vitamin-b-12 and Obesity--Morbid

The present review focuses on the side effects that ex-obese patients face following bariatric surgery. We searched through the principal medical indexes (SCOPUS, Web of Science, PubMed, MEDLINE) using the following words, both alone and in combinations: bariatrics; bariatric surgery; anemia; vitamin B12; cobalamin; folate; folic acid; iron; iron supplements; gut microbiota; lactalbumin; α-lactalbumin. To perform exhaustive research, we considered articles published since 1985. Bariatric surgery induces states of nutritional deficiencies. In particular, the surgery results in a drastic fall in the levels of iron, cobalamin, and folate. Despite the dietary supplements which can counteract such decrease, some limitations exist in the nutraceutical approach. Indeed, the gastrointestinal side effects of supplements, the alterations in the microbiota, and the reduced absorption induced by the surgery may impair the effect of dietary supplements, exposing the patients to the risk of developing nutritional deficiencies. Recent literature reports the effect of promising molecules to counteract such limitations, which include α-lactalbumin, a whey protein with prebiotic activities, and new pharmaceutical forms of iron supplements, namely micronized ferric pyrophosphate. If on the one hand, α-lactalbumin enhances intestinal absorption and helps in restoring a physiological microbiota, micronized ferric pyrophosphate has a high tolerability and low or null risk of gastrointestinal side effects. Bariatric surgery represents a valid solution to obesity and obesity-related disease. However, the procedure may induce deficiencies in micronutrients. Data exists on the promising activities of α-lactalbumin and micronized ferric pyrophosphate, which may help in preventing bariatric-induced anemia.

Topics: Anemia; Bariatric Surgery; Dietary Supplements; Folic Acid; Humans; Iron; Lactalbumin; Malnutrition; Obesity; Obesity, Morbid; Vitamin B 12

The aim of this meta-analysis is to evaluate the changes in nutritional indicators in individuals with obesity before and after SG.. A systematic retrieval of the available literature was performed using PubMed, Embase, Web of Science, and Chinese National Knowledge Infrastructure databases. The following indicators were evaluated: serum 25-hydroxyvitamin D [25(OH)D], calcium, phosphorus, iron, vitamin B12, folate, magnesium, and zinc from pre-operation to post-operation.. A total of 38 studies met inclusion criteria. A significant increase was observed in serum 25(OH)D (SMD = 0.70, 95%CI 0.38 to 1.02, P < 0.001), phosphorus (SMD = 0.40, 95%CI 0.14 to 0.67, P = 0.003), iron (SMD = 0.50, 95%CI 0.38 to 0.62, P < 0.001), and folate (SMD = 0.37, 95%CI 0.09 to 0.65, P = 0.01) after SG. Nevertheless, the increasing trend of serum phosphorus (P = 0.143) and folate (P = 0.774) disappeared in the unprescribed subgroup. A significant decrease in serum zinc (SMD =  - 0.41, 95%CI - 0.81 to - 0.01, P = 0.044) was found after SG. No significant changes in serum calcium (SMD = 0.08, 95%CI - 0.09 to 0.25, P = 0.372), vitamin B12 (SMD = 0.10, 95%CI - 0.13 to 0.33, P = 0.398), and magnesium (SMD = 0.24, 95%CI - 0.10 to 0.58, P = 0.169) were observed. However, a significant decrease in serum calcium (P = 0.042) and vitamin B12 (P = 0.037) was found in the unprescribed subgroup.. Serum 25(OH)D, phosphorus, iron, and folate levels improved after a careful monitoring and due to a rigorous supplementation. The optimal dose of calcium, magnesium, and zinc supplementation has yet to be established; therefore, a broader supplementation of trace elements and minerals has to be suggested.

Topics: Calcium; Folic Acid; Gastrectomy; Humans; Iron; Magnesium; Obesity, Morbid; Phosphorus; Vitamin B 12; Zinc

Although Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the most prevalent bariatric surgical procedures, high-level evidence is scarce regarding the assessment of postoperative nutritional risk in RYGB versus SG. Therefore, we performed a systematic review and meta-analysis to compare the risk of anemia and related micronutrient deficiencies after RYGB and SG. We analyzed 10 randomized controlled trials that compared RYGB and SG with reported incidence of postoperative anemia and/or anemia-related micronutrient deficiencies (iron, vitamin B

Topics: Anemia; Folic Acid; Gastrectomy; Gastric Bypass; Humans; Malnutrition; Micronutrients; Obesity; Obesity, Morbid; Randomized Controlled Trials as Topic; Retrospective Studies; Vitamin B 12; Vitamins

Hair loss is a common complication after metabolic and bariatric surgery (MBS). There is a lack of published systematic review in the scientific literature on this topic. The aim of this study was to perform a systematic review and meta-analysis on hair loss after MBS in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines.. PubMed, CINAHL, EMBASE, Web of Science, SCOPUS, and four Chinese databases were searched. Data were pooled using Review Manager 5.3 and Stata 12.0, and subgroups were performed if necessary and feasible.. A total of 18 studies (n = 2538) were included. The pooled results showed that the incidence of hair loss after MBS was 57% (95% CI 42-71%). It decreased with longer follow-up times. Hair loss was significantly more common in younger (mean difference (MD), - 2.45; 95% CI, - 4.26 to - 0.64; p = 0.008) women (OR, 3.87; 95% CI, 0.59 to 17.59; p = 0.08). Serum zinc (standardized mean difference (SMD), - 1.13; 95% CI, - 2.27 to 0.01, p = 0.05), folic acid (SMD = - 0.88, 95% CI - 1.29 to - 0.46, p < 0.0001), and ferritin levels (SMD, - 0.22; 95% CI, - 0.38 to - 0.05; p = 0.01), but not serum iron and vitamin B. Hair loss is common after MBS especially in younger women, and those with low serum levels of zinc, folic acid, and ferritin. Prospective studies on larger cohorts are needed.

Topics: Alopecia; Bariatric Surgery; Female; Humans; Obesity, Morbid; Prospective Studies; Vitamin B 12

Bariatric surgery may increase the risk of iron, vitamin B

Topics: Anemia; Bariatric Surgery; Copper; Folic Acid; Gastric Bypass; Humans; Iron; Obesity, Morbid; Vitamin B 12; Vitamin B 12 Deficiency; Vitamins

Obesity is associated with the gut microbiota and decreased micronutrient status. Bariatric surgery is a recommended therapy for obesity. It can positively affect the composition of the gut bacteria but also disrupt absorption of nutrients. Low levels of micronutrients can affect metabolic processes, like glycolysis, TCA cycle, and oxidative phosphorylation, that are associated with the immune system also known as immunometabolism.. MEDLINE, PUBMED, and Google Scholar were searched. Articles involving gut microbiome, micronutrient deficiency, gut-targeted therapies, transcriptome analysis, micronutrient supplementation, and bariatric surgery were included.. Studies show that micronutrients play a pivotal role in the intestinal immune system and regulating immunometabolism. Research demonstrates that gut-targeting therapies may improve the microbiome health for bariatric surgery populations. There is limited research that examines the role of micronutrients in modulating the gut microbiota among the bariatric surgery population.. Investigations are needed to understand the influence that micronutrient deficiencies have on the gut, particularly immunometabolism. Nutritional transcriptomics shows great potential in providing this type of analysis to develop gut-modulating therapies as well as more personalized nutrition recommendations for bariatric surgery patients.

Topics: Bariatric Surgery; Citric Acid Cycle; Female; Folic Acid; Functional Food; Gastrointestinal Microbiome; Glycolysis; Humans; Immune System; Intestines; Iron; Male; Malnutrition; Micronutrients; Nutritional Status; Obesity, Morbid; Oxidative Phosphorylation; Probiotics; Thiamine; Transcriptome; Vitamin B 12; Vitamin D

Many respectable guidelines recommend lifelong vitamin B. We examined the PubMed database for all English language articles examining various doses of oral vitamin B. The data suggest that oral vitamin B. The review finds that oral supplementation doses of ≤ 15 μg vitamin B

Topics: Administration, Oral; Adult; Chemoprevention; Dietary Supplements; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Gastric Bypass; Humans; Male; Obesity, Morbid; Postoperative Complications; Vitamin B 12; Vitamin B 12 Deficiency

Obesity, defined as a body mass index >30 kg/m

Topics: Bariatric Surgery; Body Mass Index; Diet; Folic Acid; Guidelines as Topic; Humans; Iron; Micronutrients; Nutrition Assessment; Obesity, Morbid; Preoperative Care; Preoperative Period; Societies, Scientific; Thiamine; Vitamin A; Vitamin B 12; Vitamin D; Weight Loss

Vitamin B12 dosage in multivitamin supplementation in the current literature is quite variable. There is no consensus about the optimal treatment of vitamin B12 deficiency. A systematic literature search on different supplementation regimes to treat perioperative vitamin B12 deficiencies in bariatric surgery was performed. The methodological quality of ten included studies was rated using the Newcastle Ottawa scale and ranged from moderate to good. The agreement between the reviewers was assessed with a Cohen's kappa (0.69). The current literature suggests that 350 μg oral vitamin B12 is the appropriate dose to correct low vitamin B12 levels in many patients. Further research must focus on a better diagnosis of a vitamin B12 deficiency, the optimal dose vitamin B12 supplementation, and clinical relevance next to biochemical data.

Topics: Bariatric Surgery; Dietary Supplements; Humans; Obesity, Morbid; Perioperative Care; Perioperative Period; Vitamin B 12; Vitamin B 12 Deficiency

Bariatric surgery aims at weight reduction of severely obese patients. The Roux-en-Y technique is one of the most common bariatric procedures and is occasionally accompanied by nutrient insufficiencies and metabolic changes. According to the literature, skin architecture and immunity change after bariatric surgery and may lead to inflammation and increased susceptibility to pathogens. Additionally, vitamin and mineral deficiencies frequently develop in these patients and affect the skin's defense mechanisms, possibly contributing to dermatological complications. Knowledge and recognition of skin changes after bariatric surgery make an important asset for the dermatologist and help in the proper treatment of these patients. We report 2 cases of infectious skin lesions where vitamin and trace element deficiencies have possibly contributed to their persistence and resistance to traditional treatments.

