Integrated Metabolic and Micronutrient Dynamics Across the First Postoperative Year: Interval-Based Profiling in 340 Brazilian Women Undergoing Sleeve Gastrectomy

AIMS: This study aimed to characterize the temporal dissociation between metabolic recovery and nutritional status during the first postoperative year following sleeve gastrectomy in women. MATERIALS AND METHODS: This retrospective cohort study evaluated 340 women undergoing sleeve gastrectomy using laboratory data from routine clinical follow-up. Biochemical markers were assessed preoperatively and at approximately 40, 120, 180, and 365 days postoperatively. A comprehensive multisystem panel was used to track longitudinal changes in nutritional, haematologic, metabolic, hepatic, inflammatory, renal, and endocrine parameters using an interval-based analytical approach. RESULTS: Distinct postoperative trajectories were identified between metabolic recovery and nutritional status. Metabolic and inflammatory parameters improved rapidly and remained stable throughout follow-up, including reductions in fasting glucose, triglycerides, liver enzymes, uric acid, and C-reactive protein, alongside sustained increases in HDL cholesterol. In contrast, several nutritional biomarkers showed progressive deterioration. Folate exhibited the earliest and most pronounced decline, decreasing by more than two-thirds within 40 days and remaining persistently reduced throughout follow-up. Vitamin B12 declined progressively, reaching concentrations compatible with early biochemical insufficiency. Ferritin showed continuous depletion across all intervals, whereas serum iron increased, indicating dissociation between circulating iron and iron stores. Zinc concentrations declined sharply and remained persistently reduced, while albumin and globulins exhibited modest but consistent decreases. Multivariate analyses confirmed coordinated metabolic-hepatic remodelling occurring in parallel with a weaker and progressively deteriorating nutritional trajectory. CONCLUSIONS: Metabolic recovery and nutritional adequacy represent partially dissociated physiological processes following sleeve gastrectomy. Micronutrient deterioration begins early and progresses before overt clinical manifestations, underscoring the need for frequent biochemical monitoring and individualized supplementation strategies during postoperative follow-up.