1
|
Basolo A, Bechi Genzano S, Vitti J, Salvetti G, Gilio D, Ceccarini G, Scartabelli G, Lippi C, Bellini R, Mancini R, D'Imporzano S, Moretto C, Angeli V, Troiani D, Fierabracci P, Jaccheri R, Calderone A, Poma AM, Chiovato L, Saponati G, Santini F. Efficacy of multivitamin support following bariatric surgery in patients with obesity: a prospective observational study. Eat Weight Disord 2024; 29:34. [PMID: 38714632 PMCID: PMC11076347 DOI: 10.1007/s40519-024-01655-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 04/02/2024] [Indexed: 05/10/2024] Open
Abstract
PURPOSE Bariatric surgery (BS), an effective treatment for severe obesity and its comorbidities, may result in micronutrient and vitamin deficiencies. This monocentric prospective observational study aimed at evaluating the efficacy of a specifically designed vitamin/mineral formula (Bariatrifast, BIOITALIA S.r.l., Italy) for preventing and treating micronutrient deficiencies in patients submitted to BS. METHODS Twenty patients with severe obesity (mean weight and BMI: 123.5 kg (range 88-174) and 43.3 kg/m2 (range 37-54) respectively) underwent BS (10 vertical sleeve gastrectomy VSG, 10 Roux-en-Y gastric bypass, RYGB). The mean age was 49.9 years (range 27-68). After a presurgical visit (V0), follow-up visits were performed at 1, 3, 6 and 12 months after surgery (V1-V4). Recorded data included weight, height and BMI. A complete blood count, measurement of ferritin, folic acid, vitamin B12, ionized calcium, 25 OH vitamin D, parathyroid hormone (PTH) were obtained. Following BS, patients started the daily oral multivitamin and mineral supplement. RESULTS All patients achieved a significant weight loss (mean - 34.7 ± 11.8 kg). No deficiencies of various vitamins/micronutrients were detected during the entire study period. The serum concentrations of vitamin B12, 25-OH Vitamin D and folic acid increased over the follow-up period compared with V0 (mean increase 243 ng/L, 23 µg /L, 8 µg/L, respectively). Compared to RYGB, patients who underwent sleeve gastrectomy showed higher levels of 25-OH vitamin D at V2, V3 and V4 (all p < 0.05), and higher levels of Vitamin B12 and folic acid at V4 (p < 0.05 and p < 0.005, respectively). No adverse events were reported. CONCLUSION Following VSG or RYGB, Bariatrifast administration was associated with normal values of essential micronutrients, and it was well-tolerated without evidence of gastrointestinal side effects. Clinical Trial Registration ClinicalTrials.gov, identifiers NCT06152965.
Collapse
Affiliation(s)
- Alessio Basolo
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, 56124, Pisa, Italy
| | - Susanna Bechi Genzano
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, 56124, Pisa, Italy
| | - Jacopo Vitti
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, 56124, Pisa, Italy
| | - Guido Salvetti
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, 56124, Pisa, Italy
| | - Donatella Gilio
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, 56124, Pisa, Italy
| | - Giovanni Ceccarini
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, 56124, Pisa, Italy
| | - Giovanna Scartabelli
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, 56124, Pisa, Italy
| | - Chita Lippi
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, 56124, Pisa, Italy
| | - Rosario Bellini
- Bariatric Surgery Unit, University Hospital of Pisa, 56124, Pisa, Italy
| | - Rudi Mancini
- Bariatric Surgery Unit, University Hospital of Pisa, 56124, Pisa, Italy
| | | | - Carlo Moretto
- Bariatric Surgery Unit, University Hospital of Pisa, 56124, Pisa, Italy
| | - Valentina Angeli
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, 56124, Pisa, Italy
| | - Daniela Troiani
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, 56124, Pisa, Italy
| | - Paola Fierabracci
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, 56124, Pisa, Italy
| | - Roberta Jaccheri
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, 56124, Pisa, Italy
| | - Alba Calderone
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, 56124, Pisa, Italy
| | - Anello M Poma
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, 56100, Pisa, Italy
| | - Luca Chiovato
- Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, PV, Italy
| | | | - Ferruccio Santini
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, 56124, Pisa, Italy.
- University of Pisa, Pisa, Italy.
| |
Collapse
|
2
|
Khalid MJ, Ayub MA, Kataria S, Hebert M, Parvathaneni A. Concomitant Occurrence of Peripheral Neuropathy and Vision Loss Due to Multivitamin Deficiency After Bariatric Surgery. Cureus 2024; 16:e59959. [PMID: 38854179 PMCID: PMC11162093 DOI: 10.7759/cureus.59959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 06/11/2024] Open
Abstract
Vitamin deficiencies, especially after Bariatric surgery, are common and, when not properly addressed, can lead to debilitating complications. Bariatric procedures, to variable degrees, alter the anatomy and physiology of the gastrointestinal; this alteration makes these patients more susceptible to developing nutritional deficiencies. Peripheral neuropathy is one of the complications that can arise from nutritional deficiencies, and it can cause severe functional impairment. Vision loss is a relatively uncommon complication after weight loss procedure. Changes in the retinal nerve fiber layer, choroidal thickness, and visual fields due to hypovitaminosis result in nutritional optic neuropathy and retinopathy. The main retinal complication is nyctalopia (night blindness), which is caused by vitamin A deficiency. We present a case of concomitant peripheral neuropathy and vision loss secondary to reduced levels of multiple vitamins following gastric bypass surgery. This case highlights the need for regular vitamin level monitoring and appropriate replenishment in patients after bariatric surgery to prevent significant morbidities.
Collapse
Affiliation(s)
- Muhammad J Khalid
- Neurology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Muhammad A Ayub
- Neurology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Saurabh Kataria
- Neurology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Michael Hebert
- Neurology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Arvin Parvathaneni
- Neurology, Louisiana State University Health Sciences Center, Shreveport, USA
| |
Collapse
|
3
|
Mitra AT, Das B, Sarraf KM, Ford-Adams M, Fehervari M, Ashrafian H. Bone health following paediatric and adolescent bariatric surgery: a systematic review and meta-analysis. EClinicalMedicine 2024; 69:102462. [PMID: 38333369 PMCID: PMC10850131 DOI: 10.1016/j.eclinm.2024.102462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/17/2024] [Accepted: 01/17/2024] [Indexed: 02/10/2024] Open
Abstract
Background Childhood obesity is a pressing health crisis of epidemic proportions. Bariatric surgery (BS) is an effective weight loss solution however its role in the paediatric population is contentious owing to the paucity of weight specific and generalised health outcomes. This systematic review and meta-analysis aimed to assess the impact of paediatric BS on bone health. Methods This prospectively registered systematic review (PROSPERO ID: CRD42023432035) was performed in accordance with PRISMA guidelines. We searched MEDLINE (1946-1928 September 2023), EMBASE (1947-1928 September 2023) via the Ovid platform, and the Cochrane Review Library to identify scientific publications reporting bone outcome measures in patients under the age of 18 years who underwent BS. Meta-analysis was undertaken on post-operative weight and bone parameters in paediatric patients following BS. Outcomes were reported as weighted or standardized mean difference with 95 percent confidence intervals. Subgroup analysis by intervention, quality scoring and risk of bias were assessed. Findings Twelve studies with 681 patients across 5 countries (mean age 17 ± 0.57 years) were included. The quality of included studies was rated as high and there was substantial between-study heterogeneity for most factors included in the meta-analysis (I2 from 0% to 99.1%). Patients underwent Roux-en-Y gastric bypass (RYGB, n = 216), sleeve gastrectomy (SG, n = 257), gastric band (n = 184) or intragastric balloon placement (n = 24). BS was associated with significant weight reduction, body mass index (BMI) -12.7 kg/m2 (95% CI -14.5 to -10.9, p < 0.001), with RYGB being most effective, BMI -16.58 kg/m2 (95% CI -19.6 to -13.6, p < 0.001). Patients who underwent SG or RYGB had significantly lower lumbar bone mineral density, -0.96 g/cm2 (95% CI -0.1 to -0.03, p < 0.001), Z score, -1.132 (95% CI -1.8 to -0.45, p < 0.001) and subtotal body bone mineral density, -0.7 g/cm2 (95% CI -1.2 to -0.2, p < 0.001) following surgery. This was accompanied with higher markers of bone resorption, C-terminal telopeptide of type 1 collagen 0.22 ng/ml (95% CI 0.12-0.32, p < 0.001) and osteocalcin, 10.83 ng/ml (95% CI 6.01-15.67, p < 0.001). There was a significant reduction in calcium levels following BS, -3.78 mg/dl (95% CI -6.1 to -1.5, p < 0.001) but no difference in 25-hydroxyvitamin D, phosphate, bone alkaline phosphatase, procollagen type 1 N propeptide or parathyroid hormone. Interpretation BS effectively reduces weight in paediatric patients, but RYGB and SG may have adverse effects on bone health in the medium term. It is crucial to monitor and support bone health through appropriate nutritional supplementation and judicious follow-up. Long-term data is needed to fully understand the clinical implications of these findings on bone outcomes. Funding Medical Research Council (MRC), United Kingdom.
Collapse
Affiliation(s)
- Anuja Tulip Mitra
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, London, United Kingdom
| | - Bibek Das
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, London, United Kingdom
| | - Khalid Maher Sarraf
- Department of Orthopaedics, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, Paddington, London, United Kingdom
| | - Martha Ford-Adams
- Department of Paediatric Endocrinology, Kings College Hospital NHS Foundation Trust, London, United Kingdom
| | - Matyas Fehervari
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, London, United Kingdom
- Department of Bariatric Surgery, Chelsea and Westminster Hospital, London, United Kingdom
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, London, United Kingdom
| |
Collapse
|
4
|
Karimi Behnagh A, Eghbali M, Abdolmaleki F, Abbasi M, Mottaghi A. Pre- and Post-surgical Prevalence of Thiamine Deficiency in Patients Undergoing Bariatric Surgery: a Systematic Review and Meta-analysis. Obes Surg 2024; 34:653-665. [PMID: 38095772 DOI: 10.1007/s11695-023-06896-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 01/26/2024]
Abstract
Thiamine deficiency is a life-threatening nutritional abnormality observed in the patients with obesity and following bariatric surgery. The aim of the present study is to determine the prevalence of thiamine deficiency prior to and after bariatric procedures. PubMed, Web of Science, Google scholar, CENTRAL, ProQuest, and Scopus were searched to retrieve relevant studies containing data on thiamine deficiency in patients with obesity who underwent bariatric surgery. A proportional meta-analysis approach was used to pool the prevalence of thiamine deficiency prior and after surgery. Our comprehensive literature search retrieved 41 studies with relevant data. The pooled prevalence of thiamine deficiency was 7% (95% CI: 4-12%) at baseline. We observed that 19% (95% CI: 0-68%), 9% (95% CI: 3-17%), and 6% (95% CI: 3-9%) of patients had developed thiamine deficiency at 3 months, 6 months, and 1 year after surgery, respectively. We also report that the prevalence of thiamine deficiency in pregnant women who had history of bariatric surgery. The rate was highest in the first trimester (12%) compared to that in the second (8%) and third (10%) trimesters. The baseline prevalence is 7% for thiamine deficiency in bariatric surgery candidates. The prevalence rate of thiamin deficiency increased to 19% and 9% 3 and 6 months after surgery; however, the rate decreased to 6% 1 year after surgery. Due to the higher prevalence of thiamine deficiency in the early post-operative phase, close monitoring during this period is recommended. A similar strategy should be implemented for pregnant women with history of bariatric surgery in their first trimester.
