Nie Yuntao, Ping An, Liu Baoyin, Meng Hua
Department of General Surgery & Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing, China.
School of Basic Medical Sciences, Capital Medical University, Beijing, China.
Front Nutr. 2025 Jul 9;12:1616340. doi: 10.3389/fnut.2025.1616340. eCollection 2025.
Anemia is a common nutritional complication after bariatric surgery, deteriorating quality of life. Despite 10-30% of patients with obesity being anemic preoperatively, current guidelines do not recommend managing anemia before surgery. This study aims to evaluate the impact of preoperative anemia on postoperative anemia and related nutritional abnormalities.
Patients undergoing bariatric surgery at two bariatric centers from 2017 to 2021 were reviewed and followed for 1 year. Anemia was defined by WHO criteria. Nutritional abnormalities included ferritin, folate, and vitamin B12 deficiency, and low transferrin saturation (TS) levels.
A total of 452 patients were included, of whom 53 (11.7%) were diagnosed with anemia before surgery. Patients with preoperative anemia were more likely to develop postoperative anemia (69.8% vs. 34.8%, < 0.001), ferritin deficiency (77.4% vs. 41.6%, < 0.001), and low TS levels (56.6% vs. 20.3%, < 0.001) than normal patients. Changes in hemoglobin, ferritin, folate, and vitamin B12 levels did not differ significantly between patients with preoperative anemia and normal patients. After fully adjusting for covariates, preoperative anemia was independently associated with postoperative anemia (OR 3.52, 95% CI 1.83-7.06, < 0.001), moderate to severe anemia (OR 5.03, 95% CI 2.48-10.20, < 0.001), ferritin deficiency (OR 3.77, 95% CI 1.74-8.17, = 0.001), and low TS levels (OR 4.12, 95% CI 2.16-7.84, < 0.001).
Preoperative anemia significantly elevates the risk of postoperative anemia, especially moderate to severe cases, and increases the incidence of iron deficiency. It is crucial to actively screen for and correct preoperative anemia to enhance hemoglobin levels and prevent postoperative anemia.
贫血是减重手术后常见的营养并发症，会降低生活质量。尽管10%至30%的肥胖患者术前存在贫血，但当前指南并不建议在手术前对贫血进行处理。本研究旨在评估术前贫血对术后贫血及相关营养异常的影响。
对2017年至2021年在两个减重中心接受减重手术的患者进行回顾性研究，并随访1年。贫血按照世界卫生组织标准定义。营养异常包括铁蛋白、叶酸和维生素B12缺乏，以及转铁蛋白饱和度（TS）水平低。
共纳入452例患者，其中53例（11.7%）在手术前被诊断为贫血。术前贫血患者比正常患者更易发生术后贫血（69.8%对34.8%，P<0.001）、铁蛋白缺乏（77.4%对41.6%，P<0.001）和低TS水平（56.6%对20.3%，P<0.001）。术前贫血患者与正常患者的血红蛋白、铁蛋白、叶酸和维生素B12水平变化无显著差异。在对协变量进行充分调整后，术前贫血与术后贫血（比值比3.52，95%置信区间1.83至7.06，P<0.001）、中度至重度贫血（比值比5.03，95%置信区间2.48至10.20，P<0.001）、铁蛋白缺乏（比值比3.77，95%置信区间1.74至8.17，P=0.001）和低TS水平（比值比4.12，95%置信区间2.16至7.84，P<0.001）独立相关。
术前贫血显著增加术后贫血风险，尤其是中度至重度贫血，并增加缺铁发生率。积极筛查并纠正术前贫血对于提高血红蛋白水平和预防术后贫血至关重要。