Topics: Abscess; Acinetobacter baumannii; Acinetobacter Infections; Anti-Bacterial Agents; Calcium; Female; Gastric Bypass; Humans; Leg Ulcer; Middle Aged; Obesity, Morbid; Pseudomonas aeruginosa; Pseudomonas Infections; Recurrence; Skin Diseases, Bacterial; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin D; Vitamin D Deficiency; Zinc

After Roux-en-Y gastric bypass (RYGB), patients often develop a vitamin B-12 deficiency.. Our objective was to investigate whether oral supplementation increases and normalizes low vitamin B-12 concentrations (vitamin B-12 > 200 pmol/L) in RYGB patients as compared to intramuscular injections.. A randomized controlled trial in RYGB patients with subnormal serum B-12 concentrations was performed. One group (IM B-12) received bimonthly intramuscular hydroxocobalamin injections (2000 µg as loading dose and 1000 µg at follow-up) for 6 mo. The second group (oral B-12) received daily doses of oral methylcobalamin (1000 µg). Serum vitamin B-12 was determined at baseline (T0) and at 2 (T1), 4 (T2), and 6 mo (T3) after start of treatment. Concentrations of the secondary markers methylmalonic acid (MMA) and homocysteine (Hcy) were measured at T0 and T3.. Fifty patients were included and randomized, 27 in IM B-12 and 23 in oral B-12. The median vitamin B-12 concentration at T0 was 175 pmol/L (range: 114-196 pmol/L) for IM B-12 and 167 pmol/L (range: 129-199 pmol/L) for oral B-12. Vitamin B-12 normalized in all individuals, and there was no significant difference in vitamin B-12 between the two groups. MMA and Hcy concentrations decreased significantly after 6 mo within each group (P < 0.001 and P < 0.001 for MMA and P = 0.03 and P = 0.045 for Hcy, respectively). There was no significant difference between the groups at 6 mo for both MMA and Hcy (P = 0.53 and P = 0.79).. The efficacy of oral vitamin B-12 supplementation was similar to that of hydroxocobalamin injections in the present study. Oral supplementation can be used as an alternative to hydroxocobalamin injections to treat RYGB patients with low values of serum vitamin B-12. This trial was registered at clinicaltrials.gov as NCT02270749.

Topics: Administration, Oral; Dietary Supplements; Female; Gastric Bypass; Humans; Injections, Intramuscular; Male; Obesity, Morbid; Vitamin B 12; Vitamin B 12 Deficiency

Micronutrient deficiencies represent a common condition after bariatric surgery (BS). The prevalence of these nutritional disorders before BS is still debated. The aim of our study was to retrospectively evaluate the prevalence of micronutrient deficiencies in candidates for BS.. A prospectively maintained database of our institution was searched to find all patients who underwent surgery between January and December 2021. The following data were collected: age, gender, body mass index (BMI), obesity-associated diseases, and preoperative serum levels of vitamin B12, folate, and vitamin D.. Preoperative micronutrient deficiencies were frequently found in candidates for BS. Approximately 90% of patients had deficient or insufficient serum levels of vitamin D preoperatively. Almost half of the patients had a preoperative deficit of folate, and vitamin B12 deficiency was significantly more frequent in the female population. It is mandatory to screen all patients undergoing BS for vitamin deficiencies before surgery.

Topics: Bariatric Surgery; Female; Folic Acid; Humans; Micronutrients; Obesity, Morbid; Retrospective Studies; Vitamin B 12; Vitamin D; Vitamins

Roux-en-Y gastric bypass (RYGB) surgery is one of the most commonly performed bariatric procedures for weight loss in humans. However, this procedure is not risk-free, and patients may experience complications that include small bowel obstruction, gastrointestinal bleeding, chronic diarrhea, ulcers, malnutrition, and anemia. In particular, anemia is a recognized long-term complication and can be severe. Rats have been used as a model to study the effects of gastric bypass surgeries. They can experience similar complications as people, but the development of severe anemia has not previously been reported in rats. We observed 2 cases of severe anemia in female Sprague-Dawley rats after RYGB surgery. These cases prompted us to further investigate the frequency and severity of anemia after RYGB in rats. Blood work and necropsies were performed on 9 additional female Sprague-Dawley rats (5 with RYGB, 4 with sham surgery). In these 9 rats, only one had signs of clinical anemia. These 3 anemic rats displayed moderate to severe pallor of the eyes and ears. Necropsy findings in anemic RYGB rats included pale internal organs and eccentric heart enlargement, which led to a significantly higher heart:body weight ratio in RYGB rats as compared with sham controls. Anemic rats had either a macrocytic normochromic anemia, consistent with vitamin B

Topics: Anemia; Animals; Female; Gastric Bypass; Humans; Obesity, Morbid; Rats; Rats, Sprague-Dawley; Vitamin B 12

Micronutrient deficiencies are common after Roux-en-Y gastric bypass (RYGB). This study explores whether vitamin and mineral deficiency was associated with adherence to recommended supplementation 12 years after RYGB.. The cross-sectional Bariatric Surgery Observation Study (BAROBS) was conducted in 2018-2020 at three hospitals in Central Norway. We report data on 490 patients' self-reported adherence to recommended supplements and vitamin and mineral levels in the blood. The patients, who had RYGB between 2003 and 2009, were recommended an over-the-counter multivitamin-mineral supplement, calcium/vitamin D (1000 mg/20 µg) and vitamin B. Twelve years after RYGB, adherence to supplements, though in sub-optimal doses of new recommendations, decreases the probability of vitamin and mineral deficiency, especially for thiamine, vitamin B

Topics: Adult; Calcium; Cross-Sectional Studies; Female; Folic Acid; Gastric Bypass; Humans; Male; Malnutrition; Middle Aged; Obesity, Morbid; Vitamin B 12; Vitamin D; Vitamins

Vitamin B12 deficiency can be seen in the cases with sleeve gastrectomy. Because the chief factor in vitamin B12 deficiency is gastric atrophy, we aimed to evaluate the effect of atrophy on postoperative vitamin B12 levels in patients who underwent sleeve gastrectomy.. Sixty patients were included in this study. Vitamin B12 levels were compared with presence of atrophy before the operation and after vitamin B12 supplementation.. Atrophy was observed in 37 (61.7%) of the cases; 23 (38.3%) patients had no atrophy. There was a statistically significant difference between the presence of atrophy and vitamin B12 levels (p = 0.024). Despite vitamin B12 support, there were statistically significant low vitamin B12 levels after the operation in female patients having atrophy (p = 0.023). The same significance was not observed in males (p = 0.480).. Vitamin B12 deficiency following obesity surgery is a condition that must be monitored and prevented. We found that histopathologically confirmed atrophy had an adverse effect on postoperative vitamin B12 levels. These findings can be a guide for the clinicians in the management of these cases.. La deficiencia de vitamina B12 se puede observar en los casos de gastrectomía en manga. Debido a que el factor principal en la deficiencia de vitamina B12 es la atrofia gástrica, nuestro objetivo fue evaluar el efecto de la atrofia en los niveles posoperatorios de vitamina B12 en pacientes que se sometieron a gastrectomía en manga.. se incluyeron 60 pacientes en este estudio. Los niveles de vitamina B12 se compararon con la presencia de atrofia antes de la operación y después de la suplementación con vitamina B12.. Se observó atrofia en 37(61.7%) de los casos; 23 (38.3%) pacientes no presentaron atrofia. Hubo una diferencia estadísticamente significativa entre la presencia de atrofia y los niveles de vitamina B12 (p = 0.024). A pesar del apoyo de vitamina B12, hubo niveles bajos de vitamina B12 estadísticamente significativos después de la operación en pacientes femeninas con atrofia (p = 0.023). No se observó la misma significación en los hombres (p = 0.480).. La deficiencia de vitamina B12 luego de una cirugía de obesidad es una condición que debe ser monitoreada y prevenida. Encontramos que la atrofia confirmada histopatológicamente tuvo un efecto adverso sobre los niveles posoperatorios de vitamina B12. Estos hallazgos pueden ser una guía para los médicos en el manejo de estos casos.

Topics: Atrophy; Dietary Supplements; Female; Gastrectomy; Humans; Male; Obesity, Morbid; Vitamin B 12; Vitamin B 12 Deficiency

Post-bariatric weight loss can cause iatrogenic malnutrition and micronutrient depletion. In this study, we evaluated the impact of gastric bypass surgery (GB) and multivitamin supplement use on maternal micronutrient status before and across pregnancy. A retrospective medical chart review of 197 singleton pregnancies after GB with a due date between 2009 and 2019 was performed at a bariatric expertise center in the Netherlands. Hemoglobin, calcium, iron status, folate, vitamin D, vitamin B12 and ferritin levels were determined before and after GB during standard follow-up and at all gestational trimesters and analyzed using linear mixed models. Patients were prescribed standard multivitamin supplements or multivitamins specifically developed for post-bariatric patients (FitForMe WLS Forte (FFM)). Overall, hemoglobin and calcium levels decreased after surgery and during pregnancy, whereas folate, vitamin D, and vitamin B12 levels increased, and iron levels remained stable. FFM use was associated with higher hemoglobin, folate, vitamin D, and ferritin levels. In conclusion, through adequate supplementation and follow-up, GB does not have to result in impaired micronutrient status. Supplements developed specifically for post-bariatric patients generally result in higher micronutrient values than regular multivitamins before and during pregnancy. These data emphasize the urgent need for nutritional counseling including dietary and multivitamin supplement advise for post-bariatric women contemplating and during pregnancy.

Topics: Dietary Supplements; Female; Gastric Bypass; Humans; Micronutrients; Netherlands; Obesity, Morbid; Pregnancy; Retrospective Studies; Vitamin B 12

Patients with morbid obesity have a high risk of deficits in micronutrients, after bariatric surgery. The reasons why systematic use of multivitamin and trace element supplements cannot prevent all deficits are complex and should deserve more attention. Little is known about the influence of micronutrient deficits at surgery.. This present study aimed to explore the deficit in vitamin B12 vs other micronutrients during the follow-up of a French cohort of cases with bariatric surgery under systematic multivitamin/trace elements supplementation and to determine whether it was influenced by clinical, metabolic characteristics at surgery.. We prospectively enrolled obese patients with bariatric surgery (laparoscopic gastric bypass or laparoscopic sleeve gastrectomy) between 2013 and 2018 (OBESEPI/ALDEPI Cohort, NCT02663388). They received a daily multivitamin/micronutrients supplement. Follow-up data at 4 visits, 2, 12, 18 and 24 months after surgery, were collected.. The highest rate of deficits was observed at visit 1 for vitamin D (35.7%), iron (21.9%) and folate (10.2%). Except B12, the deficits of all micronutrients decreased in later visits. In contrast, cases with vitamin B12 deficit decreased from 13.5% at surgery to 2.0% at visit 1, and increased in later visits, with a maximum of 12.0% at visit 3. Vitamin B12 concentration at surgery was the single predictor of B12 deficit at visit 3. It was also associated with age, and APRI score, an index of nonalcoholic fatty liver disease (NAFLD), in multivariate analysis.. The failure of systematic supplementation with multivitamin/trace elements tablets to prevent specific deficits illustrates the need for adapted specific supplementations, in some cases. The worsening of B12 deficit rate in the 18-24 months follow-up depends in part to low B12 at time of surgery. A special consideration should be devoted to this subset of patients. The cohort study was registered at clinicaltrials.gov as NCT02663388.