Collapse
Affiliation(s)
- Arman Karimi Behnagh
- Research Center for Prevention of Cardiovascular Diseases, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Eghbali
- Research Center for Prevention of Cardiovascular Diseases, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Fereshteh Abdolmaleki
- Research Center for Prevention of Cardiovascular Diseases, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Mehrnaz Abbasi
- Department of Nutritional Sciences, Auburn University, Auburn, AL, USA
| | - Azadeh Mottaghi
- Research Center for Prevention of Cardiovascular Diseases, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
5
|
Tugcan MO, Cetinkunar S, Sahan O, Yaprak GK, Tugcan Y, Avci BS, Ozturk HA, Kuvvetli A, Avci A. Analysis of postoperative emergency admission and hospitalization of patients who underwent bariatric surgery: A single-center experience. Asian J Surg 2024; 47:320-327. [PMID: 37659937 DOI: 10.1016/j.asjsur.2023.08.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/11/2023] [Accepted: 08/24/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND Bariatric surgery is a treatment with a low risk of complications that is becoming common in obesity treatment. OBJECTIVE The aim of this study is to evaluate postoperative visits to the emergency department by patients who underwent bariatric surgery and to investigate what postoperative conditions are encountered in these patients and what can be done to prevent emergency room admission and hospitalization. SETTING University Hospital. METHODS The study included 394 patients aged 18 years underwent bariatric surgery for obesity. Emergency department (ED) admissions and diagnoses of patients who underwent bariatric surgery were analyzed in two groups, surgery-related and surgery-unrelated. RESULTS It was found that 22% (n: 87) of patients visited the ED at least once; 4.8% (n: 19) of them were hospitalized; and 78.1% (n: 68) of 87 patients did not need to be hospitalized. Low preoperative iron, folic acid, and ferritin levels increase the number of visits to ED with a bariatric surgery-related complaint, urinary tract infection was the most common diagnosis and did not require hospitalization; the most common diagnosis of hospitalized patients was gastrointestinal perforation, pulmonary embolism, intra-abdominal abscess. CONCLUSION Despite the low risk of complications, bariatric surgery is a surgery associated with a high number of preventable postoperative emergency visits. ED visits can be reduced by calling these patients for more frequent outpatient check-ups, providing intravenous hydration therapy in outpatient clinics and, if necessary, providing prescribed treatment.
Collapse
Affiliation(s)
- Mustafa Oguz Tugcan
- Health Science University, Adana City Research and Training Hospital, Department of Emergency Medicine, Adana, Turkey.
| | - Suleyman Cetinkunar
- Health Science University, Adana City Research and Training Hospital, Department of Emergency Medicine, Adana, Turkey.
| | - Ozge Sahan
- Health Science University, Adana City Research and Training Hospital, Department of Emergency Medicine, Adana, Turkey.
| | - Gazi Kutalmis Yaprak
- Health Science University, Adana City Research and Training Hospital, Department of Emergency Medicine, Adana, Turkey.
| | - Yagmur Tugcan
- Cukurova University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Adana, Turkey.
| | - Begum Seyda Avci
- Health Science University, Adana City Research and Training Hospital, Department of Emergency Medicine, Adana, Turkey.
| | - Huseyin Ali Ozturk
- Health Science University, Adana City Research and Training Hospital, Department of Emergency Medicine, Adana, Turkey.
| | - Adnan Kuvvetli
- Health Science University, Adana City Research and Training Hospital, Department of Emergency Medicine, Adana, Turkey.
| | - Akkan Avci
- Health Science University, Adana City Research and Training Hospital, Department of Emergency Medicine, Adana, Turkey.
| |
Collapse
|
6
|
Zarshenas N, Tapsell LC, Batterham M, Neale EP, Talbot ML. Investigating the Prevalence of Copper and Zinc Abnormalities in Patients Pre and Post bariatric Surgery-an Australian Experience. Obes Surg 2023; 33:3437-3446. [PMID: 37773088 PMCID: PMC10602995 DOI: 10.1007/s11695-023-06822-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 08/19/2023] [Accepted: 09/15/2023] [Indexed: 09/30/2023]
Abstract
INTRODUCTION Bariatric surgery predisposes patients to nutritional deficiencies. There are limited studies on zinc and copper abnormalities in this cohort. PURPOSE The aim of this study was to identify the prevalence of these abnormalities in a cohort of Australian bariatric patients. Inflammatory markers, adherence to multivitamin supplementation (MVS) and the presence of gastrointestinal (GI) symptoms were also investigated. MATERIAL AND METHODS Data was collected on all patients who attended a single clinic in Sydney, Australia, from August 2020 to August 2021. RESULTS The study cohort consisted of 231 patients (76.2% female; mean pre-operative body mass index of 43.4 ± 7.1 kg/m2), most of whom underwent sleeve gastrectomy (78.8%). Data were collected preoperatively and then at ≤ 6 months, 1 and > 2 years postoperatively. Prior to surgery, low levels of zinc (2.1%) and copper (0.7%) were rare, but elevated copper levels were common (16.7%) and potentially related to an elevated C-reactive protein (CRP) (47.7%). Following surgery at > 2 years, the mean total weight loss (TWL) was 33.5 ± 12.4. CRP levels improved over time. Post operatively, low zinc (2.7-3.6%) and copper (1.5%) levels were rare. Patients with low levels in zinc and copper were a higher-risk group and generally exhibited GI symptoms, despite taking MVS. CONCLUSION In the initial post-operative stages and with good adherence to MVS containing copper and zinc, abnormalities may not be a concern. Patients with GI symptoms appear to be at higher risk of abnormalities; increasing awareness, thorough screening, and more comprehensive supplementation are recommended.
Collapse
Affiliation(s)
- Nazy Zarshenas
- School of Medical, Indigenous and Health Sciences, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, NSW, Australia.
- Shore Surgical, 156-158 Pacific Highway, Greenwhich, Sydney, NSW, 2065, Australia.
| | - Linda C Tapsell
- School of Medical, Indigenous and Health Sciences, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Marijka Batterham
- School of Mathematics and Applied Statistics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, NSW, Australia
| | - Elizabeth P Neale
- School of Medical, Indigenous and Health Sciences, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Michael L Talbot
- St George and Sutherland Clinical School, St George Private Hospital, Suite 3 Level 5 1 South St, Kogarah, Sydney, NSW, 2217, Australia
- University of New South Wales, Sydney, Australia
| |
Collapse
|
7
|
Klair N, Patel U, Saxena A, Patel D, Ayesha IE, Monson NR, Ramphall S. What Is Best for Weight Loss? A Comparative Review of the Safety and Efficacy of Bariatric Surgery Versus Glucagon-Like Peptide-1 Analogue. Cureus 2023; 15:e46197. [PMID: 37905277 PMCID: PMC10613430 DOI: 10.7759/cureus.46197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
Obesity is a global health concern, necessitating effective weight-loss interventions. This study aimed to compare the efficacy and safety of semaglutide, a pharmacotherapeutic option, with bariatric surgery, a commonly utilized surgical intervention, for weight reduction. A systematic review of clinical trials, including the STEP (Semaglutide Treatment Effect in People) trials, sustain trials, pioneer trials, and the STAMPEDE (Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently) trial, was conducted to evaluate the outcomes of these interventions. The analysis of the clinical trials revealed that semaglutide demonstrated significant weight reduction in participants. However, adverse effects such as gastrointestinal (GI) disturbances, increased pulse rate, and rare cases of thyroid cancer were observed. Long-term effects showed partial weight regain and a return of certain cardiometabolic variables to baseline levels after semaglutide withdrawal. Comparatively, bariatric surgery, as demonstrated in the Longitudinal Assessment of Bariatric Surgery (LABS) consortium and supported by the STAMPEDE trial, exhibited higher efficacy in weight reduction and the management of obesity-induced complications such as diabetes. The STAMPEDE trial demonstrated that bariatric surgery, specifically Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), led to a significantly higher percentage of patients achieving desired diabetes treatment targets compared to medical therapy alone. While bariatric surgery showed superior efficacy, it also carried a higher risk of complications. In contrast, semaglutide presented a noninvasive alternative with significant weight reduction and lower incidences of adverse effects. In conclusion, this study highlights that bariatric surgery, such as Roux-en-Y gastric bypass and sleeve gastrectomy, remains a highly effective intervention for weight loss and management of obesity-induced complications. However, semaglutide represents a valuable noninvasive alternative, offering significant weight reduction and lower risks of adverse effects. The choice between these interventions should be based on individual patient characteristics and a comprehensive assessment of the risk-benefit profile.
Collapse
Affiliation(s)
- Nimra Klair
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Utkarsh Patel
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ayushi Saxena
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Dhara Patel
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ismat E Ayesha
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Neetha R Monson
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Shivana Ramphall
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| |
Collapse
|
8
|
Haghighat N, Sohrabi Z, Bagheri R, Akbarzadeh M, Esmaeilnezhad Z, Ashtary-Larky D, Barati-Boldaji R, Zare M, Amini M, Hosseini SV, Wong A, Foroutan H. A Systematic Review and Meta-Analysis of Vitamin D Status of Patients with Severe Obesity in Various Regions Worldwide. Obes Facts 2023; 16:519-539. [PMID: 37640022 PMCID: PMC10697766 DOI: 10.1159/000533828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 08/14/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Managing nutritional deficiencies is an essential component in the treatment of severe obesity. Vitamin D deficiency is often reported in investigations in severely obese cohorts. However, no prior study has summarized findings on this topic. Consequently, the aim of this systematic review and meta-analysis was to investigate the 25-hydroxyvitamin D [25(OH)D] status in individuals with severe obesity in different regions worldwide. We also evaluated levels of calcium, parathyroid hormone (PTH), and magnesium as secondary outcome measures. METHODS We searched Medline, PubMed, Scopus, the Cochrane Library, and EMBASE for relevant observational studies published in English from 2009 to October 2021. The heterogeneity index among the studies was determined using the Cochran (Q) and I2 tests. Based on the heterogeneity results, the random-effect model was applied to estimate the prevalence of vitamin D deficiency. RESULTS We identified 109 eligible observational studies. Overall, 59.44% of patients had vitamin D deficiency [25(OH)D <20 ng/mL], whereas 26.95% had vitamin D insufficiency [25(OH)D 20-30 ng/mL]. Moreover, the mean 25(OH)D level was 18.65 ng/mL in 96 studies. The pooled mean estimate of the serum calcium, PTH, and magnesium was 9.26 mg/dL (95% confidence interval [CI]: 9.19-9.32, I2 = 99.7%, p < 0.001), 59.24 pg/mL (95% CI: 54.98, 63.51, I2 = 99.7%, p < 0.001), and 0.91 mg/dL (95% CI: 0.84, 0.98, I2 = 100.0%, p < 0.001), respectively. The results of the subgroup analysis indicated that the mean estimates of 25(OH)D were highest in North America (21.71 ng/mL [19.69, 23.74], [I2 = 97.2%, p < 0.001]) and lowest in Southeast Asia (14.93 ng/mL [14.54, 15.33], [I2 = 0.0%, p = 0.778]). CONCLUSION The results obtained showed a significant prevalence of vitamin D deficiency among severely obese individuals in various geographical regions, whereas the highest and lowest mean estimates were reported for North America and Southeast Asia, respectively.
