Short-term changes in biochemical parameters following laparoscopic sleeve gastrectomy in patients from the Newfoundland & Labrador bariatric surgery cohort study

Pedersen, Mette Rode (2015) Short-term changes in biochemical parameters following laparoscopic sleeve gastrectomy in patients from the Newfoundland & Labrador bariatric surgery cohort study. Masters thesis, Memorial University of Newfoundland.

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Abstract

Background Biochemical abnormalities associated with micronutrient status and non-alcoholic fatty liver disease (NAFLD) are often observed prior to bariatric surgeries, and the changes following surgery can be associated with either improvements or worsening. However, evidence on these changes following laparoscopic sleeve gastrectomy (LSG) is limited. Purpose The purpose of this quasi-experimental study was to determine the baseline status of certain biochemical parameters associated with micronutrient status and NAFLD prior to LSG and compare them to the status post-LSG. Methods A total of 188 patients, who underwent the LSG procedure between May 2011 and May 2014, consented to partake in this study. Laboratory measurements of select biochemical parameters associated with micronutrients (25-hydroxyvitamin D, PTH, vitamin B12, calcium, ferritin, hemoglobin and mean cell volume) and NAFLD status (bilirubin, ALP, ALT, GGT, HDL, LDL and triglycerides) were assessed at baseline and re-evaluated at 3 and 6 months post-LSG. Results A subgroup consisting of 95 patients were included in the current thesis, as they had completed their baseline, 3 and 6 months evaluations. 82.1 % of patients were female with a mean BMI of 49.3 ± 6.8 kg/m2. At baseline, 53 patients (55.8 %) presented with abnormal blood levels for the micronutrient-related parameters, and there was a non-significant decrease to 50.5 % and 46.3 % at 3 and 6 months post-LSG, respectively. Prior to surgery, the most common abnormalities were elevated PTH and low 25-hydroxyvitamin D (25-OH-D). The majority of the micronutrients and related parameters did not change significantly following LSG. A significant reduction in the proportion of patients with low 25-OH-D was observed, from 21.3 % at baseline to 1.4 % (1 patient) at the 6-month follow-up (p < 0.001), which may be attributed to increased supplement use. The majority of patients (80 %) presented with abnormal blood levels for one or more of the select parameters associated with NAFLD at baseline, the most common being abnormal GGT, triglycerides, HDL, LDL and ALT. There was a significant improvement post-operatively, with 60 % and 50.5 % of patients at 3 and 6 months post-LSG, respectively, presenting with abnormal levels for the select biochemical parameters (p < 0.001). Conclusion Patients experienced an improvement in 25-OH-D post-LSG, which may have been attributed to increased use of supplements. An improvement in the majority of the biochemical parameters associated with NAFLD was also observed. The overall improvements observed may also be attributed to the significant weight loss following LSG.

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