Topics: Adult; Bariatric Surgery; Dietary Supplements; Female; Follow-Up Studies; Humans; Longitudinal Studies; Male; Micronutrients; Middle Aged; Nutritional Status; Obesity, Morbid; Postoperative Complications; Postoperative Period; Predictive Value of Tests; Preoperative Period; Prospective Studies; Risk Factors; Vitamin B 12; Vitamin B 12 Deficiency

Nutritional deficiencies are a well-recognized long-term complication following bariatric surgery. The presence of preoperative deficiencies has been shown to be predictive of postoperative deficiencies.. The aim of the study was to investigate the prevalence of micronutrient deficiency in a large sample of patients with severe obesity preoperatively, and to determine whether such deficiencies may be related to patient's sex, body mass index, or ethnic subgroup.. A cross-sectional study of data collected at the time of the preoperative evaluation.. Data were collected during the preoperative evaluation of 872 bariatric surgery candidates in a university hospital in Israel between 2011 and 2018. The patients were 72.9% women, with a mean age of 37.9±12.1 years and mean body mass index of 42.4±4.7 MAIN OUTCOME MEASURES: Nutritional deficiencies according to blood assays. Data on anthropometrics, comorbidities, and demographic characteristics was also collected.. Baseline differences between patient subgroups were analyzed using independent-samples t test, analysis of variance, or χ. Deficiencies of vitamin D, iron, folate, vitamin B-12, elevated parathyroid hormone and low transferrin saturation were present in 75.2%, 42.6%, 28.5%, 8.5%, 35.5%, and 70% of patients, respectively. Nutritional deficiencies were significantly more common among women compared with men for iron (45.9% vs 33.5%; P=0.002), low transferrin saturation (77.7% vs 44.6%; P<0.001), vitamin D (77.5% vs 69.2%; P=0.019) and elevated parathyroid hormone level (39.5% vs 22.9%; P=0.002). Iron, transferrin saturation, and vitamin D deficiencies were more prevalent in Arab patients compared with Jewish patients: 59.6% vs 36%; P<0.001, 80.2% vs 62.8%; P=0.003, and 85.1% vs 71.6%; P<0.001, respectively. Vitamin D and iron deficiency were more common among higher body mass index subgroups (P=0.004 and P=0.040, respectively).. The results indicate a high prevalence of nutritional deficiencies, mainly of iron and vitamin D in bariatric surgery candidates. Patients at higher risk for nutritional deficiencies include those with higher body mass index, women, and Arabs.

Topics: Adult; Arabs; Bariatric Surgery; Body Mass Index; Cross-Sectional Studies; Deficiency Diseases; Female; Folic Acid; Humans; Iron; Iron Deficiencies; Israel; Male; Micronutrients; Middle Aged; Nutrition Assessment; Nutritional Status; Obesity, Morbid; Preoperative Period; Prevalence; Risk Factors; Sex Factors; Vitamin B 12; Vitamin D

Topics: Anastomosis, Roux-en-Y; Anemia, Iron-Deficiency; Gastric Bypass; Humans; Obesity, Morbid; Vitamin B 12

Topics: Folic Acid; Humans; Insulin Resistance; Metabolic Syndrome; Obesity, Morbid; Vitamin B 12; Vitamin B 12 Deficiency

To compare the nutritional status follow up of patients who underwent Roux-en-Y gastric bypass (BGYR) and Sleeve gastrectomy (SG) in hospitals of the private and public health systems, in Pernambuco.. This study included patients who underwent bariatric surgery in the public and private health systems, in Pernambuco, from 2008 to 2016. Anthropometric and biochemical (hemoglobin, B12, iron and ferritin) data were evaluated in the preoperative period and at 3, 6 and 12 months after the operation.. There were no significant difference between patients seen at the two health systems regarding the levels of hemoglobin, iron, anemia and vitamin B12. Patients who underwent the RYGB, presented with iron deficiency which was significantly lower for those in the private system, but only at the 3 month evaluation. Low levels of ferritin were observed at the 6 month evaluation, and patients in the private health system presented with the highest ferritin deficiency. The rate of surgical success was significantly higher in those patients undergoing the RYGB at the private system.. After a 12-month bariatric surgery follow-up, there was no statistically significant difference regarding micronutrient deficiency between patients followed up at the private and public health systems.. Comparar a evolução do perfil nutricional de pacientes submetidos ao bypass gástrico em Y de Roux (BGYR) e ao Sleeve, em hospitais dos setores público e privado da Saúde de Pernambuco.. O estudo incluiu pacientes submetidos à cirurgia bariátrica nos setores público e privado de saúde de Pernambuco no período de 2008 a 2016. Foram avaliados dados antropométricos e bioquímicos (Hemoglobina, Vitamina B12, Ferro e Ferritina) no período pré-operatório e com 3, 6 e 12 meses de pós-operatório.. Não foram registradas diferenças significativas entre os pacientes internados nos dois setores da Saúde no tocante às variáveis: níveis hemoglobina, anemia por deficiência de ferro e vitamina B12 em nenhuma das avaliações e conforme o tipo de cirurgia. Entre os pacientes submetidos ao BGYR, os níveis de ferro sérico foram significativamente menores nos pacientes do setor privado da Saúde apenas na primeira avaliação. Baixos níveis de ferritina sérica foram observados na segunda avaliação, sendo os pacientes do setor privado os que apresentaram menores valores. O sucesso cirúrgico foi significativamente maior no grupo que realizou o BGYR na rede privada.. Com um seguimento de 12 meses pós-cirurgia bariátrica, não foi observada diferença estatisticamente significante no que diz respeito às deficiências de micronutrientes entre pacientes usuários dos setores público e privado de Saúde.

Topics: Adult; Bariatric Surgery; Female; Ferritins; Follow-Up Studies; Hemoglobins; Humans; Male; Middle Aged; Nutritional Status; Obesity, Morbid; Private Sector; Public Sector; Retrospective Studies; Vitamin B 12; Young Adult

There is a high prevalence of hyperhomocysteinemia that has been linked to high cardiovascular risk in obese individuals and could be attributed to poor nutritional status of folate and vitamin B12. We sought to examine the association between blood homocysteine (Hcy) folate, and vitamin B12 levels and vascular dysfunction in morbidly obese adults using novel ex vivo flow-induced dilation (FID) measurements of isolated adipose tissue arterioles. Brachial artery flow-mediated dilation (FMD) was also measured. Subcutaneous and visceral adipose tissue biopsies were obtained from morbidly obese individuals and non-obese controls. Resistance arterioles were isolated in which FID, acetylcholine-induced dilation (AChID), and nitric oxide (NO) production were measured in the absence or presence of the NO synthase inhibitor, L-NAME, Hcy, or the superoxide dismutase mimetic, TEMPOL. Our results demonstrated that plasma Hcy concentrations were significantly higher, while folate, vitamin B12, and NO were significantly lower in obese subjects compared to controls. Hcy concentrations correlated positively with BMI, fat %, and insulin levels but not with folate or vitamin B12. Brachial and arteriolar vasodilation were lower in obese subjects, positively correlated with folate and vitamin B12, and inversely correlated with Hcy. Arteriolar NO measurements and sensitivity to L-NAME were lower in obese subjects compared to controls. Finally, Hcy incubation reduced arteriolar FID and NO sensitivity, an effect that was abolished by TEMPOL. In conclusion, these data suggest that high concentrations of plasma Hcy and low concentrations of folate and vitamin B12 could be independent predictors of vascular dysfunction in morbidly obese individuals.

Topics: Adult; Alcohol Drinking; Arterioles; Bariatric Surgery; Brachial Artery; Female; Folic Acid; Folic Acid Deficiency; Homocysteine; Humans; Hyperhomocysteinemia; Male; Nitric Oxide; Nutritional Status; Obesity, Morbid; Vascular Diseases; Vitamin B 12; Vitamin B 12 Deficiency

Bariatric surgery increases the risk of micronutrient deficiencies, including vitamin B12 (B12) deficiency. We analysed early changes in biomarkers of B12 status following bariatric surgery.. We prospectively included adult patients (n = 27) referred for either Roux-en-Y Gastric Bypass (RYGB) (n = 19) or Sleeve Gastrectomy (SG) (n = 8). Blood samples were drawn before surgery and 2 and 6 months following surgery for measurement of B12, holotranscobalamin (holoTC), and methylmalonic acid (MMA). The B12 absorption capacity was estimated from the increase in plasma holoTC two days after a standardised oral B12 challenge.. B12 status decreased following both RYBG and SG. While a decrease in plasma B12 was not evident until 6 months postoperatively, we observed a statistically significant decrease in plasma holoTC and increase in MMA already 2 months postoperatively. These changes were more pronounced at 6 months post surgery. Correspondingly, the B12 absorption capacity was decreased following surgery.. HoloTC and MMA were superior to B12 to detect early changes in B12 status following bariatric surgery. Our data challenge the current concept that liver B12 stores secure long-term maintenance of B12 status. They indicate that B12 treatment in pharmacological doses may be warranted immediately after surgery.

Topics: Adult; Aged; Avitaminosis; Biomarkers; Female; Gastrectomy; Gastric Bypass; Homocysteine; Humans; Male; Methylmalonic Acid; Middle Aged; Obesity, Morbid; Postoperative Complications; Prospective Studies; Transcobalamins; Vitamin B 12

Low vitamin B12 and high folate during pregnancy are associated with visceral obesity and insulin resistance in offspring. In the general population, high folate exacerbates the increase of methylmalonic acid, a marker of vitamin B12 deficiency. However, the influence of vitamin B12 and folate and their related markers on insulin resistance and metabolic syndrome remains unknown in severe obesity.. To evaluate the influence of vitamin B12 and folate on HOMA-IR and components of metabolic syndrome in severe obesity.. 278 consecutive obese patients were assessed prospectively for HOMA-IR, red blood cell (RBC) folates, homocysteine and methylmalonic acid. We compared the associations with the components of metabolic syndrome during the preoperative multidisciplinary evaluation (period-1) and before bariatric surgery (period-2).. The HOMA-IR was higher in patients with highest tertile of RBC and either lowest tertile of plasma B12 or highest tertile of MMA (p < 0.034 and 0.011, respectively). Lg HOMA-IR was negatively correlated with Lg homocysteine (p < 0.0001) and positively correlated with Lg serum folate (p < 0.001). The independent predictors for HOMA-IR at period 2 were either BMI and homocysteine (model 1 without serum folate, p = 0.010 and p = 0.002, respectively) or BMI and MMA (model 2 without homocysteine, p = 0.030 and p = 0.004, respectively). Age and RBC folate remained independently associated with the number of metabolic syndrome components (p = 0.006 and 0.020, respectively).. RBC folate, homocysteine, and MMA predict HOMA-IR in severe obesity. Our findings challenge the benefit of folate fortified food in severe obesity, in particular in patients with a deficit of vitamin B12. The cohort study was registered at clinicaltrials.gov as NCT02663388.

