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The observed decrease in serum ferritin concentration might have been secondary to depletion of the bodys iron reserves after bariatric surgery as the prevalence of anemia in the Optimum 2.0 group increased from 13% at T24 to 18% at T36, suggesting that the bodys iron stores were not sufficient to prevent patients from developing iron-deficiency anemia

[DOI] [PMC free article] [PubMed] [Google Scholar] 240.Diamond I., Messing R.O

This 'first-pass effect' exposes the compound to hepatic enzymes