Page 400 - Read Online

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

deficiencies in some variables such as iron (P = 0.00026), biotin (P < 0.00001), zinc (P < 0.00001), vitamin
B12 (P = 0.018), vitamin B1 (P = 0.012), vitamin A (P < 0.00001), vitamin E (P = 0.00016), vitamin C (P =
0.014), and vitamin D (P < 0.00001) was significant for patients younger than 45 years of age who received
or did not receive supplements. In those older than 45 years, in addition to those variables, folic acid (P =
0.0278) and riboflavin (P = 0.012) were statistically significant among subjects with or without supplements
[Table 1].

Relationship between hair loss and nutritional parameters
Subjects who complained of hair loss (effluvium or alopecia) were mostly postoperative women without a
prescription for supplements (53% in the younger group; 58% in the older group), and in the older group
without a prescription for supplements hair loss was also more frequent and statistically significant (82% in
total) in comparison with the younger group without a prescription for supplements (69% in total)
postoperatively (P = 0.03236) [Figure 1]. In the group with a prescription for supplements, the rate of hair
loss was lower than in the group without a prescription for supplements (40% overall in the younger group;
36% overall in the older group) postoperatively [Figure 1]. The prevalence of hair loss regardless of age and
gender among subjects with or without a prescription for supplements was significant at P < 0.00001.

DISCUSSION
After BS, many subjects complain of symptoms suggestive of nutritional deficiencies, the most frequently
reported being hair loss, cramps, and paresthesia. Postoperative symptoms do not result in severe health
consequences; they cause a daily discomfort for patients. Hair loss is a common complication after bariatric
surgery and is reported in more than half of the subjects in the short term after BS. Hair loss is related to
rapid weight reduction; furthermore, zinc, iron, and other micronutrient deficiencies can also be
involved [16,17] . There are only a few data on the treatment of these symptoms . Treatment of hair loss with
[18]
vitamins B5 and B6 is common after BS, whereas there are no data on the association between hair loss after
BS and deficits in these vitamins . This is the main reason for our study that aimed to determine the main
[11]
deficiencies that underlie hair loss and their treatment with supplements after BS.

The frequently reported nutritional deficiencies after BS are iron, vitamin B12, vitamin D, vitamin B1, and
zinc deficits [10,11,20-23] . In our study, vitamin A, iron, and zinc deficits were the most frequently observed after
BS. Indeed, we observed a higher prevalence of vitamin A, iron, and zinc deficits in both groups (those
younger and older than 45 years of age) without a prescription for supplements compared to both groups
with a prescription for supplements.

The analysis of patients with and without a prescription for supplements indicated significant differences
for hair loss between the groups with and without hair loss concerning the postoperative use of
supplements. The prevalence of hair loss was 69% and 82% in the younger and older groups, respectively, 12
months after BS, which is in line with previous reports [24,25] . By using the supplements postoperatively, the
prevalence of hair loss was only 40% and 36% in the younger and older groups, respectively.

Preoperative monitoring of the combination of several nutritional deficits could be used to identify patients
[26]
at risk and prevent the onset of deficiencies and their consequences after BS . Identification and correction
of micronutrient deficiencies was essential for treating hair loss. Our patients stated they benefited from
supplements. Indeed, most patients stopped losing hair after being prescribed vitamin and mineral
supplements one year after BS. As a consequence, diet counseling and adequate supplementation are
required after BS to avoid hair loss. Postoperatively, all patients should receive lifelong supplementation.