Topics: Adult; Body Mass Index; Erythrocytes; Female; Folic Acid; Homocysteine; Humans; Insulin Resistance; Male; Metabolic Syndrome; Methylmalonic Acid; Middle Aged; Obesity, Morbid; Vitamin B 12; Vitamin B 12 Deficiency

The study aim was to determine the prevalence of abnormal serum biochemistries associated with micronutrient deficiencies before and after laparoscopic sleeve gastrectomy (LSG).. Two hundred and one patients had LSG surgery between May 2011 and May 2014. Using a prospective cohort study design, data were collected on ferritin, hemoglobin (Hgb), mean cell volume (MCV), calcium, albumin, 25-hydroxyvitamin D (25-OH-D), PTH, and vitamin B. Patients were female (81.6%) with mean ± SD, BMI (48.8 ± 6.8 kg/m. Abnormal serum biochemistries indicative of micronutrient deficiencies were prevalent before surgery; reduced abnormal values were observed after surgery, likely due to an increased use of multivitamins.

Topics: Adult; Dietary Supplements; Female; Ferritins; Gastrectomy; Humans; Laparoscopy; Male; Malnutrition; Middle Aged; Nutrition Therapy; Obesity, Morbid; Postoperative Period; Prospective Studies; Vitamin B 12; Vitamin D; Vitamins

Topics: Dietary Supplements; Gastric Bypass; Humans; Obesity, Morbid; Vitamin B 12; Vitamins

The rising rates of bariatric surgery (BS) are accompanied by neurological complications related to nutrient deficiencies. One of the risk factors for neurological complications in BS patients is poor vitamin and mineral supplementation. Prevention, diagnosis and treatment of these disorders are necessary parts of lifelong care after BS. Particularly important for optimal functioning of the nervous system are vitamin B

Topics: Adult; Anemia; Dietary Supplements; Female; Folic Acid; Gastric Bypass; Humans; Minerals; Nervous System Diseases; Obesity, Morbid; Vitamin B 12; Vitamin B 12 Deficiency; Vitamins

Nutritional deficiencies may occur after bariatric surgery despite supplementation. Fracture risk may also be elevated after bariatric surgery.. To compare 25-hydroxyvitamin D [25(OH)D], vitamin B12, and albumin serum concentrations in severely obese patients who had undergone either Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Fracture data was compared with data for a conservatively treated group of severely obese patients.. We considered 253 RYGB and 142 SG performed between 2007 and 2010. At 1- and 2-year control follow-ups, weight was measured and blood samples were drawn. The control group of 199 obese patients received lifestyle intervention and weight was measured at 1 and 2 years post-intervention between 2002 and 2006. We retrospectively collected fracture data for all patients through the end of 2016.. At follow-ups, the mean serum 25(OH)D and albumin levels were within reference ranges and were similar between the RYGB and SG groups. Serum median vitamin B12 level was significantly higher in the SG group compared with the RYBG group, 319 versus 286 pmol/L at 2 years, respectively, p = 0.04. The cumulative risk for fracture was higher in the bariatric groups compared with the control group. The Cox multivariate model showed higher age, bariatric surgery, and lower body mass index (BMI) at the 2-year control increased the risk for fracture after obesity treatment.. Vitamin 25(OH)D, B12, and albumin levels were mainly within recommended levels during the 2 years after bariatric surgery. The cumulative fracture risk was higher in bariatric patients.

Topics: Adult; Age Factors; Body Mass Index; Cohort Studies; Female; Finland; Fractures, Spontaneous; Gastrectomy; Gastric Bypass; Humans; Male; Middle Aged; Obesity, Morbid; Retrospective Studies; Serum Albumin; Vitamin B 12; Vitamin D; Weight Reduction Programs

The aim of this study was to evaluate the prevalence of hair loss after laparoscopic sleeve gastrectomy (LSG). The effects of variables on the likelihood that patients developed hair loss were also examined.. Fifty patients who underwent LSG were enrolled in this prospective study. Demographics, hematocrit, iron, zinc, folic acid, vitamin B12, total proteins, and albumin were evaluated preoperatively and 6 months postoperatively.. Hair loss was observed in 56% of patients and particularly in 46% in females and in 10% in males. Analysis of variance indicated statistical differences for hair loss among the groups with and without hair loss concerning preoperative zinc (p < 0.001), postoperative zinc (p < 0.001), preoperative B12 (p < 0.001), postoperative B12 (p < 0.001), postoperative folic acid (p = 0.039), and postoperative use of supplements (p < 0.001). Patients with hair loss had lower values of zinc preoperatively and postoperatively compared to patients without hair loss (0.61 vs 0.81 mcg/ml) (0.46 vs 0.73 mcg/ml) and also lower values of vitamin B12 preoperatively and postoperatively compared to patients without hair loss (243.04 vs 337.41 pg/ml) (261.54 vs 325.68 pg/ml). Interestingly, the zinc levels were normal preoperatively and lower to normal levels postoperatively and the levels of vitamin B12 were lower than normal values preoperatively in patients with hair loss. Patients with hair loss had mean lower levels of postoperative folic acid of 8 ng/ml.. The prevalence of hair loss was 56% 6 months after LSG. Preoperative monitoring and counseling of these micronutrients may be a preventive and therapeutic measure.

Topics: Adult; Alopecia; Dietary Supplements; Female; Folic Acid; Gastrectomy; Humans; Iron; Laparoscopy; Male; Micronutrients; Middle Aged; Obesity, Morbid; Postoperative Complications; Prevalence; Prospective Studies; Vitamin B 12; Zinc

Helicobacter Pylori (HP) infection is systematically screened for before carrying out bariatric surgery. Criteria to determine "at risk" patients and avoid systematic screening are lacking. We evaluated the prevalence of HP infection and associated predictive factors in a population of patients with class II and III obesity volunteering for bariatric surgery.. Observational, cross-sectional study of patients included in the severe obesity outcome network (SOON) cohort. All patients underwent HP screening. The relationship between plasma metabolic parameters and vitamin levels, medical history and socio-economic parameters, and HP infection was analyzed.. Data from 201 patients, median age 43 years [IQR 35; 52] (81% female) were analyzed. Forty-four patients (22%) were infected with HP and successfully treated, most with a single course of treatment, either combined antibiotics or Pylera®. HP infection was associated with social precariousness as defined by the French "Evaluation de la Précarité et des Inégalités de santé dans les Centres d'Examens de Santé" (EPICES) score (Evaluation of Poverty and Health Inequalities in Health-Assessment Centers) (OR, 1.027; 95% CI, 1.008-1.046; p < 0.004) and with higher levels of vitamin B. The prevalence of HP infection was 22% and was associated with social precariousness. Plasma glucose/insulin and lipid/lipoprotein profiles, liver enzymes or vitamin deficiencies were not associated with HP infection. The number of characteristics associated with HP infection was insufficient to define patients who do not require HP screening before bariatric surgery.

Topics: Adult; Bariatric Surgery; Cohort Studies; Cross-Sectional Studies; Female; Helicobacter Infections; Helicobacter pylori; Humans; Male; Mass Screening; Middle Aged; Obesity, Morbid; Prevalence; Vitamin B 12

Patients are at risk of anemia post Roux-en-Y gastric bypass (RYGB). We sought to determine the prevalence of anemia and related nutritional deficiencies 5 years after RYGB and to evaluate adherence to nutritional supplements with iron, vitamin B12, and folate.. Patients operated with RYGB 2004-2006 were eligible for evaluation. Blood samples were collected and use of nutritional supplements was recorded preoperatively, and at outpatients' consultations 1, 2, and 5 years postoperatively. Of 203 patients operated, 184 (91%) completed the 5 year follow-up and were included in the study. Of these, 97% had valid measurements of hemoglobin both at baseline and after 5 years.. During the 5 years after RYGB, the prevalence of anemia increased from 4% preoperatively to 24% in females, and from 0% to 7% in males. Ferritin levels decreased gradually in both genders. Iron deficiency increased from 6% preoperatively to 42% at 5 years in females, and from 0% to 9% in males. Vitamin B12 deficiency was not altered while folate deficiency decreased from 10% preoperatively to 1% at 5 years. Five years after surgery 25% reported the use of supplements with iron, while 83% used vitamin B12 and 65% used multivitamins with folate.. We observed a long-term increase in anemia and iron deficiency after RYGB in both genders, but most pronounced in women. Our postoperative protocol for prevention of vitamin B12 and folate deficiencies appear acceptable. Iron status and iron supplementation seems to need stronger emphasis during follow-up after RYGB.

Topics: Adult; Anemia, Iron-Deficiency; Dietary Supplements; Female; Folic Acid; Folic Acid Deficiency; Follow-Up Studies; Gastric Bypass; Humans; Iron; Linear Models; Male; Medication Adherence; Middle Aged; Norway; Obesity, Morbid; Postoperative Period; Sex Distribution; Vitamin B 12; Vitamin B 12 Deficiency

Anemia following bariatric surgery is a known complication. To prevent nutrient deficiencies, adolescents require multivitamin/mineral supplementation following bariatric surgery. The purpose of this study was to investigate if routine multivitamin/mineral supplementation is sufficient to prevent anemia in adolescents undergoing bariatric surgery, particularly sleeve gastrectomy (SG), a procedure that may induce nutrient malabsorption.. We conducted a retrospective review of pediatric patients who underwent SG (34 patients) and laparoscopic adjustable gastric banding (LAGB) (141 patients) (January 2006 through December 2013). We examined anemia marker levels (iron, ferritin, folate, B. Following SG, folate levels decreased 3 and 6 months postsurgery but returned to baseline levels at 12 months. Furthermore, the SG group demonstrated lower folate levels compared with LAGB at 3 and 6 months. B. While anemia did not occur in any patients while on recommended routine supplementation, folate levels were significantly reduced following SG and were lower in SG compared with LAGB patients. Additional folate supplementation seemed to improve folate levels, which highlights the importance of ongoing surveillance by primary care providers and the need for additional folate supplementation following SG.