Collapse
Affiliation(s)
- Neda Haghighat
- Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Sohrabi
- Department of Community Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Bagheri
- Department of Exercise Physiology, University of Isfahan, Isfahan, Iran
| | - Marzieh Akbarzadeh
- Department of Community Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Esmaeilnezhad
- Department of Community Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Damoon Ashtary-Larky
- Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Barati-Boldaji
- Department of Community Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Morteza Zare
- Department of Community Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoud Amini
- Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Alexei Wong
- Department of Health and Human Performance, Marymount University, Arlington, VA, USA
| | - Hamidreza Foroutan
- Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
9
|
Park S, Kim S, Kim S, Shin AR, Park Y. Nutritional Intervention for a Patient With Sleeve Gastrectomy. Clin Nutr Res 2023; 12:177-183. [PMID: 37593213 PMCID: PMC10432159 DOI: 10.7762/cnr.2023.12.3.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/09/2023] [Accepted: 07/14/2023] [Indexed: 08/19/2023] Open
Abstract
Bariatric surgery is the most effective treatment for sustained weight reduction, and it can result in substantial improvements in the severity of type 2 diabetes, metabolic syndrome, nonalcoholic fatty liver disease, and quality of life. However, sleeve gastrectomy, a weight loss surgery that removes two-thirds of the stomach, reduces appetite and nutrient absorption, impairing digestion and the absorption of nutrients like iron, vitamin B12, and protein-bound nutrients. This case study aims to demonstrate that patients undergoing sleeve gastrectomy require long-term and periodic monitoring of biochemical data, weight changes, and caloric and protein intake by a professional nutritionist to prevent malnutrition and nutritional deficiencies. In this case study, a 48-year-old woman was diagnosed with morbid obesity, hypertension, sleep apnea syndrome, and chronic gastritis. At initial evaluation, she was 160 cm tall and weighed 89 kg, with a body mass index of 34.8 kg/m2. At 1 postoperative year, she consumed 650 kcal and 25 g of protein per day, the percentage of excess weight loss was 141.1%, and body mass index was 21 kg/m2. Compared to preoperative levels, calcium and folic acid levels did not decrease after 1 postoperative year, but hemoglobin, ferritin, and vitamin B12 levels decreased. In conclusion, when patients experience rapid weight loss after sleeve gastrectomy, follow-up should be frequent and long. Dietary education should be conducted according to digestive symptoms, and oral nutritional supplements, including vitamins and minerals.
Collapse
Affiliation(s)
- Seonhye Park
- Nutrition Care Services, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Sohye Kim
- Nutrition Care Services, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Soyoun Kim
- Nutrition Care Services, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Ah-Reum Shin
- Nutrition Care Services, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Youngmi Park
- Nutrition Care Services, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| |
Collapse
|
10
|
Assakran BS, Khalid R, Bennasser T, Alsaif M, Alsawyan W, Alsaleem H, Alsalhi A. Prevalence and Risk Factors of Anemia in Patients After Bariatric Surgery in Qassim Region, King Fahad Specialist Hospital. Cureus 2023; 15:e40131. [PMID: 37435259 PMCID: PMC10332640 DOI: 10.7759/cureus.40131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 07/13/2023] Open
Abstract
Introduction There is a high prevalence of obesity among the Saudi population. Anemia due to iron deficiency or an inflammatory state is often associated with obesity. Multiple nutritional deficiencies are associated with bariatric surgeries, with anemia being one of the commonest causes. Aim This study aimed to evaluate the prevalence of anemia after bariatric surgery among patients in the Qassim Region, Saudi Arabia. Patients and methods This retrospective cohort study was conducted at King Fahad Specialist Hospital Al-Qassim (Buraydah), Saudi Arabia. We reviewed data from patients' records who underwent bariatric surgeries from January 2018 to January 2021. By using a structured data collection form, we collected data such as demographic variables, surgery perioperative-related data, postoperative complications and interventions, type of transfusion required after surgery, postoperative medications and/or supplements and duration, and blood count indices. Results Of the 520 patients who underwent bariatric surgery, 61% were females, and 31.7% were aged between 26 to 35 years old. The most prominent type of bariatric surgery was sleeve gastrectomy (97.1%). The prevalence of anemia among patients who underwent bariatric surgery was 28.1%. Independent risk factors for anemia were female gender, microcytic red blood cells, and low normal hematocrit and hemoglobin (Hgb) levels. It is interesting to know that sleeve gastrectomy and elevated BMI levels are considered to be the protective factors for developing anemia postoperatively. Conclusion There was a high prevalence of anemia among bariatric patients postoperatively. Female gender with decreasing hematocrit and hemoglobin levels after the surgery might be more at the receiving end for developing anemia than the other patients. Further longitudinal studies are needed to establish the prevalence and risk factors for developing anemia among bariatric surgery patients.
Collapse
Affiliation(s)
| | - Renad Khalid
- College of Medicine, Qassim University, Buraydah, SAU
| | | | - Maha Alsaif
- College of Medicine, Qassim University, Buraydah, SAU
| | | | | | - Ahlam Alsalhi
- Family Medicine, Primary Health Care Al Muntazah, Buraydah, SAU
| |
Collapse
|
11
|
Aaseth JO, Alexander J. Postoperative Osteoporosis in Subjects with Morbid Obesity Undergoing Bariatric Surgery with Gastric Bypass or Sleeve Gastrectomy. Nutrients 2023; 15:nu15061302. [PMID: 36986032 PMCID: PMC10057453 DOI: 10.3390/nu15061302] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/03/2023] [Accepted: 03/05/2023] [Indexed: 03/09/2023] Open
Abstract
Obesity has become a worldwide epidemic accompanied by adverse health effects. The limited efficiency of traditional weight reduction regimens has led to a substantial increase in the use of bariatric surgery. Today, sleeve gastrectomy (SG) and Roux-en-Y-gastric bypass (RYGB) are the most used procedures. The present narrative review focuses on the risk of developing postoperative osteoporosis and summarizes some of the most relevant micronutrient deficiencies associated with RYGB and SG. Preoperatively, the dietary habits of obese individuals might lead to precipitated deficiencies in vitamin D and other nutrients affecting bone mineral metabolism. Bariatric surgery with SG or RYGB can aggravate these deficiencies. The various surgical procedures appear to affect nutrient absorption differently. Being purely restrictive, SG may particularly affect the absorption of vitamin B12 and also vitamin D. In contrast, RYGB has a more profound impact on the absorption of fat-soluble vitamins and other nutrients, although both surgical methods induce only a mild protein deficiency. Despite adequate supplementation of calcium and vitamin D, osteoporosis may still occur after the surgery. This might be due to deficiencies in other micronutrients, e.g., vitamin K and zinc. Regular follow-ups with individual assessments and nutritional advice are indispensable to prevent osteoporosis and other adverse postoperative issues.
Collapse
Affiliation(s)
- Jan O. Aaseth
- Department of Research, Innlandet Hospital Trust, P.O. Box 104, N-2381 Brumunddal, Norway
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, N-2418 Elverum, Norway
- Correspondence: ; Tel.: +47-9959-6960
| | - Jan Alexander
- Norwegian Institute of Public Health, P.O. Box 222, N-0213 Oslo, Norway
| |
Collapse
|
12
|
Zappa MA, Iossa A, Busetto L, Chiappetta S, Greco F, Lucchese M, Micanti F, Mingrone G, Navarra G, Raffaelli M, De Luca M. SICOB-endorsed national Delphi consensus on obesity treatment optimization: focus on diagnosis, pre-operative management, and weight regain/insufficient weight loss approach. Eat Weight Disord 2023; 28:5. [PMID: 36763219 PMCID: PMC9918586 DOI: 10.1007/s40519-023-01537-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/05/2023] [Indexed: 02/11/2023] Open
Abstract
PURPOSE Overweight and obesity affects 60% of adults causing more than 1.2 million deaths across world every year. Fight against involved different specialist figures and multiple are the approved weapons. Aim of the present survey endorsed by the Italian Society of Bariatric Surgery (SICOB) is to reach a national consensus on obesity treatment optimization through a Delphi process. METHODS Eleven key opinion leaders (KOLs) identified 22 statements with a major need of clarification and debate. The explored pathways were: (1) Management of patient candidate to bariatric/metabolic surgery (BMS); (2) Management of patient not eligible for BMS; (3) Management of patient with short-term (2 years) weight regain (WR) or insufficient weight loss (IWL); (4) Management of the patient with medium-term (5 years) WR; and (5) Association between drugs and BMS as WR prevention. The questionnaire was distributed to 65 national experts via an online platform with anonymized results. RESULTS 54 out of 65 invited panelists (83%) respond. Positive consensus was reached for 18/22 statements (82%); while, negative consensus (s20.4; s21.5) and no consensus (s11.5, s17) were reached for 2 statements, respectively (9%). CONCLUSION The Delphi results underline the importance of first-line interdisciplinary management, with large pre-treatment examination, and establish a common opinion on how to properly manage post-operative IWL/WR. LEVEL OF EVIDENCE V Report of expert committees.
Collapse
Affiliation(s)
- Marco Antonio Zappa
- Director of General Surgery Unit, Asst Fatebenefratelli-Sacco Milan, Milan, Italy
| | - Angelo Iossa
- Department of Medico Surgical Sciences and Biotechnologies Sapienza Polo Pontino, ICOT Hospital Latina, Latina, Italy.
| | - Luca Busetto
- Department of Medicine, University of Padua, Padua, Italy
| | - Sonja Chiappetta
- Obesity and Metabolic Surgery Unit, Department for General Surgery, Ospedale Evangelico Betania, Naples, Italy
| | - Francesco Greco
- Director of Bariatric and Metabolic Surgery Unit, Istituto ospedaliero Fondazione Poliambulanza di Brescia, Brescia, Italy
| | - Marcello Lucchese
- Director of General and Bariatric Surgery Unit, Santa Maria Nuova Hospital-Azienda Sanitaria Toscana Centro, Florence, Italy
| | - Fausta Micanti
- UOC Psychiatric and Psychologic School of Medicine, University Federico II of Naples, Naples, Italy
| | - Geltrude Mingrone
- Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Division of Diabetes and Nutritional Sciences, School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, UK
| | - Giuseppe Navarra
- Department of Human Pathology, University of Messina, Messina, Italy
| | - Marco Raffaelli
- U.O.C. of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS and CREO, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Maurizio De Luca
- Director of General Surgery Unit Ospedali di Rovigo e di Trecenta, Trecenta, Italy
| |
Collapse
|
13
|
Berardi G, Vitiello A, Abu-Abeid A, Schiavone V, Franzese A, Velotti N, Musella M. Micronutrients Deficiencies in Candidates of Bariatric Surgery: Results from a Single Institution over a 1-Year Period. Obes Surg 2023; 33:212-218. [PMID: 36331725 PMCID: PMC9834098 DOI: 10.1007/s11695-022-06355-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS A total of 174 patients were included in our study. Mean age and BMI were 39.2 ± 11.4 years and 44.3 ± 7.1 kg/m2, respectively. One hundred and thirty-nine patients (79.9%) had at least one preoperative micronutrient disorder, with vitamin D deficiency being the most common (116, 66.7%), followed by a deficit of folate (76, 43.7%) and vitamin B12 (10, 5.7%). Forty-seven (27%) individuals had insufficient levels of vitamin D. Comparison of deficiencies between sexes showed that vitamin B12 < 20 ng/ml was significantly more frequent in women (p = 0.03). DLP showed a mild significant effect on folate levels (p = 0.01), while the association of HNT and T2DM had a mild significant effect on vitamin B12 (p = 0.02). CONCLUSIONS 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.
