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      Determining the prevalence and causes of anaemia in patients after bariatric surgery in a Saudi hospital

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          Abstract

          Objectives

          Obesity is a chronic disease with high prevalence in Saudi population. Bariatric surgery is an effective method for significant weight reduction. However, various types of nutritional deficiencies occur after weight loss surgery which increase the risk of anaemia. In this study, we aimed to determine the incidence of anaemia after bariatric surgery.

          Method

          A retrospective descriptive study was conducted with 70 patients of both genders aged over 16 years. These patients underwent bariatric surgery between February 2016 and March 2018 and had completed 6 months or more of post-surgery follow-up. Anthropometric and laboratory data were obtained before and after surgery at standard time intervals. All patients were on postoperative vitamin supplements.

          Results

          Of the total study patients, 41 were women (58.57%) and 29 were men (41.42%) with a median age of 38.5 years (range, 16–65). The median follow-up time was 8 months (6–24 months). Postoperatively, 16 patients (22.9%) developed anaemia, and interestingly, all of them were women (39%). Fifteen of these sixteen patients (93.8%) had microcytic anaemia. Two of those sixteen patients (12.5%) had Roux-en-Y gastric bypass, while fourteen (87.5%) had sleeve gastrectomy.

          Conclusion

          Anaemia and its related nutritional deficiencies are a common complication after bariatric surgery which exerts a major impact on health, particularly in women. Hence, a strict post-operative follow-up and appropriate supplementation are recommended to combat anaemia and its related nutritional deficiencies.

          الملخص

          أهداف البحث

          تعد السمنة مرضا مزمنا مع وجود انتشار واسع لها بين سكان المملكة العربية السعودية. وبينما تعد جراحات السمنة طريقة فاعلة لإنقاص الوزن، لوحظ نقص عدد من العناصر الغذائية لدى الخاضعين لهذه الجراحات، مما يرفع نسبة إصابة المرضى بفقر الدم. وتهدف هذه الدراسة لوصف معدلات الإصابة بفقر الدم بعد عمليات جراحة السمنة.

          طرق البحث

          شملت هذه الدراسة الوصفية الاستعادية ٧٠ مريضا تجاوزت أعمارهم ١٦ عاما، من الجنسين، خضعوا لجراحات السمنة في الفترة ما بين فبراير ٢٠١٦ ومارس ٢٠١٨، الذين قضوا فترة لا تقل عن ٦ أشهر بعد إجراء عمليات السمنة. ولقد تم جمع البيانات القياسية والمخبرية قبل وبعد العملية على فترات زمنية موحدة. علما بأنه قد تم وصف فيتامينات تكميلية بعد العملية لجميع المرضى.

          النتائج

          ٤١ من العينة كانوا إناثا (٥٨.٥٧٪)، و٢٩ منهم كانوا ذكورا (٤١.٤٢٪)، بمتوسط عمري ٣٨,٥ عاما، حيث كانت أعمار المرضى تتراوح بين ١٦ و٦٥ عاما. ولقد تمت متابعة المرضى لمدة متوسطها ٨ أشهر، حيث تراوحت مدة المتابعة للمرضى بين ٦-٢٤ شهرا بعد العملية. وبينت الدراسة أن ١٦ من جميع المرضى (٢٢.٩٪) أصيبوا بفقر الدم، وكان جميعهن من الإناث (٣٩٪). ولوحظ أن ١٥ من أصل ١٦ مريضة (٩٣.٨٪) مصابات بفقر الدم لديهم صغر حجم كريات الدم الحمراء. اثنتان من أصل ١٦ مريضة (١٢.٥٪) أصيبتا بفقر الدم خضعتا لجراحة تغيير مسارالمعدة، بينما خضعت ١٤ مريضة (٨٧.٥٪) لتكميم المعدة.

          الاستنتاجات

          يعد فقر الدم ونقص العناصر الغذائية المرتبط به أحد المضاعفات الشائعة بعد جراحات السمنة، الأمر الذي له أثر كبير على صحة المرضى بعد هذا النوع من العمليات، خصوصا عند الإناث. لذلك نوصي بالمتابعة الدقيقة بعد العملية وإعطاء المكملات الغذائية المناسبة.

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          Most cited references25

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          Trends in bariatric surgical procedures.

