which was significantly lower for those in the private system, but only at the 3 month evaluation. Low levels of ferritin were observed at the 6 month evaluation, and patients in the private health system presented with the highest ferritin deficiency. The rate of surgical success was significantly higher in those patients undergoing the RYGB at the private system.

Conclusions:

After a 12-month bariatric surgery follow-up, there was no statistically significant difference regarding micronutrient deficiency between patients followed up at the private and public health systems.

Headings:
Bariatric Surgery; Deficiency Diseases; Nutritional Requirements; Nutritional Status; Supplemental Health; Public Health

Variable	n	%	P-value
Age range			p⁽¹⁾ < 0.001*
20 to 29	153	22.1
30 to 39	260	37.6
40 to 59	278	40.2
Mean ± Standard deviation	37.6±9.3
Sex			p⁽¹⁾ < 0.001*
Male	172	24.9
Female	519	75.1
BMI Classification - Pre			p⁽¹⁾ < 0.001*
Overweight	4	0.6
Grade I obesity	16	2.3
Grade II obesity	202	29.2
Grade III obesity	469	67.9
TOTAL	691	100.0
AH			p⁽¹⁾ < 0.001*
Yes	378	54.9
No	310	45.1
TOTAL	688	100.0
DM			p⁽¹⁾ < 0.001*
Yes	174	25.3
No	513	74.7
TOTAL	687	100.0
System			p⁽¹⁾ < 0.001*
Public	314	45.4
Private	377	54.6
Type of surgery			p⁽¹⁾ < 0.001*
Bypass	582	84.2
Sleeve	109	15.8
TOTAL	691	100.0
Surgery success			p⁽¹⁾ < 0.001*
Yes	335	93.8
No	22	6.2
TOTAL	357	100.0

	System
Type of surgery	Public		Private		Total group		OR (CI at 95%)	P-value
	n	%	n	%	n	%
Bypass	230	73.2	352	93.4	582	84.2	1.00	p(1) < 0.001*
Sleeve	84	26.8	25	6.6	109	15.8	5.14 (3.19 a 8.28)
TOTAL	314	100.0	377	100.0	691	100.0

		System
Type of surgery	Evaluation	Public		Private		Total group		OR (CI at 95%)	P-value
		n	%	N	%	n	%
Bypass	Hb (3 months)								p⁽¹⁾ = 0.769
	Altered	33	20.6	60	19.5	93	19.9	1.07 (0.67 to 1.73)
	Normal	127	79.4	248	80.5	375	80.1	1.00
	TOTAL	160	100.0	308	100.0	468	100.0

	Hb (6 months)								p⁽¹⁾ = 0.776
	Altered	40	24.1	45	25.4	85	24.8	1.00
	Normal	126	75.9	132	74.6	258	75.2	1.07 (0.66 to 1.75)
	TOTAL	166	100.0	177	100.0	343	100.0

	Hb (12 months)								p⁽¹⁾ = 0.130
	Altered	38	36.2	38	27.1	76	31.0	1.52 (0.88 to 2.63)
	Normal	67	63.8	102	72.9	169	69.0	1.00
	TOTAL	105	100.0	140	100.0	245	100.0


Sleeve	Hb (3 months)								p⁽¹⁾ = 0.444
	Altered	12	22.2	7	30.4	19	24.7	1.00
	Normal	42	77.8	16	69.6	58	75.3	1.53 (0.51 to 4.58)
	TOTAL	54	100.0	23	100.0	77	100.0

	Hb (6 months)								p⁽²⁾ = 1.000
	Altered	11	23.9	1	20.0	12	23.5	**
	Normal	35	76.1	4	80.0	39	76.5
	TOTAL	46	100.0	5	100.0	51	100.0

	Hb (12 months)								p⁽²⁾ = 1.000
	Altered	6	30.0	-	-	6	28.6	**
	Normal	14	70.0	1	100.0	15	71.4
	TOTAL	20	100.0	1	100.0	21	100.0
P-value between types of surgery in the evaluation 1		p⁽¹⁾ = 0.803		p⁽²⁾ = 0.278		p⁽¹⁾ = 0.334
P-value between types of surgery in evaluation 2		p⁽¹⁾ = 0.979		p⁽²⁾ = 1.000		p⁽¹⁾ = 0.846
P-value between types of surgery in evaluation 3		p⁽¹⁾ = 0.595		p⁽²⁾ = 1.000		p⁽¹⁾ = 0.816

		System
Type of surgery	Evaluation	Public		Private		Total group		OR (CI at 95%)	P-value
		n	%	n	%	n	%
Bypass	Fe (3 months)								p⁽¹⁾ = 0.003*
	Low	45	35.7	67	22.0	112	26.0	1.97 (1.25 to 3.11)
	Normal	81	64.3	238	78.0	319	74.0	1.00
	TOTAL	126	100.0	305	100.0	431	100.0
	Fe (6 months)								p⁽¹⁾ = 0.157
	Low	26	18.2	21	12.4	47	15.1	1.57 (0.84 to 2.92)
	Normal	117	81.8	148	87.6	265	84.9	1.00
	TOTAL	143	100.0	169	100.0	312	100.0
	Fe (12 months)								p⁽¹⁾ = 0.755
	Low	12	12.6	15	11.3	27	11.8	1.14 (0.51 to 2.56)
	Normal	83	87.4	118	88.7	201	88.2	1.00
	TOTAL	95	100.0	133	100.0	228	100.0
Sleeve	Fe (3 months)								p⁽²⁾ = 1.000
	Low	10	21.3	5	21.7	15	21.4	1.00
	Normal	37	78.7	18	78.3	55	78.6	1.03 (0.31 to 3.45)
	TOTAL	47	100.0	23	100.0	70	100.0
	Fe (6 months)								p⁽²⁾ = 0.538
	Low	4	12.5	1	20.0	5	13.5	**
	Normal	28	87.5	4	80.0	32	86.5
	TOTAL	32	100.0	5	100.0	37	100.0
	Fe (12 months)								p⁽²⁾ = 1.000
	Low	1	5.6	-	-	1	5.3	**
	Normal	17	94.4	1	100.0	18	94.7
	TOTAL	18	100.0	1	100.0	19	100.0
P-value between types of surgery in the evaluation 1		p⁽¹⁾ = 0.070		p⁽¹⁾ = 0.980		p⁽¹⁾ = 0.416
P-value between types of surgery in evaluation 2		p⁽¹⁾ = 0.441		p⁽²⁾ = 0.496		p⁽¹⁾ = 0.802
P-value between types of surgery in evaluation 3		p⁽²⁾ = 0.689		p⁽²⁾ = 1.000		p⁽¹⁾ = 0.705