Collapse
Affiliation(s)
- Giovanna Berardi
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”—via S.Pansini, 80131 Naples, Italy
| | - Antonio Vitiello
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”—via S.Pansini, 80131 Naples, Italy
| | - Adam Abu-Abeid
- Division of General Surgery, Affiliated to Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv University, 6 Weizman Street, 64230906 Tel Aviv, Israel
| | - Vincenzo Schiavone
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”—via S.Pansini, 80131 Naples, Italy
| | - Antonio Franzese
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”—via S.Pansini, 80131 Naples, Italy
| | - Nunzio Velotti
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”—via S.Pansini, 80131 Naples, Italy
| | - Mario Musella
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”—via S.Pansini, 80131 Naples, Italy
| |
Collapse
|
14
|
Wernicke's encephalopathy in an adolescent following bariatric surgery. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
15
|
The need and safety of vitamin supplementation in adults with obesity within 9 months post sleeve gastrectomy (SG): assessment based on intake. Sci Rep 2022; 12:14295. [PMID: 35995922 PMCID: PMC9395356 DOI: 10.1038/s41598-022-18487-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 08/12/2022] [Indexed: 11/24/2022] Open
Abstract
The aim of the study was to assess the need and safety of vitamin supplementation in adults with obesity post bariatric surgery (SG), based on intake assessment. Patients with obesity class III, and with obesity class II with comorbidities were followed up at 3, 6 and 9 months post bariatric surgery. Based on a 4-day food record questionnaire, the intake of vitamins and calories was assessed and an interview regarding the consumption of supplements was conducted. The study showed a deficiency in the dietary intake of vitamin D, folate (B9) and vitamin B1 (in 93–100% of respondents), vitamins E and C (in 53–67% of respondents), vitamins A, PP and vitamins B2 and B6 (in 10 to 23% of respondents) and vitamin B12 (only 1 woman). The intake of multivitamin supplements was implemented by 72% of respondents, independently, all patients were taking a vitamin D supplement. Vitamin deficiencies were only reported in a small percentage of patients (3–17%), who did not take supplements throughout the observation period. Supplementation with vitamins D, E, C, B1 and folic acid (B9), used regularly, supplemented the nutritional deficiencies of patients. The intake of vitamin A, B2, PP, and B6 with supplements did not significantly affect the overall intake. Supplementation with vitamin B12 turned out to be unjustified to the nutritional recommendations. The dietary and/or supplemental intake of vitamins did not exceed the tolerable upper intake level (UL). The results of the study confirm the need to implement vitamin supplementation for bariatric patients and its safety.
Collapse
|
16
|
Argyrakopoulou G, Konstantinidou SK, Dalamaga M, Kokkinos A. Nutritional Deficiencies Before and After Bariatric Surgery: Prevention and Treatment. Curr Nutr Rep 2022; 11:95-101. [PMID: 35174473 DOI: 10.1007/s13668-022-00400-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Bariatric surgery has the unique ability to drive substantial and sustainable weight loss in people living with obesity. Non-reversibility of these surgical techniques provides lifelong benefits but entails the need for continuous medical follow-up. The purpose of the current paper is to review and summarize current data on nutritional deficiencies in patients before and after bariatric surgery. RECENT FINDINGS The cornerstone of preventing the emergence of disorders related to nutritional deficiencies is preoperative screening and correct supplementation since they may be exacerbated postoperatively. Following guidelines in conjunction to a lifelong personalized medical approach is of high importance. Bariatric surgery is a well-studied successful and durable means of weight loss that may lead to nutritional deficiencies. There is, thus, a medical need for careful monitoring and treatment of micro- and macronutrient deficiencies by an experienced multidisciplinary team.
Collapse
Affiliation(s)
| | - Sofia K Konstantinidou
- Diabetes and Obesity Unit, Athens Medical Center, Athens, 15125, Greece.,First Department of Propaedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Maria Dalamaga
- Department of Biological Chemistry, School of Medicine, National and Kapodistrian University of Athens, Athens, 11527, Greece
| | - Alexander Kokkinos
- First Department of Propaedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| |
Collapse
|
17
|
Endoscopic sleeve gastroplasty and postprocedural nutritional deficiencies: results from a single center exploratory study. Eur J Gastroenterol Hepatol 2021; 33:e1039-e1041. [PMID: 35048661 DOI: 10.1097/meg.0000000000002316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Nutritional deficiencies following endoscopic sleeve gastroplasty (ESG) are unknown. We retrospectively studied nutritional deficiencies in 20 patients who underwent ESG at our institution. No subjects had preprocedural anemia, whereas 22.2% (N = 2/9) developed anemia at 12 months. Vitamin D deficiency developed in one subject post-ESG. Vitamin A, E, C and magnesium deficiencies developed in 8.3% (N = 1/12), 18.2% (N = 2/11), 14.3% (N = 1/7) and 10% (N = 1/10) of subjects, respectively, at 12 months. Vitamin B12 and B6 deficiencies were detected in 12.5 and 14.3% of the subjects at baseline, however, resolved at 12 months. There were no pre- or postprocedural deficiencies in zinc, selenium, copper, folate, thiamine, phosphorus or calcium. In this study, nutritional deficiencies were observed in a very small subset of patients at various time points after ESG.
Collapse
|
18
|
Mulita F, Lampropoulos C, Kehagias D, Verras GI, Tchabashvili L, Kaplanis C, Liolis E, Iliopoulos F, Perdikaris I, Kehagias I. Long-term nutritional deficiencies following sleeve gastrectomy: a 6-year single-centre retrospective study. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2021; 20:170-176. [PMID: 35069068 PMCID: PMC8764960 DOI: 10.5114/pm.2021.110954] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 08/24/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Sleeve gastrectomy (SG) is associated with short-term nutritional deficiencies postoperatively. This study evaluates the long-term percentage of excess weight loss (% EWL), and nutritional deficiencies in a single-centre cohort undergoing SG as a primary procedure, with a 6-year follow-up. MATERIAL AND METHODS From January 2005 to December 2010 the records of 209 patients who underwent laparoscopic SG were retrieved from a computer database for analysis. Sixty out of the 209 paients completed follow-ups for 6 years. RESULTS Median % EWL at 1, 2, 3, 4, 5, and 6 years postoperatively was 80.9%, 79.1%, 73.8%, 71.8%, 71.5%, and 64.9%, respectively. Prior to surgery, 17.2% had anaemia. Deficiencies of iron, ferritin, folic acid, vitamin B12, magnesium, and phosphorus were 22%, 5.3%, 1.4%, 3.8%, 29.7%, and 5.3%, respectively. Six years post-surgery, deficiencies of haemoglobin, ferritin, and B12 worsened (36.7%, 43.3%, and 11.7%, p = 0.001, p < 0.001, p = 0.019, respectively), whereas there was no significant difference in deficiencies of iron, folic acid, magnesium, and phosphorus (25%, 1.7%, 20%, and 3%, p = 0.625, p = 0.896, p = 0.139, p = 0.539, respectively). There was elevated PTH before and 6 years after surgery (2.9% and 1.7%, p = 0.606). CONCLUSIONS This retrospective study shows that laparoscopic sleeve gastrectomy had a considerable effect on specific nutritional deficiencies in our patients at 6 years post-surgery. Knowledge of micronutrient deficiencies in these patients is beneficial for both prevention and management of nutritional complications associated with SG with the administration of oral nutritional supplementation according to the patient's needs.
Collapse
Affiliation(s)
- Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Greece
- Corresponding author: Francesk Mulita, Md, Department of Surgery, General University Hospital of Patras, Greece, e-mail:
| | | | | | | | | | | | - Elias Liolis
- Department of Internal Medicine, Division of Oncology, General University Hospital of Patras, Greece
| | - Fotios Iliopoulos
- Department of Surgery, General University Hospital of Patras, Greece
| | | | - Ioannis Kehagias
- Department of Surgery, General University Hospital of Patras, Greece
| |
Collapse
|
19
|
Nutritional Management in Bariatric Surgery Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212049. [PMID: 34831805 PMCID: PMC8618972 DOI: 10.3390/ijerph182212049] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 02/08/2023]
Abstract
The obesity epidemic, mainly due to lifestyle changes in recent decades, leads to serious comorbidities that reduce life expectancy. This situation is affecting the health policies of many nations around the world. Traditional measures such as diet, physical activity, and drugs are often not enough to achieve weight loss goals and to maintain the results over time. Bariatric surgery (BS) includes various techniques, which favor rapid and sustained weight loss. BS is a useful and, in most cases, the best treatment in severe and complicated obesity. In addition, it has a greater benefit/risk ratio than non-surgical traditional therapies. BS can allow the obese patient to lose weight quickly compared with traditional lifestyle changes, and with a greater probability of maintaining the results. Moreover, BS promotes improvements in metabolic parameters, even diabetes remission, and in the quality of life. These changes can lead to an increase of life expectancy by over 6 years on average. The nutrition of people before and after BS must be the subject of indications from a trained staff, and patients must be followed in the subsequent years to reduce the risk of malnutrition and the associated problems. In particular, it is still debated whether it is necessary to lose weight prior to surgery, a procedure that can facilitate the surgeon's work reducing the surgical risk, but at the same time, lengthens preparation times increasing the risks associated with concomitant pathologies. Furthermore, preventing nutritional deficiencies prior to the intervention can improve the results and reduce short- and long-term mortality.
Collapse
|
20
|
Changes in Nutritional Outcomes After Sleeve Gastrectomy: a Systematic Review and Meta-analysis. Obes Surg 2021; 32:103-114. [PMID: 34677757 DOI: 10.1007/s11695-021-05740-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 09/26/2021] [Accepted: 10/05/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of this meta-analysis is to evaluate the changes in nutritional indicators in individuals with obesity before and after SG. MATERIALS AND METHODS 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. RESULTS 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. CONCLUSIONS 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.
Collapse
|
21
|
Tynes M, Hepprich M, Timper K. Regular intake of energy drinks and multivitamin supplements is associated with elevated plasma vitamin B6 levels in post-bariatric patients. Sci Rep 2021; 11:17830. [PMID: 34497284 PMCID: PMC8426371 DOI: 10.1038/s41598-021-97205-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 08/20/2021] [Indexed: 12/17/2022] Open
Abstract
The aim of the present survey was to analyze plasma vitamin B6 levels in post-bariatric patients and to elucidate the causal factors associated with elevated plasma vitamin B6 levels. This is a retrospective analysis of electronic patient data of all post-bariatric patients evaluated at the endocrine outpatient clinic of the University Hospital Basel in 2017, for which plasma vitamin B6 values were assessed during regular follow-up visits. In total, 205 patients were included in the study, whereof a minority of 43% had vitamin B6 levels in the normal range. 50% of the patients had vitamin B6 levels up to fourfold higher than the upper normal limit and 7% had levels more than fourfold above the upper normal limit. Vitamin B6 deficiency was not observed in any patient. While multivitamin supplementation in general was associated with elevated plasma vitamin B6 levels, the highest vitamin B6 levels were found after biliopancreatic diversion (BPD) and in patients who reported daily energy drink intake. Elevated plasma vitamin B6 levels up to fourfold above the upper normal limit are common in postbariatric patients and are associated with regular multivitamin supplementation, while highly elevated plasma vitamin B6 levels were seen primarily upon regular energy drink intake. Thus, a regular follow-up of vitamin B6 plasma levels and critical evaluation of vitamin B6 supplementation, either as part of the multivitamin preparation or related to regular energy drink intake, is highly warranted and should be an integral part of the routine post-bariatric follow-up.