Topics: Adolescent; Anemia, Iron-Deficiency; Bariatric Surgery; Biomarkers; Body Mass Index; Dietary Supplements; Female; Ferritins; Folic Acid; Follow-Up Studies; Gastrectomy; Hematocrit; Hemoglobins; Humans; Iron; Laparoscopy; Male; Obesity, Morbid; Pediatric Obesity; Postoperative Care; Retrospective Studies; Vitamin B 12; Weight Loss

To determine the relationship among vitamin B12 status, obesity severity, and metabolic syndrome and its components in obese children... This case-control study was conducted at the School of Medicine, Gaziosmanpasa University, Tokat, Turkey, from January 2012 and October 2014, and comprised cases of obese and healthy children. The obese children were divided into three groups according to body mass index-standard deviation score quartiles. Group 1 included the first quartile, group 2 included the second and third quartiles, and group 3 included the fourth quartile. Patients with a body mass index of >95th percentile, according to reference curves for Turkish children and adolescents, were considered obese.Patients with a body mass index between15th and 85th percentile were considered to have normal weight. The World Health Organisation's modified metabolic syndrome criteria for children were used to diagnose metabolic syndrome.SPSS 19 was used for data analysis.. Of the 256 participants, 153(59.8%) were obese and 103(40.2%) were healthy controls. The mean age of the obese children was 12.69±2.29 years and that of healthy controls was 13.05±2.48 years. Mean vitamin B12 levels were significantly lower among obese children than healthy volunteers (p<0.001). Age and body mass index-standard deviation score were significantly associated with vitamin B12 status (r= -0.175, p=0.030; r= -0.210, p=0.09, respectively).. Increase in body mass index-standard deviation score was associated with a decrease in vitamin B12 levels.

Topics: Adolescent; Case-Control Studies; Child; Female; Humans; Insulin Resistance; Male; Metabolic Syndrome; Obesity, Morbid; Severity of Illness Index; Turkey; Vitamin B 12

Topics: Adult; Anticoagulants; Blood Coagulation; Gastrectomy; Humans; Hyperhomocysteinemia; Male; Obesity, Morbid; Recurrence; Thrombophilia; Treatment Outcome; Venous Thromboembolism; Vitamin B 12; Vitamin B 12 Deficiency; Vitamins

The association between obesity and different types of anemia remained uncertain. The present study aimed to assess the relation between obesity parameters and the occurrence of iron deficiency anemia and also megaloblastic anemia among Iranian population.. This cross-sectional study was performed on 1252 patients with morbid obesity that randomly selected from all patients referred to Clinic of obesity at Rasoul-e-Akram Hospital in 2014. The morbid obesity was defined according to the guideline as body mass index (BMI) equal to or higher than 40 kg/m2. Various laboratory parameters including serum levels of hemoglobin, iron, ferritin, folic acid, and vitamin B12 were assessed using the standard laboratory techniques.. BMI was adversely associated with serum vitamin B12, but not associated with other hematologic parameters. The overall prevalence of iron deficiency anemia was 9.8%. The prevalence of iron deficiency anemia was independent to patients' age and also to body mass index. The prevalence of vitamin B12 deficiency was totally 20.9%. According to the multivariable logistic regression model, no association was revealed between BMI and the occurrence of iron deficiency anemia adjusting gender and age. A similar regression model showed that higher BMI could predict occurrence of vitamin B12 deficiency in morbid obese patients.. Although iron deficiency is a common finding among obese patients, vitamin B12 deficiency is more frequent so about one-fifth of these patients suffer vitamin B12 deficiency. In fact, the exacerbation of obesity can result in exacerbation of vitamin B12 deficiency.

Topics: Adolescent; Adult; Aged; Anemia, Iron-Deficiency; Anemia, Megaloblastic; Biomarkers; Body Mass Index; Child; Cross-Sectional Studies; Female; Ferritins; Folic Acid; Hemoglobins; Hospitals, University; Humans; Iran; Iron; Male; Middle Aged; Obesity, Morbid; Prevalence; Vitamin B 12; Vitamin B Complex

Vitamin B12 deficiency is common after bariatric surgery. Vitamin B12 is a poor predictor of functional vitamin B12 status, since deficiencies might even occur within the reference limits. Therefore, vitamin B12 deficiencies with serum vitamin B12 levels are between 140 and 200 pmol/L remain undetected. Methylmalonic acid (MMA), however, will detect these deficiencies as accumulates due to functional intracellular vitamin B12 deficiencies. MMA is a relative expensive analysis and is therefore not generally available. To lower the costs, we only request MMA when vitamin B12 levels are between these levels. As a result, more biochemical deficiencies are found. However, it was not known whether bariatric patients with vitamin B12 levels between 140 and 200 pmol/L would benefit from supplementation.. Bariatric patients with vitamin B12 levels between 140 and 200 pmol/L with (n = 45) and without (n = 45) intramuscular hydroxocobalamin injections were compared.. Treated patients showed a significant increase of vitamin B12 levels (P < 0.001) and a significant decrease in MMA levels (P < 0.001). Biochemical improvement occurs in both patients with and without clinical symptoms. The control group showed a significant increase of MMA levels (P < 0.001). To examine whether biochemical benefits of vitamin B12 supplementation are correlated with clinical improvement, patient records were checked for complaints. Complaints were disappeared after treatment, while no improvement was seen in untreated patients.. This study shows that all bariatric patients with vitamin B12 levels between 140 and 200 pmol/L benefit clinical and biochemical from vitamin B12 supplementation, regardless the MMA levels.

Topics: Adult; Aftercare; Bariatric Surgery; Dietary Supplements; Female; Humans; Male; Methylmalonic Acid; Middle Aged; Obesity, Morbid; Retrospective Studies; Treatment Outcome; Vitamin B 12; Vitamin B 12 Deficiency

The incidence of vitamin B. In this retrospective matched cohort study, we included 63 patients with methylmalonic acid (MMA) levels ≥300 nmol/L. Group A (n = 21) received 6 intramuscular (im) vitamin B. The total post-bariatric patient population consisted of 14 males (22.2 %) and 49 women (77.8 %) with a mean current body mass index of 30.6 ± 8.0 kg/m. In this study, a shorter injection regime is probably not sufficient to treat a vitamin B

Topics: Adult; Aged; Bariatric Surgery; Case-Control Studies; Dietary Supplements; Female; Humans; Injections, Intramuscular; Male; Methylmalonic Acid; Middle Aged; Obesity, Morbid; Postoperative Complications; Retrospective Studies; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

Anemia after Roux-en-Y gastric bypass (RYGB) has been reported in 5 to 64 % of patients. Since absorption of specific elements is reduced, proper supplementation is mandatory. The aim of this study was to investigate the frequency of anemia, its causes, and the related deficiencies during the 1st postoperative year after RYGB.. A retrospective review of our prospectively collected database was performed. A total of 486 patients who underwent RYGB in a 5-year period and completed at least 1-year follow-up were included. Daily supplements as suggested by the AACE/TOS/ASMBS guidelines were routinely prescribed. Blood count, iron profile, folic acid, and B12 measurements 1 year after surgery were reviewed.. One hundred ninety-five males and 291 females were included, with a mean age of 39.9 ± 11.6 years and a mean body mass index (BMI) of 42.4 ± 6.3 kg/m(2). Anemia 1 year after surgery was found in 19 patients (4 %), 6 males and 13 females. In seven women, it was related to iron deficiency. Two additional women had iron deficiency combined with low vitamin B12. Anemia was secondary to inflammation in two and indeterminate in two. In the six males, the cause of anemia was inflammation in three and indeterminate in three. Abnormal bleeding was found in five of these patients.. Frequency of anemia 1 year after RYGB in our population was low (4 %). Anemia non-attributable to malabsorption was frequently present (n = 9/19). Iron deficiency was found exclusively in women. The most common non-malabsorptive types of anemia were inflammation and dysfunctional uterine bleeding.

Topics: Adult; Anemia; Body Mass Index; Dietary Supplements; Feasibility Studies; Female; Folic Acid; Gastric Bypass; Humans; Iron; Iron Deficiencies; Male; Middle Aged; Obesity, Morbid; Postoperative Complications; Postoperative Period; Retrospective Studies; Vitamin B 12

Few prospective studies have compared changes of nutrient intake while assessing effectiveness of thiamin, vitamin B12, and folate supplementation to prevent B vitamin deficiencies immediately following Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). Therefore, we determined the response to 3 months supplementation on maintaining blood B vitamin concentrations.. Women undergoing RYGB (n = 11) and SG (n = 11) consumed bariatric vitamin supplements (12 mg thiamin, 350 μg vitamin B12, 800 μg folic acid) daily for 3 months. Height, weight, body mass index, and blood vitamin concentrations were measured preoperatively and at 3 months. Wilcoxon signed-rank analyses compared body weight parameters, laboratory indices, and nutrient intake at baseline and 3 months.. Supplementation for 3 months maintained blood thiamin, increased serum folate from 13.1 ± 5.4 to 16.3 ± 6.0 nmol/L (P = 0.049), and increased serum vitamin B12 concentrations from 498 ± 150 to 736 ± 340 pg/mL (P = 0.005). Dietary intake of thiamin and folate decreased in the combined surgical groups, while dietary intake of B12 was maintained. Bariatric B vitamin supplements provided multiple intakes of the Recommended Dietary Allowances (1090% thiamin, 14,583% vitamin B12, 200% folate).. Although energy intake decreased 64%, B vitamin supplementation for 3 months resulted in a 48% increase of serum vitamin B12, a modest increase of serum folate, and no reduction of blood thiamin concentrations. Long-term effects of the rapid rise of serum B12 levels attributed to the high content of supplements warrant further investigation.