          The increasing prevalence and associated sociodemographic disparities of morbid obesity are serious public health concerns. Bariatric surgical procedures provide greater and more durable weight reduction than behavioral and pharmacological interventions for morbid obesity. To examine trends for elective bariatric surgical procedures, patient characteristics, and in-hospital complications from 1998 to 2003 in the United States. The Nationwide Inpatient Sample was used to identify bariatric surgery admissions from 1998-2002 (with preliminary data for 12 states from 2003) using International Classification of Diseases, Ninth Revision, codes for foregut surgery with a confirmatory diagnosis of obesity or by diagnosis related group code for obesity surgery. Annual estimates and trends were determined for procedures, patient characteristics, and adjusted complication rates. Trends in bariatric surgical procedures, patient characteristics, and complications. The estimated number of bariatric surgical procedures increased from 13,365 in 1998 to 72,177 in 2002 (P<.001). Based on preliminary state-level data (1998-2003), the number of bariatric surgical procedures is projected to be 102 794 in 2003. Gastric bypass procedures accounted for more than 80% of all bariatric surgical procedures. From 1998 to 2002, there were upward trends in the proportion of females (81% to 84%; P = .003), privately insured patients (75% to 83%; P = .001), patients from ZIP code areas with highest annual household income (32% to 60%, P<.001), and patients aged 50 to 64 years (15% to 24%; P<.001). Length of stay decreased from 4.5 days in 1998 to 3.3 days in 2002 (P<.001). The adjusted in-hospital mortality rate ranged from 0.1% to 0.2%. The rates of unexpected reoperations for surgical complications ranged from 6% to 9% and pulmonary complications ranged from 4% to 7%. Rates of other in-hospital complications were low. These findings suggest that use of bariatric surgical procedures increased substantially from 1998 to 2003, while rates of in-hospital complications were stable and length of stay decreased. However, disparities in the use of these procedures, with disproportionate and increasing use among women, those with private insurance, and those in wealthier ZIP code areas should be explored further.
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            Obesity as an Emerging Risk Factor for Iron Deficiency

            Iron homeostasis is affected by obesity and obesity-related insulin resistance in a many-facetted fashion. On one hand, iron deficiency and anemia are frequent findings in subjects with progressed stages of obesity. This phenomenon has been well studied in obese adolescents, women and subjects undergoing bariatric surgery. On the other hand, hyperferritinemia with normal or mildly elevated transferrin saturation is observed in approximately one-third of patients with metabolic syndrome (MetS) or nonalcoholic fatty liver disease (NAFLD). This constellation has been named the “dysmetabolic iron overload syndrome (DIOS)”. Both elevated body iron stores and iron deficiency are detrimental to health and to the course of obesity-related conditions. Iron deficiency and anemia may impair mitochondrial and cellular energy homeostasis and further increase inactivity and fatigue of obese subjects. Obesity-associated inflammation is tightly linked to iron deficiency and involves impaired duodenal iron absorption associated with low expression of duodenal ferroportin (FPN) along with elevated hepcidin concentrations. This review summarizes the current understanding of the dysregulation of iron homeostasis in obesity.
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              A Review of Prevalence of Obesity in Saudi Arabia

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                Author and article information

                Contributors
                Journal
                J Taibah Univ Med Sci
                J Taibah Univ Med Sci
                Journal of Taibah University Medical Sciences
                Taibah University
                1658-3612
                28 March 2020
                April 2020
                28 March 2020
                : 15
                : 2
                : 129-135
                Affiliations
                [a ]Medicine Department, College of Medicine, Taibah University, Almadinah Almunawwarah, KSA
                [b ]Hematology Division, Medicine Department, Prince Mohammed Bin Abdulaziz Hospital, Ministry National Guard – Health Affairs, Almadinah Almunawwarah, KSA
                [c ]College of Medicine, Taibah University, Almadinah Almunawwarah, KSA
                Author notes
                []Corresponding address: College of Medicine, Taibah University, P. O. Box 51084, Almadinah Almunawwarah, 41543, KSA. turkialwasaidi@ 123456hotmail.com
                Article
                S1658-3612(20)30028-7
                10.1016/j.jtumed.2020.02.001
                7184217
                32368209
                4d7f777c-1286-4b86-b43b-6bb163882d55
                © 2020 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 5 December 2019
                : 4 February 2020
                : 7 February 2020
                Categories
                Original Article

                فقر الدم,جراحات السمنة,تكميم المعدة,تغييرمسارالمعدة,anaemia,bariatric surgery,roux-en-y gastric bypass,sleeve gastrectomy

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