Collapse
Affiliation(s)
- Martina Tynes
- Faculty of Medicine, University of Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland.,Clinic of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Matthias Hepprich
- Clinic of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.,Clinic of Endocrine and Metabolic Disorders, Cantonal Hospital Olten, Basler Strasse 150, 4600, Olten, Switzerland
| | - Katharina Timper
- Clinic of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland. .,Department of Biomedicine, University Basel, Hebelstrasse 20, 4031, Basel, Switzerland.
| |
Collapse
|
22
|
Anvari S, Samarasinghe Y, Alotaiby N, Tiboni M, Crowther M, Doumouras AG. Iron supplementation following bariatric surgery: A systematic review of current strategies. Obes Rev 2021; 22:e13268. [PMID: 34013662 DOI: 10.1111/obr.13268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 12/17/2022]
Abstract
Iron deficiency (ID) and iron deficiency anemia (IDA) are common following bariatric surgery; however, there are limited standardized treatment recommendations for their management. The purpose of this study was to review the current strategies for iron supplementation following bariatric surgery and assess their relative efficacy in managing ID and IDA. MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were searched to January 2021. Primary outcomes of interest were prevention or improvement in ID or IDA with iron supplementation. Forty-nine studies with 12,880 patients were included. Most patients underwent Roux-en-Y gastric bypass (61.9%). Iron supplementation was most commonly administered orally for prevention of ID/IDA and was effective in 52% of studies. Both IV and oral iron were given for treatment of ID/IDA. Fifty percent (3/6) of the oral and 100% (3/3) of the IV supplementation strategies were effective at treating ID. Iron supplementation strategies employed following bariatric surgery are highly variable, and many do not provide sufficient iron to prevent the development of ID and IDA, potentially due to poor patient adherence. Further high-quality prospective trials, particularly comparing intravenous and oral iron, are warranted in order to determine the ideal dosage, route, and duration of iron supplementation.
Collapse
Affiliation(s)
- Sama Anvari
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Nouf Alotaiby
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada.,Centre for Minimal Access Surgery (CMAS), St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,Department of General Surgery, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Maria Tiboni
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Mark Crowther
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Aristithes G Doumouras
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada.,Centre for Minimal Access Surgery (CMAS), St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
23
|
The impact of preoperative vitamin administration on skeletal status following sleeve gastrectomy in young and middle-aged women: a randomized controlled trial. Int J Obes (Lond) 2021; 45:1925-1936. [PMID: 33980995 DOI: 10.1038/s41366-021-00845-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/29/2021] [Accepted: 04/26/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND The appropriate strategies to minimize skeletal deterioration following bariatric surgeries are inconclusive. This randomized controlled trial evaluated the effect of preoperative vitamin supplementation on bone mineral density (BMD) and biochemical parameters in females post-sleeve gastrectomy (SG). METHODS Participants were randomized to a 2-month preoperative treatment with a multivitamin and vitamin D 4000 IU/d (intervention arm) or 1200 IU/d (control arm). Preoperative and 12-month postoperative follow-up evaluations included anthropometrics, biochemical parameters, and dual energy X-ray absorptiometry (DEXA). RESULTS Sixty-two females (median age 29.7 years and median BMI 43.4 kg/m2) were recruited, 87% completed the 12-month follow-up. For the intervention and control arms, significant and similar reductions at 12-months post-surgery were observed in BMD of the hip (-6.8 ± 3.7% vs. -6.0 ± 3.6%; P = 0.646) and of the femoral neck (-7.1 ± 5.8% vs. -7.2 ± 5.5%; P = 0.973). For the intervention compared to the control arm, the 25 hydroxyvitamin D (25(OH)D) increment was greater after 2 months treatment, and vitamin D deficiency rates were lower at 3 and 6-months follow-up (P < 0.016). However, at 12-months postoperative, 25(OH)D values and vitamin D deficiency were comparable between the arms (P > 0.339). Predictors for BMD decline in the total hip were the percentage of excess weight-loss, age>50 years, and lower initial BMI (P ≤ 0.003). CONCLUSIONS SG was associated with a significant decline in BMD of the hip and femoral neck in young and middle-aged women, and was unaffected by preoperative vitamin D supplementation. Females who are peri-menopausal or with greater postoperative weight-loss should be particularly followed for BMD decline.
Collapse
|
24
|
The Effect of Protein Consumption on Fat-Free Mass, Fat Mass, and Weight Loss 1 Year After Sleeve Gastrectomy and Roux-en-Y Gastric Bypass. Obes Surg 2021; 31:4741-4748. [PMID: 34426908 DOI: 10.1007/s11695-021-05565-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 06/23/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) both limit protein and calorie intake and result in loss of fat-free mass (FFM), fat mass (FM), and weight. This study examined protein consumption and body composition changes after bariatric surgery. METHODS A prospective study of patients undergoing SG and RYGB between January 1 and December 31, 2016, with 1-year follow-up. Dietary, body composition, and physical activity data were collected at 3, 6, and 12 months post-operatively by bioelectric impedance and food records. Clinical laboratory data were obtained pre- and post-surgery. RESULTS One hundred and five patients (62 [59%] SG and 43 [41%] RYGB) were included in this study. Mean age was 31.8 ± 7.22 years. TWL% after 1 year in SG was 27.11% (p < 0.001) and that in RYGB was 30.41% (p < 0.0001). Reported protein consumptions after RYGB increased from 41.59 ± 22.86 g/day at 3 months (p = 0.004) to 57.90 ± 19.24 g/day at 12 months compared to 52.36 ± 25.04 g and 53.54 ± 29.75 g in SG. Similarly, energy intake after RYGB at 3 and 12 months increased from 895.9 ± 422.61 to 1188.15 ± 463.86 kcal/day compared to 1007.67 ± 422.62 to 1068 ± 575.89 kcal/day after SG (p = 0.009). There was a significant loss of fat-free mass and muscle mass in SG patients at 3 and 12 months from 61.58 ± 3.61 kg and 58.47 ± 3.09 kg to 54.18 ± 11.05 (p < 0.001) and 51.55 ± 10.62 (p = 0.004) but not in RYGB patients. Physical activity levels were similar in SG and RYGB patients. CONCLUSION There was a significant preservation of muscle mass after RYGB. Protein intake in majority of the patients was below 60 g/day during the first year after SG and RYGB.
Collapse
|
25
|
Sun L, Wang C, Sun W, Wang C. A Pilot Study of Nutritional Status Prior to Bariatric Surgery in South China. Front Nutr 2021; 8:697695. [PMID: 34322512 PMCID: PMC8310917 DOI: 10.3389/fnut.2021.697695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/14/2021] [Indexed: 12/29/2022] Open
Abstract
Objective: The was a pilot study to assess the biochemical and historical information about bariatric patients before undergoing the surgery in the aim of identifying nutritional deficiencies and their prevalence from 2015 to 2020. Methods: Clinical data of 247 patients (105 males and 142 females) were included. Vitamins, trace elements, electrolytes, albumin, globulin, hemoglobin, folate, ferritin, microalbuminuria (MAU), and parathyroid hormone (PTH) levels were determined to explore the nutritional status according to gender, age, high body mass index (BMI), and waist circumstance (WC). Results: The mean age, mean BMI, and mean WC of the candidates were 32.95 ± 10.46 years, 38.01 ± 7.11 kg/m2, and 117.04 ± 16.18 cm, respectively. The prevalence of preoperative nutritional deficiencies was 76.88% for 25 (OH) vitamin D, 19.84% for globulin, 11.74% for albumin, 11.02% for sodium, 8.33% for folic acid, 10.48% (male) and 6.34% (female) for chloride, 4.05% for calcium, 3.07% (male) and 0.70%(female) for ferritin, 11.90% for elevated PTH, and 44.96% for MAU. Males exhibited increased prevalence of globulin and MAU relative to females (P < 0.05). Older groups are more likely to exhibit albumin deficiency (P = 0.007), globulin deficiency (P = 0.003), and zinc deficiency (P = 0.015). In addition, 25 (OH) D deficiency and albumin deficiency were more common in patients with BMI ≥ 47.5 kg/m2 (P = 0.049 and 0.015, respectively). Wider WC (≥150 cm) exhibited higher rates of albumin deficiencies (P = 0.011). Conclusion: Electrolyte and nutritional deficiencies were common in patients prior to bariatric surgery in South China. Routine evaluation of electrolyte and nutritional levels should be carried out in this population.
Collapse
Affiliation(s)
- Linli Sun
- Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | | | - Wei Sun
- Department of Pharmacy, Third Xiangya Hospital, Central South University, Changsha, China
| | - Chunjiang Wang
- Department of Pharmacy, Third Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
26
|
Pellegrini M, Rahimi F, Boschetti S, Devecchi A, De Francesco A, Mancino MV, Toppino M, Morino M, Fanni G, Ponzo V, Marzola E, Abbate Daga G, Broglio F, Ghigo E, Bo S. Pre-operative micronutrient deficiencies in patients with severe obesity candidates for bariatric surgery. J Endocrinol Invest 2021; 44:1413-1423. [PMID: 33026590 PMCID: PMC8195915 DOI: 10.1007/s40618-020-01439-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 09/28/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE In patients with obesity, micronutrient deficiencies have been reported both before and after bariatric surgery (BS). Obesity is a chronic pro-inflammatory status, and inflammation increases the risk of micronutrient malnutrition. Our objective was to assess in pre-BS patients the prevalence of micronutrient deficiencies and their correlation with blood values of C-reactive protein (CRP). METHODS Anthropometric data, instrumental examinations, and blood variables were centrally measured in the first 200 patients undergoing a pre-BS evaluation at the "Città della Salute e della Scienza" Hospital of Torino, starting from January 2018. RESULTS At least one micronutrient deficiency was present in 85.5% of pre-BS patients. Vitamin D deficiency was the most prevalent (74.5%), followed by folate (33.5%), iron (32%), calcium (13%), vitamin B12 (10%), and albumin (5.5%) deficiency. CRP values were high (> 5 mg/L) in 65% of the patients. These individuals showed increased rate of iron, folate, vitamin B12 deficiency, and a higher number of micronutrient deficiencies. In a multiple logistic regression model, increased CRP levels were significantly associated with deficiencies of vitamin B12 (OR = 5.84; 95% CI 1.25-27.2; p = 0.024), folate (OR = 4.02; 1.87-8.66; p < 0.001), and with the presence of ≥ 2 micronutrient deficiencies (OR = 2.31; 1.21-4.42; p = 0.01). CONCLUSIONS Micronutrient deficiencies are common in patients with severe obesity undergoing BS, especially when inflammation is present. In the presence of increased CRP values before surgery, it might be advisable to search for possible multiple micronutrient deficiencies.
