Long-term risk of anaemia after bariatric surgery: results from the Swedish Obese Subjects study

SPS commentary:

A commentary notes that although micronutrient supplementation is recommended after surgery, recommendations vary, and the evidence base for optimal supplementation is underdeveloped. It adds that a balance between supplement burden and benefit, in terms of preventing deficiencies and complications, is difficult to find without a better evidence base. Furthermore, anecdotally, many people find that the costs of supplementation (including iron supplementation), or the side-effects of supplementation (e.g. constipation), are considerable deterrents to ongoing use. It suggests that in the absence of good data from RCTs on optimal postoperative micronutrient supplementation, local guidelines should be applied, though in the current study, most people were not on iron supplementation by the end of the follow-up period, but many of them did not develop anaemia despite not taking supplements. It acknowledges that currently, it is not possible to individualise care with respect to micronutrient supplementation so for now, the prudent approach is to apply local guidelines and a case can be made for a supervised trial withdrawal of supplementation if haematological and haematinic indices are normal but continuing to monitor micronutrient indices, and reinstating supplementation if these indices deteriorate, is crucial.