		System
Type of surgery	Evaluation	Public		Private		Total group		OR (CI at 95%)	P-value
		n	%	n	%	N	%
Bypass	Ferritin (3 months)								p⁽¹⁾ = 0,203
	Altered	3	2.5	16	5.3	19	4.5	1.00
	Normal	119	97.5	287	94.7	406	95.5	2.21 (0.63 to 7.73)
	TOTAL	122	100.0	303	100.0	425	100.0

	Ferritin (6 months)								p⁽¹⁾ = 0.006*
	Altered	2	1.6	16	9.2	18	6.0	**
	Normal	126	98.4	158	90.8	284	94.0
	TOTAL	128	100.0	174	100.0	302	100.0
	Ferritin (12 months)								p⁽¹⁾ = 0.409
	Altered	7	8.3	16	11.9	23	10.5	1.00
	Normal	77	91.7	119	88.1	196	89.5	1.48 (0.58 to 3.76)
	TOTAL	84	100.0	135	100.0	219	100.0
Sleeve	Ferritin (3 months)								p⁽²⁾ = 0.109
	Altered	1	2.2	3	13.0	4	5.9	**
	Normal	44	97.8	20	87.0	64	94.1
	TOTAL	45	100.0	23	100.0	68	100.0
	Ferritin (6 months)								**
	Altered	-	-	-	-	-	-	**
	Normal	36	100.0	5	100.0	41	100.0
	TOTAL	36	100.0	5	100.0	41	100.0
	Ferritin (12 months)								**
	Altered	-	-	-	-	-	-	**
	Normal	15	100.0	1	100.0	16	100.0
	TOTAL	15	100.0	1	100.0	16	100.0
P-value between types of surgery at evaluation 1		p⁽²⁾ = 1.000		p⁽²⁾ = 0.141		p⁽²⁾ = 0.542
P-value between types of surgery at evaluation 2		p⁽²⁾ = 1.000		p⁽²⁾ = 1.000		p⁽²⁾ = 0.145
P-value between types of surgery at evaluation 3		p⁽¹⁾ = 0.590		p⁽²⁾ = 1.000		p⁽²⁾ = 0.378

		System
Type of surgery	Assessment	Public		Private		Total group		OR (CI at 95%)	P-value
		n	%	n	%	N	%
Bypass	B12 (3 months)								p⁽¹⁾ = 0.495
	Low	8	16.7	62	20.9	70	20.3	1.00
	Normal	40	83.3	234	79.1	274	79.7	1.32 (0.59 to 2.98)
	TOTAL	48	100.0	296	100.0	344	100.0
	B12 (6 months)								p⁽¹⁾ = 0.481
	Low	33	55.0	84	49.7	117	51.1	1.24 (0.68 to 2.23)
	Normal	27	45.0	85	50.3	112	48.9	1.00
	TOTAL	60	100.0	169	100.0	229	100.0
	B12 (12 months)								p⁽¹⁾ = 0.213
	Low	21	48.8	77	59.7	98	57.0	1.00
	Normal	22	51.2	52	40.3	74	43.0	1.55 (0.78 to 3.10)
	TOTAL	43	100.0	129	100.0	172	100.0
Sleeve	B12 (3 months)								p⁽¹⁾ = 0.544
	Low	10	31.3	9	39.1	19	34.5	1.00
	Normal	22	68.8	14	60.9	36	65.5	1.41 (0.46 to 4.35)
	TOTAL	32	100.0	23	100.0	55	100.0
	B12 (6 months)								p⁽²⁾ = 1.000
	Low	13	52.0	3	60.0	16	53.3	**
	Normal	12	48.0	2	40.0	14	46.7
	TOTAL	25	100.0	5	100.0	30	100.0
	B12 (12 months)								p⁽²⁾ = 1.000
	Low	7	46.7	1	100.0	8	50.0	**
	Normal	8	53.3	-	-	8	50.0
	TOTAL	15	100.0	1	100.0	16	100.0
P-value between types of surgery in the evaluation 1		p⁽¹⁾ = 0.126		p⁽¹⁾ = 0.043*		p⁽¹⁾ = 0.019*
P-value between types of surgery in evaluation 2		p⁽¹⁾ = 0.800		p⁽²⁾ = 1.000		p⁽¹⁾ = 0.817
P-value between types of surgery in evaluation 3		p⁽¹⁾ = 0.885		p⁽²⁾ = 1.000		p⁽¹⁾ = 0.590

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