Integrated health original article Influence of diet and supplements on iron status after gastric bypass surgery

Background: Iron deficiency is common after Roux-en-Y gastric bypass (RYGB) surgery, but there is no consensus on the optimal diet quality and quantity for restoring and preserving iron status. Objectives: The authors explored the impact of dietary and supplemental sources of iron and absorptive factors on iron status. Setting: Academic, United States. Methods: In a cross-sectional cohort of individuals who underwent RYGB, nutrient intakes from food and supplements were measured using 3-day food records. Blood biomarkers of iron status, including concentrations of ferritin, total iron binding capacity, serum transferrin receptor (sTfR), and the sTfR:ferritin ratio, were assessed by a reference laboratory; iron deficiency was defined as having at least 2 abnormal measures. Associations between iron status biomarkers and dietary predictors were determined using regression analysis. Results: Of the 36 participants, 97% were female, the mean age was 45 years (95% confidence interval, 41–48 years), and body mass index was 32 (30–35) kg/m 2 . Iron deficiency was found in 42% of participants. Dietary intake of heme iron, found in meats, was favorably associated with 3 iron status biomarkers (ferritin, β ¼ .366; sTfR:ferritin ratio, β ¼ –.459; and total iron binding capacity, β ¼ –18.26; all P o .05), independent of obesity-induced inflammation. Intake of vitamin C from food contributed to iron status (ferritin, β ¼ .010 and sTfR:ferritin ratio, β ¼ –.011; P o .05). Use of supplementary non-heme iron, at doses recommended for prophylaxis (45 mg/d), was positively associated with serum ferritin (β ¼ .964; P ¼ .029). Conclusions: For patients who have undergone RYGB, consuming high, but realistic amounts of heme iron in meat, vitamin C from food, and adherence to recommended iron supplements can prevent iron deficiency. (Surg Obes Relat Dis 2016;12:651–658.) r 2016 American Society for Metabolic and Bariatric Surgery. All rights reserved.