Collapse
Affiliation(s)
- M Pellegrini
- Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126, Torino, Italy
| | - F Rahimi
- Unit of Clinical Nutrition, "Città della Salute e della Scienza" Hospital of Turin, Turin, Italy
| | - S Boschetti
- Unit of Clinical Nutrition, "Città della Salute e della Scienza" Hospital of Turin, Turin, Italy
| | - A Devecchi
- Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126, Torino, Italy
| | - A De Francesco
- Unit of Clinical Nutrition, "Città della Salute e della Scienza" Hospital of Turin, Turin, Italy
| | - M V Mancino
- Unit of Clinical Nutrition, "Città della Salute e della Scienza" Hospital of Turin, Turin, Italy
| | - M Toppino
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - M Morino
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - G Fanni
- Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126, Torino, Italy
| | - V Ponzo
- Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126, Torino, Italy
| | - E Marzola
- Department of Neuroscience, University of Turin, Turin, Italy
| | - G Abbate Daga
- Department of Neuroscience, University of Turin, Turin, Italy
| | - F Broglio
- Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126, Torino, Italy
- Diabetes and Metabolic Diseases Clinic, "Città della Salute e della Scienza" Hospital of Turin, Turin, Italy
| | - E Ghigo
- Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126, Torino, Italy
- Diabetes and Metabolic Diseases Clinic, "Città della Salute e della Scienza" Hospital of Turin, Turin, Italy
| | - S Bo
- Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126, Torino, Italy.
- Diabetes and Metabolic Diseases Clinic, "Città della Salute e della Scienza" Hospital of Turin, Turin, Italy.
| |
Collapse
|
27
|
Sherf-Dagan S, Sinai T, Goldenshluger A, Globus I, Kessler Y, Schweiger C, Ben-Porat T. Nutritional Assessment and Preparation for Adult Bariatric Surgery Candidates: Clinical Practice. Adv Nutr 2021; 12:1020-1031. [PMID: 33040143 PMCID: PMC8262552 DOI: 10.1093/advances/nmaa121] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/25/2020] [Accepted: 09/03/2020] [Indexed: 12/13/2022] Open
Abstract
Bariatric surgery (BS) has proven to be highly efficacious in the treatment of obesity and its comorbidities. However, careful patient selection is critical for its success. Thus, patients should undergo medical, behavioral, and nutritional assessment by a multidisciplinary team. From the nutritional point of view, BS candidates should undergo nutritional assessment, preparation, and education by a registered dietitian in the preoperative period. Currently, detailed specified and comprehensive information on these topics is lacking. The present narrative review aimed to summarize the available literature concerning both the preoperative nutritional assessment components and the preoperative nutritional preparation and education components of patients planning to undergo BS. Current literature indicates that proper management before BS should include a comprehensive nutritional assessment, in which it is advisable to perform a clinical interview to assess patients' medical background, weight management history, eating patterns and pathologies, oral health, physical activity habits, nutritional status, supplementation usage, BS knowledge, surgery expectations and anthropometric measurements. Nutritional preparation and educational strategies should include an individualized preoperative weight-loss nutrition program, improvement of glycemic control, micronutrients deficiencies correction, eating and lifestyle habits adaptation, physical activity initiation, and strengthening knowledge on obesity and BS. At this stage, more well-designed intervention and long-term cohort studies are needed in order to formulate uniform evidence-based nutritional guidelines for patients who plan to undergo BS, including populations at higher nutritional risk. Moreover, postoperative outcomes of presurgical nutritional intervention programs should be studied.
Collapse
Affiliation(s)
- Shiri Sherf-Dagan
- Department of Nutritional Sciences, School of Health Sciences, Ariel University, Ariel, Israel
- Department of Nutrition, Assuta Medical Center, Tel Aviv, Israel
| | - Tali Sinai
- Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
- School of Nutritional Sciences, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Ariela Goldenshluger
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, and Sylvan Adams Sports Institute, Tel-Aviv University, Tel Aviv, Israel
| | | | - Yafit Kessler
- Department of Nutritional Sciences, School of Health Sciences, Ariel University, Ariel, Israel
- Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel
| | - Chaya Schweiger
- Nutrition Service, Rabin Medical Center, Campus Beilinson, Petach Tiqva, Israel
| | - Tair Ben-Porat
- Department of Nutrition, Hadassah-Hebrew University Medical Center, Ein-Kerem Campus, Jerusalem, Israel
- Department of Human Metabolism and Nutrition, Braun School of Public Health, Hebrew University, Jerusalem, Israel
| |
Collapse
|
28
|
Zetu C, Popa S, Munteanu R. Postbariatric Surgery Hypoglycemia and Nutritional Deficiencies: Long-Term Follow-Up. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2020.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Cornelia Zetu
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy “Carol Davila,” Bucharest, Romania
| | - Simona Popa
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Rubin Munteanu
- Department of Surgery, Euroclinic-Regina Maria Hospital Bucharest, Bucharest, Romania
| |
Collapse
|
29
|
Abstract
Beriberi is a nutritional complication of gastric surgery, caused by deficiency of vitamin B1, or thiamine. Thiamine deficiency leads to impaired glucose metabolism, decreased delivery of oxygen by red blood cells, cardiac dysfunction, failure of neurotransmission, and neuronal death. This review describes the history and pathophysiology of beriberi as well as the relationship between beriberi and nutritional deficiencies after gastric surgery. A literature review of the history and pathophysiology of beriberi and the risk factors for thiamine deficiency, particularly after gastric resection or bariatric surgery, was performed. Recommendations for nutritional follow-up post gastric surgery are based on current national guidelines. Patients may have subclinical thiamine deficiency after upper gastrointestinal surgery, and thus beriberi may be precipitated by acute illness such as sepsis or poor dietary intake. This may occur very soon or many years after gastrectomy or bariatric surgery, even in apparently well-nourished patients. Prompt recognition and administration of supplemental thiamine can decrease morbidity and mortality in patients with beriberi. Dietary education post surgery and long-term follow-up to determine nutritional status, including vitamin and mineral assessment, is recommended for patients who undergo gastric surgery.
Collapse
Affiliation(s)
- Robert Beaumont Wilson
- Upper Gastrointestinal Surgery Department, University of New South Wales, Liverpool Public Hospital, Liverpool, Sydney, New South Wales, Australia, and the Sydney Institute for Obesity Surgery, Ashfield, Sydney, New South Wales, Australia
| |
Collapse
|
30
|
Batar N, Pulat Demir H, Bayram HM. Assessment of nutritional status, body composition and blood biochemical parameters of patients following sleeve gastrectomy: 6 months follow up. Clin Nutr ESPEN 2021; 43:184-190. [PMID: 34024512 DOI: 10.1016/j.clnesp.2021.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/24/2021] [Accepted: 04/10/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Today, Sleeve gastrectomy (SG) has recently become the most common bariatric procedure among various bariatric surgical procedures due to its advantages. The aim of this study is to investigate nutritional status, body composition and biochemical parameters following SG. METHODS This was a prospective study, the subjects were patients who underwent SG at a special obesity clinic in İstanbul, Turkey, between 01.05.2017 and 01.11.2017. The mean body mass index (BMI) of the participants was 42.15 ± 4.84 kg/m2 for men and 41.44 ± 4.34 kg/m2 for women, preoperatively. Nutritional status, some anthropometric measurements and blood sampling were taken at each visit. Data were collected and analyzed for the present study at the following periods: pre-operation (pre-op), 1 month, 3 months and 6 months after surgery. RESULTS A total of 47 SG patients (20 men, 27 women) were evaluated. The mean BMI was 30.23 ± 3.56 kg/m2 for men and 30.35 ± 4.36 kg/m2 for women after 6 months and the amount of excess weight loss (EWL) increased in the 3 months (p < .001). Mean energy, fiber, vitamin A, vitamin C, vitamin B1, niacin, vitamin B12, folate, calcium, magnesium, iron, zinc, phosphorus and iodine were above the Dietary Reference Intake (DRI) recommendations. A significant association was found between protein intake and fat free mass loss in both genders after SG at 6 months (p < .05). CONCLUSION Nutrition deficiencies are common for patients after SG. Therefore, it is important to routinely monitor these patients with a professional team.
Collapse
Affiliation(s)
- Nazlı Batar
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Istanbul Kultur University, Bahcelievler, 34191, Istanbul, Turkey.
| | - Halime Pulat Demir
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Istanbul Gelisim University, Avcilar, 34310, Istanbul, Turkey.
| | - Hatice Merve Bayram
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Istanbul Gelisim University, Avcilar, 34310, Istanbul, Turkey.
| |
Collapse
|
31
|
Al Mansoori A, Shakoor H, Ali HI, Feehan J, Al Dhaheri AS, Cheikh Ismail L, Bosevski M, Apostolopoulos V, Stojanovska L. The Effects of Bariatric Surgery on Vitamin B Status and Mental Health. Nutrients 2021; 13:1383. [PMID: 33923999 PMCID: PMC8073305 DOI: 10.3390/nu13041383] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/16/2021] [Accepted: 04/16/2021] [Indexed: 02/06/2023] Open
Abstract
Diet is a modifiable factor that ensures optimal growth, biochemical performance, improved mood and mental functioning. Lack of nutrients, notably vitamin B, has an impact on human health and wellbeing. The United Arab Emirates is facing a serious problem of micronutrient deficiencies because of the growing trend for bariatric surgery, including Roux-en-Y gastric bypass and sleeve gastrectomy. People undergoing bariatric surgery are at high risk of developing neurological, cognitive, and mental disabilities and cardiovascular disease due to deficiency in vitamin B. Vitamin B is involved in neurotransmitter synthesis, including γ-aminobutyric acid, serotonin, dopamine, and noradrenaline. Deficiency of vitamin B increases the risk of depression, anxiety, dementia and Alzheimer's disease. In addition, vitamin B deficiency can disrupt the methylation of homocysteine, leading to hyperhomocysteinemia. Elevated homocysteine levels are detrimental to human health. Vitamin B deficiency also suppresses immune function, increases the production of pro-inflammatory cytokines and upregulates NF-κB. Considering the important functions of vitamin B and the severe consequences associated with its deficiency following bariatric surgery, proper dietary intervention and administration of adequate supplements should be considered to prevent negative clinical outcomes.
Collapse
Affiliation(s)
- Amna Al Mansoori
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates; (A.A.M.); (H.S.); (H.I.A.); (A.S.A.D.)
| | - Hira Shakoor
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates; (A.A.M.); (H.S.); (H.I.A.); (A.S.A.D.)
| | - Habiba I. Ali
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates; (A.A.M.); (H.S.); (H.I.A.); (A.S.A.D.)
| | - Jack Feehan
- Institute for Health and Sport, Victoria University, Melbourne, VIC 8001, Australia; (J.F.); (V.A.)
- Department of Medicine-Western Health, The University of Melbourne, Melbourne, VIC 8001, Australia
| | - Ayesha S. Al Dhaheri
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates; (A.A.M.); (H.S.); (H.I.A.); (A.S.A.D.)
| | - Leila Cheikh Ismail
- Clinical Nutrition and Dietetics Department, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates;
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford OX1 2JD, UK
| | - Marijan Bosevski
- Faculty of Medicine Skopje, University Clinic of Cardiology, University of Ss. Cyril and Methodius, 1010 Skopje, North Macedonia;
| | - Vasso Apostolopoulos
- Institute for Health and Sport, Victoria University, Melbourne, VIC 8001, Australia; (J.F.); (V.A.)
| | - Lily Stojanovska
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates; (A.A.M.); (H.S.); (H.I.A.); (A.S.A.D.)
