Micronutrient status 2 years after bariatric surgery: a prospective nutritional assessment
Open accessAbstract
Background: Among commonly performed bariatric surgeries, biliopancreatic diversion with duodenal switch (BPD-DS) provides greater weight loss than Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG), with sustained metabolic improvements. However, the risk of long-term nutritional deficiencies due to the hypoabsorptive component of BPD-DS hinders its widespread use. Objective: The aim of the study was to examine nutritional status over 2 years after BPD-DS, RYGB or SG. Methods: Patients were recruited in the REMISSION trial (NCT02390973), a single-center, prospective study. Out of 215 patients, 73, 48 and 94, respectively, underwent BPD-DS, RYGB or SG. Weight loss, micronutrient serum levels (including iron, calcium, parathormone, vitamins A, B12 and D), and nutritional supplementation were assessed over 2 years. Patients were supplemented according to the type of surgery and individual micronutrient level evolution. Results: = 0.08). BPD-DS patients showed lower levels of iron, calcium and vitamin A than SG patients at 24 months. Groups had similar levels of vitamin D at 24 months. Prevalence of vitamin D, calcium, iron, vitamin A and vitamin B12 deficiency was similar among groups at 24 months. Rates of vitamin D insufficiency and iron deficiency were lower at 24 months than at baseline. Micronutrient intake was consistent with recommendations in groups post-surgery, but most BPD-DS patients took vitamin A and vitamin D supplement doses above initial recommendations. Conclusion: With appropriate medical and nutritional management, all surgeries led to similar rates of vitamin D, calcium, iron, vitamin A and vitamin B12 deficiencies at 24 months. However, initial vitamin A and vitamin D supplementation recommendations for BPD-DS patients should be revised upwards.
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The complexity, risks of malabsorption and nutritional consequences, and rare potential for accelerated liver fibrosis limit widespread adoption of BPD-DS.
“However, its complexity, risks of malabsorption and its nutritional consequences, and the rare potential for accelerated liver fibrosis limit widespread adoption [53,58,59,60].”
From Impact of Bariatric Surgery and Endoscopic Therapies on Liver Health in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Review (2025) · cites this paper as [60]
The Abstract (Background; page not provided) says that long-term nutritional-deficiency risk from BPD-DS’s hypoabsorptive component hinders its widespread use. The Introduction describes reduced nutrient absorption, but our copy does not support surgical complexity or rare accelerated liver fibrosis as reasons limiting adoption. (LLM, conf=0.88)
Experimental — accuracy not yet measuredBPD-DS carries well-recognized risks including protein-calorie malnutrition and fat-soluble vitamin deficiencies in a subset, and rare cases of acute liver failure have been documented after this procedure.
“Indeed, BPD-DS carries well-recognized risks: protein–calorie malnutrition and fat-soluble vitamin deficiencies occur in a subset, and rare cases of acute liver failure have been documented, specifically after this procedure”
From Impact of Bariatric Surgery and Endoscopic Therapies on Liver Health in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Review (2025) · cites this paper as [60]
The Introduction (page unavailable) reports high rates of fat-soluble vitamin deficiencies after BPD-DS, although the Discussion says deficiencies were low in this study's medically managed patients at 24 months. The Results note lower early prealbumin levels in BPD-DS patients, but do not establish protein–calorie malnutrition; no passage found documents acute liver failure after the procedure. (LLM, conf=0.86)
Experimental — accuracy not yet measuredSome patients with malabsorptive complications after BPD-DS have required revisional surgery to halt progressive liver dysfunction.
“some patients with malabsorptive complications have required revisional surgery (lengthening of the common channel or conversion to a gastric bypass) to halt progressive liver dysfunction [60].”
From Impact of Bariatric Surgery and Endoscopic Therapies on Liver Health in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Review (2025) · cites this paper as [60]
The Introduction describes BPD-DS as having a substantial hypoabsorptive component, and Methods > Surgical procedures gives its common-channel length (no page numbers supplied). Neither those passages nor the passages retrieved for revisional surgery and liver dysfunction report patients requiring revision to halt progressive liver dysfunction. (LLM, conf=0.72)
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- Authors
- Côté, M., Pelletier, L., Nadeau, M., Bouvet-Bouchard, L., Julien, F., Michaud, A., Biertho, L., & Tchernof, A.
- Affiliations
- Institut universitaire de cardiologie et de pneumologie de Québec (CA)
- Corresponding author
- Biertho, Laurent
- Tchernof, André
- Venue
- Frontiers in Nutrition
- Publisher
- Frontiers Media SA
- Published
- 2024-05-14
- Volume
- 11
- Pages
- 1385510-1385510
- ISSN
- 2296-861X (ISSN-L)
- PMC
- PMC11132185
- OpenAlex
- W4396905163
- Cited by
- 19
- References
- 46
- Citations by year
- 2026: 14 · 2025: 5
- FWCI
- 8.00
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Nutrition (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Canadian Institutes of Health Research
- Natural Sciences and Engineering Research Council of Canada
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
- Keywords
- bariatric surgery, biliopancreatic diversion with duodenal switch, Roux-en-Y gastric bypass, sleeve gastrectomy, micronutrient deficiency, vitamin D deficiency, iron deficiency, calcium deficiency, vitamin A deficiency, vitamin B12 deficiency, vitamin supplementation, nutritional status, weight loss
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