Dear Editor, We read with great interest the article, “The Prevalence of Vitamin B12, Hemoglobin, and Ferritin Deficiency,” which provides profound understanding into micronutrient dynamics in bariatric surgery patients and is written by Soheilipour et al.1 The topic of study is interesting, and the authors tried to shed light on the prevalence and potential clinical implications of vitamin B12, hemoglobin, and ferritin deficiency. While the study adds to the literature, we wish to highlight some methodological concerns that may limit the generalizability and interpretability of findings. First, there was no assessment of postoperative dietary intake. This is crucial to distinguish whether deficiencies result from inadequate absorption, poor dietary compliance, or failure to adhere to supplementation protocols. Heusschen et al.2 have shown that patients often fail to meet recommended intake despite supplementation, emphasizing the importance of monitoring diet postoperatively. Second, the absence of a nonsurgical obese control group restricts our ability to characterize deficiencies entirely to the surgical intervention. Obesity itself, through mechanisms such as chronic inflammation, can affect micronutrient metabolism. Pellegrini et al.3 demonstrated that micronutrient deficiencies often present even prior to surgery. Third, the sample consisted mostly of females (84%). This sex imbalance may unclear gender-specific outcomes as nutrient metabolism differs significantly between males and females. For example, premenopausal women are at higher risk for iron deficiency due to menstruation. Balanced retrieval is essential for valid findings.4 In conclusion, directing these aspects of the study will improve the accuracy of conclusions drawn from bariatric surgery research and inform more effective postoperative management approaches. Author contributions Both authors contributed to the conceptualization, writing, and critical review of the manuscript. Both authors reviewed and approved the final version of the letter. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Younas et al. (Sun,) studied this question.