Topics: Adult; Bariatric Surgery; Body Mass Index; Combined Modality Therapy; Dietary Supplements; Female; Folic Acid; Humans; Middle Aged; Obesity, Morbid; Postoperative Period; Prospective Studies; Treatment Outcome; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex; Young Adult

Bariatric surgery has gained wide acceptance as treatment for severe obesity and is associated with decreased overall mortality. The aims of this study were to evaluate the prevalence of anemia long term after Roux-en-Y gastric bypass (RYGB) and to search for factors predicting anemia.. All 745 patients who underwent RYGB between 1993 and 2003 at either Örebro or Uppsala University Hospital and who were living in Sweden were invited to participate by providing a fasting blood sample and completing a questionnaire about their health status. Full blood count, serum iron, transferrin, vitamin B12, and folic acid were determined.. Follow-up was completed in 431 patients (58 %) with mean age 51.3 ± 10 years. Of all patients, 27 % had anemia postoperatively and related deficiencies; iron, folic acid, and vitamin B12 were seen in 20, 12, and 2 %, respectively. There was no correlation between anemia and sex, follow-up time, 25-OH vitamin D level, and preoperative or postoperative BMI. An inverse correlation was found between anemia and regular medical checkups concerning gastric bypass surgery.. Twenty-seven percent of patients had anemia more than 10 years after RYGB. Anemia does not seem to progress with time and was less common in patients with regular medical checkups. Thus, improved long-term follow-up is needed.

Topics: Adult; Aged; Anemia; Female; Folic Acid; Gastric Bypass; Humans; Iron; Male; Middle Aged; Obesity, Morbid; Postoperative Period; Prevalence; Retrospective Studies; Sweden; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin D

The health behaviours of pregnant women with very severe obesity are not known, though these women are at high risk of pregnancy complications. We carried out a prospective case-control study including 148 very severely obese (BMI >40 kg/m²) and 93 lean (BMI <25 kg/m²) pregnant women. Diet, physical activity, smoking, alcohol and folic acid consumption were assessed by questionnaire in early and late (16 and 28 weeks gestation) pregnancy. Circulating levels of iron, vitamin B12 and folate and other essential trace elements and minerals were measured in a subset at each time point. The findings biochemically confirmed that very severely obese women consumed diets that were energy-rich but poor in essential micronutrients. A third of all women met physical activity recommendations for pregnancy. A third of very severely obese women and two thirds of lean women took folic acid supplements prior to pregnancy. Very severely obese women were more likely to smoke but less likely to drink alcohol than lean women (all p < 0.05). Women with very severe obesity have low self-reported intakes and circulating levels of essential micronutrients in pregnancy and few follow current recommendations for pregnancy nutrition and lifestyle. These high-risk women represent a group to target for education about health behaviours prior to and during pregnancy.

Topics: Adult; Alcohol Drinking; Body Mass Index; Case-Control Studies; Diet; Dietary Supplements; Female; Folic Acid; Health Behavior; Health Education; Humans; Iron; Motor Activity; Obesity, Morbid; Pregnancy; Pregnancy Complications; Pregnancy, High-Risk; Prospective Studies; Smoking; Surveys and Questionnaires; United Kingdom; Vitamin B 12

Sleeve gastrectomy (SG) is supposed to induce fewer nutritional deficiencies than gastric bypass (GBP). However, few studies have compared nutritional status after these two procedures, and the difference in weight loss (WL) between procedures may alter the results. Thus, our aim was to compare nutritional status after SG and GBP in subjects matched for postoperative weight. Forty-three subjects who underwent SG were matched for age, gender, and 6-month postoperative weight with 43 subjects who underwent GBP. Dietary intakes (DI), metabolic (MP), and nutritional parameters (NP) were recorded before and at 6 and 12 months after both procedures. Multivitamin supplements were systematically prescribed after surgery. Before surgery, BMI, DI, MP, and NP were similar between both groups. After surgery, LDL cholesterol, serum prealbumin, vitamin B12, urinary calcium, and vitamin D concentrations were lower after GBP than after SG, whereas WL and DI were similar after both procedures. However, the total number of deficiencies did not increase after surgery regardless of the procedure. In addition, we found a significant increase in liver enzymes and a greater decrease in C-reactive protein after GBP. In conclusion, during the first year after surgery, in patients with the same WL and following the same strategy of vitamin supplementation, global nutritional status was only slightly impaired after SG and GBP. However, some nutritional parameters were specifically altered after GBP, which could be related to malabsorption or other mechanisms, such as alterations in liver metabolism.

Topics: Adult; Body Mass Index; Calcium; Cholesterol, LDL; Dietary Supplements; Female; Gastrectomy; Gastric Bypass; Humans; Malabsorption Syndromes; Male; Middle Aged; Nutritional Status; Obesity, Morbid; Postoperative Period; Prealbumin; Treatment Outcome; Vitamin B 12; Vitamin D; Weight Loss

Severely obese subjects have been found to show a high prevalence of distinct nutritional deficiencies even without any bariatric intervention but the underlying reasons remain obscure. We tested the hypothesis that gastric Helicobacter pylori infection is associated with increased nutritional deficiency rates. Taking advantage of our large database, we identified 404 patients who had undergone a gastroscopy--as a standard diagnostic assessment before bariatric surgery--along with a histological examination of gastric mucosal biopsies with concurrent nutritional blood measurements. Eighty-five (21 %) of the obese patients included in the study displayed a gastric H. pylori infection. Sex distribution, age and body mass index did not differ between H. pylori+ and H. pylori- patients (P > 0.29). Referring to nutritional markers, neither serum levels of total protein, albumin, calcium, phosphate, magnesium, ferritin, zinc, copper, vitamin B12, folate and 25-OH vitamin D3 nor respective deficiency rates differed between the H. pylori+ and H. pylori- patients group (all P > 0.13). Overall, 49.5 % of the bariatric candidates displayed at least one nutritional deficiency. Our data confirm previous reports on high prevalences of nutritional deficiencies in severely obese subjects. However, they do not provide evidence for a contributing role of gastric H. pylori infection to these nutritional alterations.

Topics: Adult; Calcium; Copper; Deficiency Diseases; Diet; Female; Ferritins; Folic Acid; Gastric Mucosa; Gastroscopy; Helicobacter Infections; Helicobacter pylori; Humans; Magnesium; Male; Middle Aged; Obesity, Morbid; Patient Selection; Preoperative Period; Prevalence; Vitamin B 12; Zinc

Despite routine supplementation of vitamins and minerals after bariatric surgery, an important number of patients suffer from deficiencies. Little is still known about the novel restrictive procedure, sleeve gastrectomy.. A retrospective study of 30 morbidly obese patients undergoing a laparoscopic sleeve gastrectomy, between May 2008 and September 2010, was performed. Baseline albumin, ferritin, iron, zinc, calcium, vitamin D, parathormone (PTH), vitamin B12, and folic acid were obtained before operation and postoperative determinations 1, 3, 6, 9, 12, 18, and 24 months after surgery.. Before surgery, 96.7% of the patients presented vitamin D deficiency, 20% had elevated PTH, 3.3% hypoalbuminemia, and 3.3% folic acid deficiency. One year after surgery, only one patient (3.3%) presented vitamin D deficiency and had elevated PTH. The rest of parameters were within normal range. The second year after surgery, the results remain similar. A significant difference was obtained when comparing preoperative vitamin D values and postoperative determinations 12 months after surgery (increase of 51.9 ng/dl, 95% confidence interval (CI) (41.8-61.3); p < 0.001). A significant difference was determined when comparing preoperative PTH values and postoperative determinations 3 months after surgery (decrease of 16.6 pg/ml, 95% CI (2.6-30.6); p = 0.03). A significant inverse correlation was observed between weight loss and vitamin D increase at the third month after surgery (Pearson correlation coefficient -0.948; p = 0.033).. Postoperative values of vitamin D show a progressive increase, while PTH ones present a significant reduction, without any impact on serum calcium levels. We have demonstrated an inverse correlation between weight loss and vitamin D increase at the third month after surgery.

Topics: Adult; Calcium; Dietary Supplements; Female; Ferritins; Folic Acid; Gastroplasty; Humans; Iron; Middle Aged; Obesity, Morbid; Parathyroid Hormone; Postoperative Period; Retrospective Studies; Time Factors; Vitamin B 12; Vitamin D; Vitamin D Deficiency; Weight Loss; Young Adult

The purpose of this study was to describe vitamin and nutrient supplement practices and assess medication dosage formulations utilized in patients hospitalized with a history of bariatric surgery. Retrospective pilot study was conducted from January 1, 2006 through December 31, 2007 in patients with a past history of bariatric surgery. Demographic data, vitamin and nutrient supplements, and medication dosage formulations were evaluated upon admission. This was compared to published guidelines. Compliance with the following supplementation was categorized: daily multivitamin, calcium, iron, vitamin B-12, and folic acid. The frequency of non-immediate-release and enteric-coated medication dosage forms was also examined. Discrepancies were identified as lack of one of the supplements or if an inappropriate dosage formulation was ordered. Of 133 admissions, 117 (88%) had a history of a malabsorptive procedure and at least one discrepancy was found. Only 33.3% of admissions were ordered a multivitamin, 5.1% were ordered supplemental vitamin B-12, and 7.7% received a calcium supplement. Additional folic acid was ordered in 11.1% and iron ordered in 12.0%. Inappropriate medication formulations were ordered in 61.5% of patients; 34.7% included non-immediate-release formulations, 25.0% enteric-coated formulations, and 40.3% both non-immediate-release and enteric-coated. Upon discharge from the institution, 50% had inappropriate formulations continued. Patients with a history of bariatric surgery may not have their vitamin and nutrient needs met upon hospitalization. Prior bariatric surgery is not consistently taken into consideration when ordering medications. Healthcare providers need to be cognizant of vitamin regimens to recommend as well as medication dosage formulations to avoid.

Topics: Adult; Bariatric Surgery; Demography; Dietary Supplements; Drug Dosage Calculations; Female; Hospitals, Community; Humans; Intestinal Absorption; Male; Medication Errors; Middle Aged; Nutrition Disorders; Nutritional Requirements; Nutritional Status; Obesity, Morbid; Prescription Drugs; Retrospective Studies; Virginia; Vitamin B 12; Vitamins

Laparoscopic sleeve gastrectomy (LSG) has been recently introduced as a stand-alone, restrictive bariatric surgery. Theoretically, LSG attenuates micronutrients deficiencies and associated complications that typically observed following malabsorptive procedures. The aim of this study was to assess iron indices and the 1-year incidence of iron deficiency in patients undergoing LSG.. This was a prospective, cohort study; patients who underwent LSG from June 2007 to April 2008 at our institution were screened for inclusion. Preoperative hemoglobin and iron indices including serum iron, transferrin saturation, ferritin, and soluble transferrin receptor were compared to their levels at 6 and 12 months after surgery. Similarly, vitamin B12 and red blood cell (RBC) folate were analyzed as secondary end points. Weight parameters and C-reactive protein (CRP) levels were compared before surgery and 1 year postoperatively.. A total of 61 patients were included in the study. One year after surgery, there was a significant decrease in the mean body mass index from 47.5 +/- 9.6 to 30.5 +/- 6.5 (P < 0.001). The incidence of iron deficiency was 4.9% at both follow-up time points. Anemia was evident in 4.9% of patients 1 year postoperatively. Significant decrease in the means of the natural logarithm of vitamin B12 and RBC folate were observed as early as 6 months after surgery (P = 0.014; P < 0.005, respectively). The decrease in mean CRP level 12 months postoperatively was statistically significant compared to its preoperative value (P < 0.0001).. LSG is an effective procedure for the treatment of morbid obesity and its associated inflammatory state. One year after surgery, development of iron deficiency was insignificant.

