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Folate and iron status in women of childbearing age after bariatric surgery

Cherok, Lori (2018) Folate and iron status in women of childbearing age after bariatric surgery. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Women of childbearing age constitute a large proportion of bariatric surgery patients. Bariatric surgery is associated with increased risk of nutritional deficiencies. Adequate folate and iron status is important during pregnancy to ensure healthy infant outcomes. The primary purpose of this research was to determine the association between surgical procedure, Roux-en-Y gastric bypass (RYGB) vs. laparoscopic adjustable gastric banding (LAGB), and pre- to one year post-surgery change in serum folate and serum ferritin (an indicator of iron status) among women of childbearing age and to determine the prevalence of postoperative folate and iron deficiencies. There were 413 subjects (272 RYGB, 141 LABG) for the folate analyses and 426 subjects (280 RYGB, 146 LAGB) for the ferritin analyses. The subjects were a subset of participants from the Longitudinal Assessment of Bariatric Surgery study.

Type of surgery was not significantly associated with change in serum folate. Among women who underwent RYGB, daily/weekly multivitamin use at one-year follow-up and daily/weekly multivitamin use at both baseline and one-year follow-up were confounders of the relationship between RYGB and change in serum folate. The prevalence of folate deficiency one year after surgery was low, 0.7% after LAGB and 1.1% after RYGB. For change in serum ferritin, there were significant interactions between type of surgery and percent weight change and baseline serum ferritin such that the associations of percent weight change and baseline ferritin were more pronounced among women who had undergone RYGB compared to LAGB. For women who underwent RYGB, greater percent weight change from baseline was associated with greater change in serum ferritin (p<.0001). The prevalence of iron deficiency was greater (p=.04) among women who underwent RYGB than LAGB (21.8% vs. 13.7%).

This research is relevant to public health because it provides evidence that RYGB presents a potential risk to perinatal health due to iron deficiency one year after surgery for women who become pregnant. The folate results should be interpreted with caution due to the use of serum folate, an indicator of short-term folate status and intake. Additional research is recommended using red blood cell folate concentration to determine folate status.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Cherok, Lorilcherok@pitt.edulcherok
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairBelle,
Committee MemberBodnar,
Committee MemberCourcoulas,
Committee MemberKing,
Date: 28 June 2018
Date Type: Publication
Defense Date: 21 March 2018
Approval Date: 28 June 2018
Submission Date: 5 April 2018
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 176
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: bariatric surgery iron deficiency folate deficiency
Date Deposited: 28 Jun 2018 20:31
Last Modified: 28 Jun 2018 20:31


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