Department of Nutrition and Weight Management, Geisinger Health System Northeast, Scranton, PA 18503, USA.
The Center for Obesity and Metabolic Research, Geisinger Obesity Institute, Danville, PA 17821, USA.
Nutrients. 2024 Oct 2;16(19):3350. doi: 10.3390/nu16193350.
Iron is an essential nutrient in living organisms with multiple vital functions. Iron deficiency (ID) can cause long term health consequences beyond iron deficiency anemia (IDA). The high prevalence of ID and its long-term effects in patients with obesity and after metabolic and bariatric surgery (MBS) is recognized. Nevertheless, there is limited knowledge of the optimal route or dose for treatment of patients with obesity and post-MBS, and an evidence-based universal guideline for prevention and treatment of ID in short- and long-term post-MBS (PMBS) is not yet available. ID in the general population is currently treated with oral or parenteral iron, where oral iron treatment is considered the preferred option with parenteral iron as a second-line treatment in case there is intolerance or lack of response to oral iron. In patients with obesity with chronic low-grade inflammation and PMBS patients with altered gut anatomy and function, there are also alterations in the bioavailability and higher risks of side effects of available oral irons. The conclusions of current studies exploring effective treatment of iron deficiency in this population have been inconsistent and further well-planned randomized and prospective studies are needed. This is a narrative review of the literature on the available treatment options and strategies for treatment of ID in PMBS patients to recognize the knowledge gaps and provides topics of future research.
铁是生物体必需的营养物质，具有多种重要功能。缺铁（ID）除了缺铁性贫血（IDA）外，还会导致长期的健康后果。肥胖患者和代谢及减重手术后（MBS）患者中 ID 的高患病率及其长期影响已得到公认。然而，对于肥胖患者和 MBS 后的患者，最佳治疗途径或剂量知之甚少，并且针对 MBS 短期和长期后（PMBS）ID 的预防和治疗尚无循证通用指南。目前，一般人群中的 ID 采用口服或胃肠外铁剂治疗，口服铁剂治疗被认为是首选，而胃肠外铁剂则是在口服铁剂不耐受或无反应时的二线治疗。在慢性低度炎症的肥胖患者和肠道解剖和功能改变的 PMBS 患者中，可用口服铁剂的生物利用度也会发生改变，并且副作用的风险更高。目前关于探索该人群中缺铁有效治疗的研究结论并不一致，因此需要进一步进行精心设计的随机和前瞻性研究。本文对 PMBS 患者 ID 现有治疗选择和策略的文献进行了综述，以认识到知识空白，并提供未来研究的主题。