Topics: Anemia, Iron-Deficiency; Body Mass Index; C-Reactive Protein; Cohort Studies; Deficiency Diseases; Erythrocytes; Female; Ferritins; Folic Acid; Gastrectomy; Humans; Iron; Iron Deficiencies; Laparoscopy; Male; Obesity, Morbid; Postoperative Complications; Prospective Studies; Receptors, Transferrin; Transferrin; Vitamin B 12; Weight Loss

Despite the increasing use of Roux-en-Y gastric bypass (RYGBP) in the treatment of morbid obesity, data about postoperative nutritional deficiencies and their treatment remain scarce.. The aim of this study was to evaluate the efficacy of a standard multivitamin preparation in the prevention and treatment of nutritional deficiencies in obese patients after RYGBP.. This was a retrospective study of 2 y of follow-up of obese patients after RYGBP surgery. Between the first and the sixth postoperative months, a standardized multivitamin preparation was prescribed for all patients. Specific requirements for additional substitutive treatments were systematically assessed by a biologic workup at 3, 6, 9, 12, 18, and 24 mo.. A total of 137 morbidly obese patients (110 women and 27 men) were included. The mean (+/-SD) age at the time of surgery was 39.9 +/- 10.0 y, and the body mass index (in kg/m(2)) was 46.7 +/- 6.5. Three months after RYGBP, 34% of these patients required at least one specific supplement in addition to the multivitamin preparation. At 6 and 24 mo, this proportion increased to 59% and 98%, respectively. Two years after RYGBP, a mean amount of 2.9 +/- 1.4 specific supplements had been prescribed for each patient, including vitamin B-12, iron, calcium + vitamin D, and folic acid. At that time, the mean monthly cost of the substitutive treatment was $34.83.. Nutritional deficiencies are very common after RYGBP and occur despite supplementation with the standard multivitamin preparation. Therefore, careful postoperative follow-up is indicated to detect and treat those deficiencies.

Topics: Adult; Body Mass Index; Calcium; Female; Folic Acid; Follow-Up Studies; Gastric Bypass; Humans; Iron; Male; Nutrition Disorders; Nutritional Requirements; Nutritional Status; Obesity, Morbid; Postoperative Complications; Retrospective Studies; Vitamin B 12; Vitamin D; Vitamins; Weight Loss

Homocysteine is known as an independent risk factor of atherosclerosis. The aim of this study was assessment of serum homocysteine concentrations in obese children and evaluation of possible relationship between homocysteine and risk factors of atherosclerosis. 498 children with simple obesity were included into our study. There was a significant correlation between serum homocysteine levels and both traditional and new risk factors of atherosclerosis. The issues confirm a necessity of evaluation serum homocysteine levels of obese children in estimation of cardiovascular disease risk.

Topics: Adolescent; Atherosclerosis; Biomarkers; Body Mass Index; Child; Comorbidity; Female; Folic Acid; Genetic Predisposition to Disease; Homocysteine; Humans; Hypertension; Male; Obesity; Obesity, Morbid; Poland; Risk Factors; Statistics, Nonparametric; Vitamin B 12

Folate depletion and hyperhomocysteinemia increase the risk for hepatic alcoholic damage and promote oxidative stress in animals. In addition, some investigators have reported an inverse association between serum folate and body mass index and a positive correlation between total homocysteine and fat mass. We investigated whether there is an association between serum folate and total homocysteine concentrations with the presence of non-alcoholic fatty liver disease (NAFLD) in obese subjects.. Forty-three obese (body mass index > or =35 kg/m2) patients who underwent bariatric surgery and hepatic biopsy were included. Serum total homocyteine, folate and vitamin B12 concentrations and hepatic enzymes were measured. Liver biopsies were graded for the presence of fat, inflammation, and fibrosis on a scale from 0 to 3. A total histologic score was calculated based on the sum of partial scores. Severe NAFLD was defined as a total score of at least 4 or severe steatosis (partial score for fat = 3).. Severe NAFLD was present in 17 patients. Serum folate concentration was significantly lower in obese patients with NAFLD than in those with normal liver or minimal alterations (9.3 +/- 3.5 versus 12.2 +/- 3.1 ng/mL, P = 0.005). Serum total homocysteine and vitamin B12 concentrations were similar in both groups. An inverse correlation between serum folate concentration and body mass index was observed (r = -0.31, P = 0.046).. In this study, severe NAFLD in obese subjects was associated with lower serum folate concentrations and serum homocysteine and vitamin B12 concentrations were not associated with liver damage in obese subjects.

Topics: Adult; Alanine Transaminase; Aspartate Aminotransferases; Bariatrics; Body Mass Index; Case-Control Studies; Fatty Liver; Female; Folic Acid; Homocysteine; Humans; Liver Function Tests; Obesity, Morbid; Vitamin B 12

Patients undergoing either Roux-en-Y gastric bypass (RYGBP) or biliopancreatic diversion (BPD) with RYGBP are at risk of developing metabolic sequelae secondary to malabsorption. We compared the differences in nutritional complications between these two bariatric operations.. A retrospective analysis of a prospective database was done. From June 1994 to December 2001, 243 morbidly obese patients underwent various bariatric procedures at our institution. Of these patients, 79 (BMI 45.6 +/- SD = 4.9) who underwent RYGBP (gastric pouch 15 +/- 5 ml, biliopancreatic limb 60-80 cm, alimentary limb 80-100 cm and common limb the remainder of the small intestine), and 95 super obese (BMI 57.2 +/- 6.1) who underwent a BPD (gastric pouch 15 +/- 5 ml, biliopancreatic limb 150-200 cm, common limb 100 cm and alimentary limb the remainder of the small intestine), were selected and studied for the incidence of micronutrient deficiencies and level of serum albumin at yearly intervals postoperatively. A variety of nutritional parameters including Hb, Fe, ferritin, folic acid, vitamin B12 and serum albumin were measured preoperatively and compared postoperatively at 1, 3, 6, 12, 18 and 24 months, and yearly thereafter.. Nutritional parameters were compared preoperatively and at similar periods postoperatively. No statistically significant (P < 0.05) difference in the occurrence of deficiency was observed between the groups for any of the nutritional parameters studied, except for ferritin, which showed a significant difference at the 2-year follow-up (37.7% low ferritin levels after RYGBP vs. 15.2% after BPD, P = 0.0294). All of these deficiencies were mild, without clinical symptomatology and were easily corrected with additional supplementation of the deficient micronutrient, with no need for hospitalization. Regarding serum albumin, there was only one patient with a level below 3 g/dl in the RYGBP group and two in the BPD group. These three patients were hospitalized and received total parenteral nutrition for 3 weeks, without further complications.. There was no significant difference in the incidence of deficiency of the nutritional parameters studied, except for ferritin, following RYGBP vs. BPD with RYGBP. The most common deficiencies encountered were of iron and vitamin B12. The incidence of hypoalbuminemia was negligible in both groups, with mean values above 4 g/dl.

Topics: Adult; Anastomosis, Roux-en-Y; Anemia, Iron-Deficiency; Biliopancreatic Diversion; Body Mass Index; Female; Ferritins; Gastric Bypass; Humans; Iron; Male; Nutrition Disorders; Nutritional Status; Obesity, Morbid; Postoperative Complications; Retrospective Studies; Treatment Outcome; Vitamin B 12; Vitamin B 12 Deficiency; Weight Loss

Moderate alcohol consumption is associated with improved vascular risk profile and decreased mortality in the middle aged. An elevated homocysteine concentration is an independent risk factor for cardiovascular disease.. To examine the relationship between alcohol consumption and homocysteine concentrations in severely obese patients (body mass index (BMI)>35).. A careful alcohol history was obtained from 350 (male:female 1:5) consecutive patients as part of preoperative assessment for surgical treatment of obesity. Data were obtained concerning amount, frequency, timing and type of alcohol consumption. Fasting homocysteine, serum folate and vitamin B(12) concentrations were measured. Differences between groups were assessed using Student t-test, and ANOVA. Linear regression was used to assess factors influencing homocysteine concentration.. There is a U-shaped relationship between alcohol consumption and homocysteine concentrations, with light to moderate consumption being associated with lower concentrations. Those consuming <100 g/week (n=165) of alcohol had geometric mean (95% CI of mean) serum homocysteine concentrations of 8.5 (8.2-8.9) micromol/l compared with 9.5 (9.1-9.9) micromol/l for non or rare consumers (n=153; P=0.001). The lower concentrations of homocysteine in regular consumers were associated with higher folate concentrations of 9.4 (8.6-10.2) ng/ml when compared with non-consumers 7.5 (7.1-7.8) ng/ml (P=0.001). Red wine consumers (n=42) had lower fasting concentrations of homocysteine 7.8 (7.5-8.1) micromol/l compared with 153 non-consumers 9.4 (9.0-9.8) micromol/l (P<0.001), 82 beer and spirit consumers 9.0 (8.4-9.7) micromol/l (P=0.005) and 73 white wine consumers 8.8 (8.2-9.4 micromol/l (P=0.013). Red wine consumption was an independent predictor for lower homocysteine concentrations.. Mild to moderate alcohol consumption, especially red wine consumption, in obese subjects is associated with lower fasting homocysteine concentrations. This may reduce cardiovascular risk and help explain the 'French paradox'.