- Institute for Health and Sport, Victoria University, Melbourne, VIC 8001, Australia; (J.F.); (V.A.)
| |
Collapse
|
32
|
Heusschen L, Schijns W, Ploeger N, Deden LN, Hazebroek EJ, Berends FJ, Aarts EO. The True Story on Deficiencies After Sleeve Gastrectomy: Results of a Double-Blind RCT. Obes Surg 2021; 30:1280-1290. [PMID: 31776782 DOI: 10.1007/s11695-019-04252-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Since a few years, the laparoscopic sleeve gastrectomy (SG) has become the most performed bariatric operation worldwide. However, as with all bariatric procedures, SG also leads to vitamin and mineral deficiencies post-operatively and standard multivitamin supplements are probably not sufficient. OBJECTIVE The present study evaluates the effectiveness of a specialized multivitamin supplement for SG patients (WLS Optimum 1.0, FitForMe, Rotterdam, the Netherlands), compared to a standard multivitamin supplement (sMVS). DESIGN A double-blind randomized controlled trial was performed. For 12 months, patients in the intervention group received WLS Optimum, containing elevated doses of multiple vitamins and minerals. Patients in the control group were provided with sMVS, containing 100% of the recommended dietary allowance. RESULTS In total, 139 patients were available for analysis (WLS Optimum, n = 69; sMVS, n = 70). Intention-to-treat analyses revealed more folic acid deficiencies and higher serum vitamin B1 levels in the WLS Optimum group. Per protocol analyses showed that in patients using WLS Optimum, serum folic acid and vitamin B1 levels were higher, serum PTH levels were lower, and only one patient (2.6%) was anemic compared to 11 patients (17.5%) using a sMVS (p < 0.05 for all). No differences were found in prevalence of deficiencies for iron, vitamin B12, vitamin D, and other vitamins and minerals. CONCLUSIONS This optimized multivitamin supplement only affected serum levels of folic acid, PTH and vitamin B1, and anemia rates compared to a sMVS. There is a clear need to further optimize multivitamin supplementation for SG patients. Besides, non-compliance with multivitamin supplements remains an important issue that should be dealt with. CLINICAL TRIAL REGISTRY The study protocol was registered at the clinical trials registry of the National Institutes of Health (ClinicalTrials.gov; identifier NCT01609387).
Collapse
Affiliation(s)
- Laura Heusschen
- Department of Surgery, Vitalys Clinic and Rijnstate Hospital, Wagnerlaan 55, Arnhem, 6800 TA, The Netherlands. .,Divison of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands.
| | - Wendy Schijns
- Department of Surgery, Vitalys Clinic and Rijnstate Hospital, Wagnerlaan 55, Arnhem, 6800 TA, The Netherlands
| | - Nadine Ploeger
- Department of Surgery, Vitalys Clinic and Rijnstate Hospital, Wagnerlaan 55, Arnhem, 6800 TA, The Netherlands
| | - Laura N Deden
- Department of Surgery, Vitalys Clinic and Rijnstate Hospital, Wagnerlaan 55, Arnhem, 6800 TA, The Netherlands
| | - Eric J Hazebroek
- Department of Surgery, Vitalys Clinic and Rijnstate Hospital, Wagnerlaan 55, Arnhem, 6800 TA, The Netherlands
| | - Frits J Berends
- Department of Surgery, Vitalys Clinic and Rijnstate Hospital, Wagnerlaan 55, Arnhem, 6800 TA, The Netherlands
| | - Edo O Aarts
- Department of Surgery, Vitalys Clinic and Rijnstate Hospital, Wagnerlaan 55, Arnhem, 6800 TA, The Netherlands
| |
Collapse
|
33
|
Muniraj T, Day LW, Teigen LM, Ho EY, Sultan S, Davitkov P, Shah R, Murad MH. AGA Clinical Practice Guidelines on Intragastric Balloons in the Management of Obesity. Gastroenterology 2021; 160:1799-1808. [PMID: 33832655 DOI: 10.1053/j.gastro.2021.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Thiruvengadam Muniraj
- Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Lukejohn W Day
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California
| | - Levi M Teigen
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Edith Y Ho
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Stanford, California
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota
| | - Perica Davitkov
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio; Veterans Affairs, Northeast Ohio Healthcare System, Cleveland, Ohio
| | - Raj Shah
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio; Veterans Affairs, Northeast Ohio Healthcare System, Cleveland, Ohio; University Hospitals Cleveland Medical Center Cleveland, Ohio
| | - M Hassan Murad
- Kern Center for the Science of Health Care Delivery, Rochester, Minnesota
| |
Collapse
|
34
|
Shah R, Davitkov P, Abu Dayyeh BK, Saumoy M, Murad MH. AGA Technical Review on Intragastric Balloons in the Management of Obesity. Gastroenterology 2021; 160:1811-1830. [PMID: 33832658 DOI: 10.1053/j.gastro.2021.02.043] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Several strategies are available to address the obesity epidemic and range from noninvasive lifestyle interventions to medications and bariatric surgical procedures. Endoscopic bariatric techniques, such as intragastric balloons, have become an attractive alternative as a tool for weight loss that can augment the effect of lifestyle interventions. This technical review includes multiple systematic reviews performed to support a clinical practice guideline by the American Gastroenterological Association on the role of intragastric balloons as a tool for weight loss. The systematic reviews targeted a priori selected clinical questions about the effectiveness and periprocedural care of intragastric balloons and concomitant and subsequent weight-loss strategies.
Collapse
Affiliation(s)
- Raj Shah
- Case Western Reserve University School of Medicine, Cleveland, Ohio; Veterans Affairs, Northeast Ohio Healthcare System, Cleveland, Ohio; University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Perica Davitkov
- Case Western Reserve University School of Medicine, Cleveland, Ohio; Veterans Affairs, Northeast Ohio Healthcare System, Cleveland, Ohio
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Monica Saumoy
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - M Hassan Murad
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
35
|
Zarshenas N, Tapsell LC, Batterham M, Neale EP, Talbot ML. Changes in Anthropometric Measures, Nutritional Indices and Gastrointestinal Symptoms Following One Anastomosis Gastric Bypass (OAGB) Compared with Roux-en-y Gastric Bypass (RYGB). Obes Surg 2021; 31:2619-2631. [PMID: 33624210 PMCID: PMC7901677 DOI: 10.1007/s11695-021-05284-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 11/26/2022]
Abstract
Purpose Bariatric surgery is an effective treatment for obesity with new procedures emerging. However, despite comparable weight loss and improvements in metabolic outcomes, research on nutritional and gastrointestinal symptoms remains limited. Here we compare clinical data on weight, nutritional disorders and gastrointestinal symptoms of patients before and following one anastomosis gastric bypass (OAGB) and Roux-en-Y gastric Bypass (RYGB). Materials and Methods In this retrospective study, data on anthropometry, nutritional indices, dietary intake and gastrointestinal symptoms were retrieved in cohorts of patients up to 2 years following OAGB and RYGB. Results Seventy-three patients had either a RYGB (28) or an OAGB (45), with 71% seeking these as a revisional procedure. Significant and higher weight loss was observed in the OAGB cohort at 1 year (%TWL 33.0 ± 8.5 vs. 26.6 ± 12.4), albeit comparable at 2 years postoperatively (%TWL 29.0 ± 11.1 vs. 34.1 ± 11.2). Disorders such as vitamin D, active B12, folate, homocystein (Hcy) and hyperparathyroidism were present following both surgeries. Levels of vitamin D, ferritin and total protein significantly worsened over time. Gastrointestinal symptoms of diarrhoea, steatorrhoea and reflux were higher in the OAGB cohort while the RYGB cohort reported more dumping syndrome (DS). Conclusion Significant and similar weight loss results are seen following both OAGB and RYGB. Nutritional disorders were common in both cohorts and increased over time. However, the OAGB patients reported more gastrointestinal side effects, which may contribute to poor quality of life and nutritional consequences. Prospective and longer-term studies investigating the nutritional and gastrointestinal health of patients undergoing OAGB is recommended.
Collapse
Affiliation(s)
- Nazy Zarshenas
- School of Medicine, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, NSW Australia
- Shore Surgical, Suite 204, Level 2/156 Pacific Highway, Greenwich, NSW 2065 Australia
| | - Linda Clare Tapsell
- School of Medicine, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, NSW Australia
| | - Marijka Batterham
- School of Mathematics and Applied Statistics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, NSW Australia
| | - Elizabeth Phillipa Neale
- School of Medicine, Faculty of Science Medicine and Health, University of Wollongong, Wollongong, NSW Australia
| | - Michael Leonard Talbot
- Upper Gastrointestinal Surgery, St George Private Hospital, Kogarah, Sydney, NSW 2217 Australia
| |
Collapse
|
36
|
Optimizing Multivitamin Supplementation for Sleeve Gastrectomy Patients. Obes Surg 2021; 31:2520-2528. [PMID: 33624212 PMCID: PMC8113195 DOI: 10.1007/s11695-021-05282-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 11/30/2022]
Abstract
Purpose Micronutrient deficiencies are frequently reported after sleeve gastrectomy (SG), and therefore lifelong daily multivitamin supplementation is highly recommended. Based on literature and the results of a previous randomized controlled trial, a specialized multivitamin supplement for SG patients was further optimized (WLS Optimum 2.0, FitForMe). The present study reports on its short-term effectiveness. Materials and Methods An open-label study was performed in which 76 patients were included to receive WLS Optimum 2.0 for 12 months (Opt 2.0 group). This group was compared with a group of 75 patients that had received WLS Optimum 1.0 for 12 months during a previous study (Opt 1.0 group). Results Intention-to-treat analysis (Opt 1.0, n = 69; Opt 2.0, n = 75) showed higher serum levels of vitamin B12, vitamin B6, and zinc, and a lower prevalence of deficiencies for vitamin B12 and phosphate in the Opt 2.0 group. MCV and serum folic acid levels were higher in the Opt 1.0 group. Over the 12-month study period, mean increase in serum levels of phosphate, vitamin B6, and zinc was higher in the Opt 2.0 group, and MCV and serum vitamin D levels increased more in the Opt 1.0 group. Conclusion The present study showed that the use of a specialized multivitamin supplement for SG patients is effective at preventing deficiencies for most vitamins and minerals, specifically in compliant patients. However, a strict follow-up regime remains necessary to monitor nutritional status and to improve patient compliance. Supplementary Information The online version contains supplementary material available at 10.1007/s11695-021-05282-4.
Collapse
|
37
|
Quilliot D, Coupaye M, Ciangura C, Czernichow S, Sallé A, Gaborit B, Alligier M, Nguyen-Thi PL, Dargent J, Msika S, Brunaud L. Recommendations for nutritional care after bariatric surgery: Recommendations for best practice and SOFFCO-MM/AFERO/SFNCM/expert consensus. J Visc Surg 2021; 158:51-61. [PMID: 33436155 DOI: 10.1016/j.jviscsurg.2020.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Nutritional care after bariatric surgery is an issue of major importance, especially insofar as risk of deficiency has been extensively described in the literature. Subsequent to the deliberations carried out by a multidisciplinary working group, we are proposing a series of recommendations elaborated using the Delphi-HAS (official French health authority) method, which facilitates the drawing up of best practice and consensus recommendations based on the data of the literature and on expert opinion. The recommendations in this paper pertain to dietary management and physical activity, multivitamin and trace element supplementation and the prevention and treatment of specific deficiencies in vitamins B1, B9, B12, D and calcium, iron, zinc, vitamins A, E and K, dumping syndrome and reactive hypoglycemia.
