Prevalence, Ocular Manifestations, and Treatment Response in Postbariatric Vitamin A Deficiency: A Systematic Review and Meta-Analysis.
Ahmed Abdel-Sayyed, Steven Bigam, Ameen Alizada et al.
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In 30 seconds
This systematic review and meta-analysis assessed biochemical vitamin A deficiency after bariatric surgery and synthesized ocular manifestations, timing, and response to repletion. Of 21 unique studies, nine surveillance cohorts contributed to the prevalence meta-analysis. Deficiency prevalence varied by procedure: 18.0% after Roux-en-Y gastric bypass (RYGB), 59.0% after biliopancreatic diversion, 37.8% after biliopancreatic diversion with duodenal switch, and 42.5% after jejunoileal bypass. Pregnancy-specific prevalence after RYGB was 63.3% (95% CI, 43.9-80.1). Ocular presentations could occur years after surgery, and 13 of 14 treatment-response records showed improvement or resolution.
Key findings
- Vitamin A deficiency prevalence ranged from 18.0% after RYGB to 59.0% after biliopancreatic diversion across the procedures assessed.
- Pregnancy-specific post-RYGB deficiency prevalence was 63.3% (95% CI, 43.9-80.1).
- Median latency to ocular presentation was 5 years after RYGB and 14 to 27 years after other specified procedures or revisions.
- Among 14 treatment-response records with assessable ocular outcomes, 13 (93%) improved or resolved.
Why it matters
The findings indicate that deficiency risk differs by bariatric procedure and that ocular disease may emerge long after surgery, making surgical history relevant when evaluating visual symptoms. The reported improvement after repletion supports the clinical importance of recognizing possible deficiency, while the evidence does not establish a uniform risk across procedures or populations.
What to keep in mind
Certainty was limited by heterogeneity, few cohorts for some procedure subgroups, and selective reporting of ocular outcomes.