Topics: Adult; Alcohol Drinking; Alcoholic Beverages; Beer; Cardiovascular Diseases; Fasting; Female; Folic Acid; Homocysteine; Humans; Male; Middle Aged; Obesity, Morbid; Risk; Vitamin B 12; Wine

To investigate homocysteine levels and their relationship with serum folate and vitamin B12 concentrations with weight loss after the Lap-Band form of gastric restrictive surgery, with the view to minimizing risk.. We measured levels of fasting plasma homocysteine (tHcy), folate (serum and RBC) and vitamin B12 in two groups. The study group was 293 consecutive patients at 12 (n=192) or 24 (n=101) months review after surgery. The controls were 244 consecutive patients presenting for this surgery.. The group losing weight had higher geometric mean tHcy levels: 10.4 (95% CI, 9.8-10.8) micromol/l compared with 9.2 (95% CI, 8.9-9.7) in controls (P<0.001). This occurred with higher folate levels and unchanged vitamin B12 levels. Levels of folate and B12 together explained 35% (r (2)) of the homocysteine variance in the weight loss group compared with only 9% (r (2)) in controls (P<0.001). Those taking regular multivitamin supplements had lower tHcy levels: 9.6 (9.1-10.0) micromol/l vs 12.3 (11.4-13.3) in those not taking supplements (P<0.001). A low normal plateau of tHcy levels occurred at levels of folate >15 ng/l and B12)600 ng/ml. A curvilinear relationship exists between these cofactors and tHcy levels, with the dose-response relationship shifted to the right in the weight loss group.. This study shows elevated tHcy levels with weight loss, without lower serum folate or vitamin B(12) levels. There is an altered dose-response relationship with higher serum B(12) and folate levels required to maintain recommended tHcy levels. Patients losing weight have significant health benefits; however, they may be at greater risk of vascular events or fetal abnormality in association with raised tHcy levels. Multivitamin supplementation is effective in lowering tHcy levels.

Topics: Adult; Case-Control Studies; Dietary Supplements; Dose-Response Relationship, Drug; Female; Folic Acid; Homocysteine; Humans; Male; Obesity, Morbid; Vitamin B 12; Weight Loss

Low serum vitamin B-12 concentrations after gastric bypass (GB) surgery for obesity were observed in 11 of 28 patients without detectable impairment of crystalline vitamin B-12 absorption. This was observed in 2 of 19 patients with vertical banded gastroplasty (VBG). In contrast, protein-bound vitamin B-12 absorption was markedly impaired, as demonstrated in eight of these patients after GB (n = 7) and VBG (n = 1). Correction of this impaired absorption occurred when protein-bound vitamin B-12 was incubated with an enzyme mixture before consumption. Simultaneous ingestion of the enzyme mixture with protein-bound vitamin B-12 did not improve absorption of the vitamin. In a separate experiment, 10 patients with a normal result from the Schilling test failed to correct low serum vitamin B-12 concentrations with a quantity of oral crystalline vitamin B-12 equal to the recommended dietary allowance of 2 micrograms, taken twice daily for 3 mo. Serum total homocysteine values declined during this interval. An oral daily dose of 350 micrograms crystalline vitamin B-12 raised the average serum vitamin B-12 concentration to an amount greater than the lower reference limit. A dose > 350 micrograms/d was required to raise all patients' vitamin B-12 concentrations above this concentration rather than just above the population mean. We conclude that because concentrations of oral crystalline vitamin B-12 were required to normalize serum vitamin B-12 concentrations, that a mechanism other than formation of a vitamin B-12 intrinsic factor complex is responsible for crystalline vitamin B-12 absorption after GB for obesity.

Topics: Adult; Anastomosis, Roux-en-Y; Female; Gastric Bypass; Gastroplasty; Homocysteine; Humans; Intestinal Absorption; Male; Obesity, Morbid; Vitamin B 12; Vitamin B 12 Deficiency

The pathophysiologic mechanism(s) responsible for cobalamin deficiency after Roux-en-Y gastric bypass for clinically severe obesity remains unexplained. Inadequate secretion of intrinsic factor has been postulated, but decreased gastric acid secretion resulting in maldigestion and inadequate liberation of free cobalamin from its native protein-bound form is also possible. The aim of this study was to determine prospectively secretion of gastric acid and absorption of crystalline (free) and protein-bound cobalamin before and after gastric bypass. Eight patients (two men, six women) underwent orogastric intubation of the intact stomach preoperatively and the proximal gastric pouch postoperatively. Gastric acid secretion in the basal and stimulated (pentagastrin, 6 micrograms/kg) states was determined by a perfused, nonabsorbable marker technique to quantitate recovery of gastric secretion. Absorption of radiolabeled (57Co) crystalline and protein-bound cobalamin was assessed on separate days by 24-hr urinary excretion. After gastric bypass, acid secretion (mean +/- SEM) was markedly reduced in basal (9.1 +/- 3.6 vs 0.005 +/- 0.003 meq/hr; P = 0.04) and stimulated (12.8 +/- 1.8 vs 0.008 +/- 0.003 meq/30 min; P = 0.002) states. Absorption of crystalline cobalamin was decreased (15.8 +/- 2.5 vs 9.4 +/- 1.4%; P = 0.08) to a lesser extent than was protein-bound cobalamin (5.9 +/- 1.0 vs 1.1 +/- 0.3%; P = 0.004). In summary, gastric acid secretion from the gastric pouch is negligible after gastric bypass, and food-bound cobalamin is maldigested and subsequently malabsorbed presumably due to pouch achlorhydria. Decreased absorption of free cobalamin suggests decreased cobalamin-intrinsic factor complex formation.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Anastomosis, Roux-en-Y; Female; Gastric Acid; Gastric Bypass; Humans; Intestinal Absorption; Male; Middle Aged; Obesity, Morbid; Prospective Studies; Vitamin B 12; Vitamin B 12 Deficiency

This study sought to determine the basal and peak-stimulated acid secretion from the proximal gastric pouch and its relationship to absorption of free and food-bound vitamin B12 after gastric bypass for morbid obesity.. Gastric bypass can be performed safely and provides acceptable weight loss, but concerns remain about possible long-term complications such as vitamin B12 malabsorption. The authors hypothesized that by constructing a small pouch of gastric cardia, acid secretion into the pouch would be low, leading to maldigestion of food-bound vitamin B12 with subsequent malabsorption.. Basal and pentagastrin-stimulated peak acid outputs from the proximal gastric pouch were measured in ten patients after vertical Roux-en-Y gastric bypass using a perfused orogastric tube technique. Absorption of free and food-bound 57Co-vitamin B12 was evaluated separately using 24-hour urinary excretion.. Basal (mEq/hr, mean +/- standard error of the mean [SEM]) and peak-stimulated (mEq/30 min) acid secretions from the proximal gastric pouch were markedly decreased compared to those for age- and sex-matched hospital control subjects (0.01 +/- 0.01 vs. 4.97 +/- 0.66 and 0.08 +/- 0.04 vs. 12.11 +/- 1.34, respectively; p < 0.001 for each). While absorption of free vitamin B12 was not statistically different from that of control subjects (11 +/- 2 vs. 15 +/- 2%; p > 0.05), absorption of food-bound vitamin B12 was decreased (0.8 +/- 0.2 vs. 3.7 +/- 0.5%; p < 0.01).. After vertical Roux-en-Y gastric bypass for morbid obesity, acid secretion is virtually absent and food-bound vitamin B12 is maldigested and subsequently malabsorbed. The results of this study suggest that postoperative vitamin B12 supplementation is important and can be achieved with either monthly parenteral vitamin B12 or daily oral crystalline preparations.

Topics: Adult; Anastomosis, Roux-en-Y; Female; Gastric Acid; Humans; Intestinal Absorption; Male; Middle Aged; Obesity, Morbid; Vitamin B 12

A series of morbidly obese patients was treated surgically with a gastric bypass, and a subsequent series received a vertical banded gastroplasty. To compare some of the nutritional effects of these two procedures we measured serum vitamin B12 levels, absorption of food vitamin B12, frequency of microcytosis of erythrocytes, and frequency of anemia at one or more years after surgery. Patients with a gastric bypass showed greater weight loss, a greater frequency of microcytosis and anemia, more frequent subnormal serum levels of vitamin B12, and impressive failure to absorb food vitamin B12. Boiling the food containing vitamin B12 led to increased absorption.

Topics: Absorption; Adult; Erythrocyte Volume; Female; Gastric Bypass; Gastroplasty; Humans; Male; Nutritional Status; Obesity, Morbid; Postoperative Complications; Postoperative Period; Vitamin B 12

Serum iron, folate, B12 and total iron binding capacity (TIBC) were obtained preoperatively and at 6-month intervals in 40 morbidly obese patients who underwent VGB. Deficiencies of hemic micronutrients rarely occurred following VBG. Hemoglobin and hematocrit levels were within normal limits at all times. Some patients experienced transitory depression of nutrients at six months postoperatively, during the period of most rapid weight loss and lowest dietary intake. These levels return to normal by one year in almost all cases. Low B12 levels were observed in four patients at 1 year. All had been above 120 per cent overweight and had lost in excess of 100 pounds in the first postoperative year. These data indicate that hemic micronutrients remain at normal levels following VBG. B12 levels should be followed to determine possible need for supplementation other than that provided by usual daily multivitamin preparations in patients above 120 per cent ideal weight loss exceeding 100 lbs in the first postoperative year.

Topics: Female; Folic Acid; Hematocrit; Hemoglobins; Humans; Iron; Male; Obesity, Morbid; Stomach; Vitamin B 12

The vitamin E, vitamin B-6, vitamin B-12, and folate status of 22 gastric bypass subjects aged 23 to 60 years was evaluated before surgery and at 6 and 12 months after surgery. Before surgery, 77% of subjects had adequate plasma vitamin E levels; 36%, adequate plasma pyridoxal phosphate levels; 100%, adequate plasma vitamin B-12 levels; and 45%, adequate plasma folate levels. The food intake of all subjects was sharply reduced after surgery. After surgery, subjects were classified into three vitamin supplement groups on the basis of average daily vitamin supplement intake. Subjects taking higher levels of supplements containing the vitamins in question had significantly higher plasma concentrations of the vitamins than those taking low or moderate levels. The mean plasma vitamin values in the moderate supplement group were indicative of adequate status for all vitamins, but plasma vitamin B-12 levels at 12 months post-surgery were significantly lower than pre-surgery levels. In the low supplement group, mean plasma vitamin levels were in or near marginal or deficient ranges. The majority of subjects consuming supplements of vitamin E, vitamin B-6, and folate near the US RDA maintained normal vitamin status. Subjects taking more than 100 micrograms vitamin B-12 daily had adequate vitamin B-12 status. Significant correlations (r = .67 to .94) were observed between vitamin supplement levels and the respective plasma vitamin concentrations.

Topics: Adult; Anastomosis, Roux-en-Y; Body Weight; Energy Intake; Female; Folic Acid; Humans; Male; Middle Aged; Nutritional Status; Obesity, Morbid; Postoperative Period; Pyridoxine; Stomach; Vitamin B 12; Vitamin E; Vitamins