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Page 2 of 8 Kheirvari et al. Mini-invasive Surg 2021;5:40 https://dx.doi.org/10.20517/2574-1225.2021.66

Conclusion: Preoperative monitoring of the combination of several nutritional deficits could be used to identify
patients at risk and prevent the onset of deficiencies and their consequences after BS. Identification and correction
of micronutrient deficiencies were essential for treating hair loss.

Keywords: Sleeve gastrectomy, hair loss, older ages

INTRODUCTION
The prevalence of obesity, over the last three decades, has tripled with an estimated 13% of adults being
[1]
obese in 2016 . Obesity is not only a cosmetic concern but also a medical problem that increases the risk of
other diseases, such as diabetes, atherosclerotic cardiovascular diseases, high blood pressure, and some
[2-5]
kinds of cancers . According to the World Health Organization (WHO), obesity is defined as “abnormal
or excessive fat accumulation that presents a risk to health” . Obesity results from a combination of
[6]
[7]
inherited factors, environmental and socioeconomic factors, personal diet, and exercise choices .
Bariatric surgery has evolved in the United States and worldwide over the past two decades and is done to
help patients lose excess weight and reduce the risk of potentially life-threatening weight-related health
problems. Bariatric surgery is a method of treatment that can be used in the case of patients with BMI ≥
35 kg/m and coexisting complications of obesity, such as arterial hypertension, or with BMI ≥ 40 kg/m for
2
2
[8]
normal individuals . The two most commonly performed bariatric surgery procedures are Roux-en-Y
gastric bypass and sleeve gastrectomy (SG) [9-11] . However, these methods are not free from complications,
and the most common ones are micronutrient deficiencies because of preoperative malnutrition, decreased
food intake due to reduced hunger, and increased satiety and food intolerance or vomiting . Some of these
[12]
deficiencies cause severe clinical impacts, including neurological complications, anemias, bone
demineralization, and protein malnutrition [13-15] . Moreover, many patients have symptoms suggestive of
nutritional deficiencies after BS, but there are few prospective studies to specify their prevalence after
surgery [13-16] . The frequently reported complications in studies are hair loss, cramps, and paresthesia. These
symptoms are more frequent in subjects who are noncompliant to medical visits in the long term after
[11]
surgery .

The main aim of our study was to assess the link between symptoms suggestive of nutritional deficiencies
such as hair loss and a large panel of nutritional parameters in subjects who underwent bariatric surgery.

METHODS
In this prospective study performed on LSG candidates from 2018 to 2020, we included consecutive male
and female subjects who underwent LSG at our institution and with complete clinical and biological
nutritional assessments performed in Erfan Hospital. The subjects were studied were divided into those
younger and older than 45 years of age, with or without a prescription for supplements. Multivitamin
supplements were systematically prescribed after surgery, and the reference ranges were recommended by
the dietetics and nutritional experts based on age and gender. Hair loss related to nutritional deficiencies
was systematically recorded at the 12-month follow-up visit after LSG. Hair loss was defined as either an
enhanced amount of hair falling out daily (effluvium) or visible hairlessness (alopecia). Normal hair loss
(normal shedding) was referred to the loss of up to 100 hairs per day. Biological parameters (including
vitamins B1, B12, C, A, E, and D and minerals iron, folic acid, biotin, riboflavin, zinc, and selenium) were
assessed using routine techniques [11,17,18] . 25-hydroxy vitamin D was assayed with a liquid chromatography-
tandem mass spectrometry method (Waters Ltd., Elstree, UK). Vitamins A and E were carried out using a
high-performance liquid chromatography technique (Agilent Corporation, Santa Clara, CA, USA). Trace