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Adolescents at risk of nutritional deficiencies after bariatric surgery

Key clinical point: Adolescents who undergo metabolic bariatric surgery may require long-term monitoring and supplementation to prevent nutritional deficiencies.

Major finding: After 5 years, 27% of the participants who underwent vertical sleeve gastrectomy had two or more nutritional deficiencies.

Study details: A prospective cohort study involving 226 adolescents who underwent metabolic bariatric surgery.

Disclosures: The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases and the National Center for Advancing Translational Sciences of the National Institutes of Health. Dr. Courcoulas reported grant support from Allurion.


Xanthakos SA et al. Clin Gastro Hepatol. 2019 Nov 6. doi: 10.1016/j.cgh.2019.10.048.


The prevalence of obesity in adolescents has ballooned to about 20% of children aged 12-19 years. Prevention with diet and exercise remains the cornerstone of obesity policy in the pediatric population. Once patients develop obesity, however, bariatric surgery increasingly is being recommended as a treatment to achieve durable weight loss. Multiple large studies in adults have shown strong evidence of the efficacy of bariatric surgery; comparable data in pediatric patients has been sparse.

The Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS), a multicenter prospective consortium, was established in 2007 to better study outcomes of bariatric surgery in adolescents. Early data showed much-needed strong evidence of the safety and efficacy of metabolic and bariatric surgery in this population. The positive effects of these surgeries, however, needed to be weighed against the risk of nutritional deficiencies in this vulnerable population given their young age and poor compliance with vitamin supplementation. Early retrospective data suggested adolescents may be at higher risk of deficiencies.

The current study by Xanthakos et al. reports on 5-year prospective data from Teen-LABS specifically addressing the nutritional status of adolescents after Roux-en-Y gastric bypass and sleeve gastrectomy. Their data show deficiency only in iron and vitamin B12 levels after gastric bypass. More importantly, vertical sleeve gastrectomy, now the most common procedure, results in decreased risk of nutritional deficiencies compared with gastric bypass. These data add to the reassurance that surgical treatment in the adolescent population is overall safe and should be considered strongly after appropriate counseling.

Wasif M. Abidi, MD, PhD, is a gastroenterologist affiliated with Baylor St. Luke’s Medical Center, Houston.