Collapse
Affiliation(s)
- D Quilliot
- French Speaking Society of Clinical Nutrition and Metabolism (SFNCM), France.
| | - M Coupaye
- French Association for the Study and Research on Obesity (AFERO), France
| | - C Ciangura
- French Association for the Study and Research on Obesity (AFERO), France
| | - S Czernichow
- French Speaking Society of Clinical Nutrition and Metabolism (SFNCM), France
| | - A Sallé
- French Association for the Study and Research on Obesity (AFERO), France
| | - B Gaborit
- French Association for the Study and Research on Obesity (AFERO), France
| | - M Alligier
- French Obesity Research Center of Excellence (FORCE), France
| | - P-L Nguyen-Thi
- Medical Evaluation Department, Department of Clinical Research Support PARC, University of Lorraine, CHRU Nancy, Nancy, France
| | - J Dargent
- French and Francophone Society of Obesity Surgery and Metabolic Disorders (SO.FF.CO.MM), France
| | - S Msika
- French and Francophone Society of Obesity Surgery and Metabolic Disorders (SO.FF.CO.MM), France
| | - L Brunaud
- French and Francophone Society of Obesity Surgery and Metabolic Disorders (SO.FF.CO.MM), France
| |
Collapse
|
38
|
khalooeifard R, Pazouki A, khalaj A, Mokhber S, Farsani GM. Persistent Paraplegia After Sleeve Gastrectomy: a Case Report. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02318-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
39
|
Asakly S, Magen-Rimon R, Ighbariya A, Marjih-Shallufi M, Ben-Porat T, Ravid S, Eran A, Gepstein V, Hanna S, Weiss R. Bariatric Surgery-Associated Myelopathy. Obes Facts 2021; 14:431-439. [PMID: 34311464 PMCID: PMC8406245 DOI: 10.1159/000515374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 02/17/2021] [Indexed: 11/19/2022] Open
Abstract
Bariatric surgery is gaining acceptance as an efficient treatment modality for adults and adolescents with morbid obesity. The early postbariatric period has the potential to induce an immunomodulatory imbalance due to the development or worsening of nutritional deficiencies, changes in hormonal balance (specifically after sleeve gastrectomy), and a shift in the proinflammatory cytokine profile along with a major change in the gut microbiome and permeability. These changes may induce encephalomyelitic T cell activity, change neural barrier permeability, and induce gut dysbioisis, favoring a proinflammatory metabolic profile. Such changes, in genetically prone individuals or those with additional risk factors, may lead to the development of myelopathy, particularly MS. Key Message: Postbariatric myelopathy is rare but should be considered in bariatric patients with relevant complaints in the postoperative period.
Collapse
|
40
|
The Emergence of Wernicke's Encephalopathy After Gastric Sleeve. TOP CLIN NUTR 2021. [DOI: 10.1097/tin.0000000000000230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
41
|
Zhang C, Chen X, Li J, Liu Z, Liu W, Zhang J, Zhou Z. Anaemia and Related Nutritional Deficiencies in Chinese Patients with Obesity, 12 Months Following Laparoscopic Sleeve Gastrectomy. Diabetes Metab Syndr Obes 2021; 14:1575-1587. [PMID: 33880047 PMCID: PMC8051959 DOI: 10.2147/dmso.s303320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/12/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) has become a predominant bariatric procedure at present. However, data are scarce regarding the nutritional impact of this procedure on Chinese patients. This study aimed to evaluate the prevalence of nutritional deficiency after LSG in Chinese patients. METHODS Eighty-two patients with obesity were recruited from the Second Xiangya Hospital of Central South University, and all patients underwent LSG and completed the visit. RESULTS Compared with the baseline, the serum albumin levels increased significantly at 1-12 months (P<0.001) after surgery, and the hypoalbuminemia rate decreased from 8.5% to 0% throughout the study (P=0.063). Anaemia was present in 7.3% of all patients before surgery, and its prevalence increased to 11.0% at 12 months post-operation (P=0.109). The anaemia rate of fertile females was higher than that of males (21.4% vs 2.3%, P=0.036). No significant changes were found in vitamin B12 deficiency throughout the study (0% vs 3.8%, P=1.0). The increases in the folate deficiency were only discovered in the female group (3.7% vs 20%, P=0.031) and the obese without type 2 diabetes (T2D) group after LSG (27.3% vs 47.1%, P=0.031). A decrease in the ferritin levels and an increase in iron deficiency at 12 months post-surgery were found among all patients. CONCLUSION Based on 12 months of follow-up, LSG is effective in controlling metabolic syndrome and has a modest effect on nutritional deficiencies, which suggests that LSG is an effective and comparably safe procedure for Chinese patients considering nutritional deficiencies at 12 months post-surgery.
Collapse
Affiliation(s)
- Chunlan Zhang
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - Xi Chen
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - Jingping Li
- Department of Metabolic Surgery, Department of Biliopancreatic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - Zhenqi Liu
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Wei Liu
- Department of Metabolic Surgery, Department of Biliopancreatic Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People’s Republic of China
- Wei Liu Department of Metabolic Surgery, Department of Biliopancreatic Surgery, The Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, Hunan, People’s Republic of ChinaTel +86 731-85292154 Email
| | - Jingjing Zhang
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, People’s Republic of China
- Correspondence: Jingjing Zhang National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Road, Changsha, Hunan, People’s Republic of ChinaTel +86 731-85292154 Email
| | - Zhiguang Zhou
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, People’s Republic of China
| |
Collapse
|
42
|
Albaugh VL, Williams DB, Aher CV, Spann MD, English WJ. Prevalence of thiamine deficiency is significant in patients undergoing primary bariatric surgery. Surg Obes Relat Dis 2020; 17:653-658. [PMID: 33478908 DOI: 10.1016/j.soard.2020.11.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 09/20/2020] [Accepted: 11/26/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients undergoing metabolic and bariatric surgery are prone to developing micronutrient deficiencies, necessitating life-long nutritional supplementation and monitoring. Historically, these deficiencies were thought to be driven by postsurgical changes in absorption. Recent data, though, have demonstrated that obesity alone is also associated with micronutrient deficiencies. Thiamine deficiency, in particular, can lead to permanent neurologic deficits. OBJECTIVE Identify thiamine deficiency prevalence within the preoperative metabolic and bariatric surgery patient population. SETTING Single institution academic medical center. METHODS A retrospective review of deidentified data was examined that included whole blood thiamine measured from consecutive patients from April 2018 to June 2019 (n = 346). Cohort characteristics were assessed including age, operation, preoperative weight, and race/ethnicity. The majority of the cohort were women (83%) with an average age of 44.9 years. Racial representation included White/Caucasian (73%) and Black (21%), while operations included Roux-en-Y gastric bypass (58%), sleeve gastrectomy (31%), and revisions (10%). RESULTS Thiamine concentration was normally distributed with a mean of 144 nM. Overall, 3.5% of patients had thiamine concentrations below the lower limit of normal of <70 nM, while 35 additional patients (14%) were at risk for thiamine deficiency with concentrations <100 nM. On the average, these patients were of similar age and were all undergoing primary procedures (50% gastric bypass, 50% sleeve gastrectomy). Regression methods demonstrated that patients with thiamine deficiency tended to be females with higher body mass index, even after controlling for sex, height, and preoperative weight. After covariate adjustment, male sex and increasing height were both associated with higher thiamine concentration. CONCLUSION Previously quoted rates of thiamine deficiency in the preoperative patient are variable, but we describe a significant number of patients with, or at risk of, thiamine deficiency. Male sex and increasing height are likely associated with increased skeletal muscle mass, which is enriched with thiamine. Routine thiamine measurement, either preoperatively or at the time of surgery, is warranted given its limited stores within the body and potential catastrophic complications associated with acute or chronic deficiency.
Collapse
Affiliation(s)
- Vance L Albaugh
- Vanderbilt Center for Surgical Weight Loss, Vanderbilt University Medical Center, Nashville, Tennessee
| | - D Brandon Williams
- Vanderbilt Center for Surgical Weight Loss, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chetan V Aher
- Vanderbilt Center for Surgical Weight Loss, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew D Spann
- Vanderbilt Center for Surgical Weight Loss, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Wayne J English
- Vanderbilt Center for Surgical Weight Loss, Vanderbilt University Medical Center, Nashville, Tennessee.
| |
Collapse
|
43
|
de Sousa Paredes SC, Mota-Garcia F. Prevalence of nutritional deficiencies in bariatric surgery candidates and its effect on metabolic status. Hormones (Athens) 2020; 19:505-514. [PMID: 32812214 DOI: 10.1007/s42000-020-00234-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 07/29/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Nutritional deficiencies are common among obese individuals and constitute one of the main concerns in the bariatric field. The aim of this study was to investigate nutritional status in bariatric surgery candidates, comparing individuals with and without metabolic syndrome (MetS) and to explore possible associations between nutritional and metabolic status. METHODS Patients accepted for gastric sleeve surgery between 2010 and 2015 were included and anthropometric and metabolic parameters were recorded before surgery. Univariate and multivariate analyses were applied in order to find possible associations between MetS, nutritional, anthropometric, and metabolic parameters. RESULTS A total of 330 patients were evaluated (285 females, mean age of 41.88 ± 10.4 years old, mean body mass index 43.91 ± 6.2 kg/m2) and MetS was present in 47% of them. Patients without MetS presented a higher prevalence of folate deficiency (12 vs. 2%, p < 0.001). Male gender, older age, lower magnesium levels, and higher BMI and calcium levels were predictors of a greater number of MetS components. Male gender, a greater number of MetS components, and lower magnesium were predictors of higher homeostatic model assessment for insulin resistance (HOMA-IR). CONCLUSIONS The rising prevalence of obesity is causing a parallel increase in the use of bariatric surgery. The high occurrence of preoperative nutritional deficiencies can impair metabolic status and contribute to a worse outcome after surgery. Nutritional assessment and improvement before surgery may be crucial to optimize patient status, and future studies should explore the effect of the correction of these deficiencies in the metabolic status of these patients.
Collapse
Affiliation(s)
- Sílvia Cristina de Sousa Paredes
- Endocrinology Department, Hospital de Braga, Sete Fontes, São Victor, 4710-243, Braga, Portugal.
- Department of Public Health and Forensic Sciences, and Medical Education, Medical Education Unit, Faculty of Medicine, University of Porto, 4200-319, Porto, Portugal.
| | - Fernando Mota-Garcia
- Clinical Pathology Department, Hospital de Braga, Sete Fontes, São Victor, 4710-243, Braga, Portugal
| |
Collapse
|
44
|
O'Kane M, Parretti HM, Pinkney J, Welbourn R, Hughes CA, Mok J, Walker N, Thomas D, Devin J, Coulman KD, Pinnock G, Batterham RL, Mahawar KK, Sharma M, Blakemore AI, McMillan I, Barth JH. British Obesity and Metabolic Surgery Society Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery-2020 update. Obes Rev 2020; 21:e13087. [PMID: 32743907 PMCID: PMC7583474 DOI: 10.1111/obr.13087] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/21/2020] [Accepted: 05/31/2020] [Indexed: 02/06/2023]
Abstract
Bariatric surgery is recognized as the most clinically and cost-effective treatment for people with severe and complex obesity. Many people presenting for surgery have pre-existing low vitamin and mineral concentrations. The incidence of these may increase after bariatric surgery as all procedures potentially cause clinically significant micronutrient deficiencies. Therefore, preparation for surgery and long-term nutritional monitoring and follow-up are essential components of bariatric surgical care. These guidelines update the 2014 British Obesity and Metabolic Surgery Society nutritional guidelines. Since the 2014 guidelines, the working group has been expanded to include healthcare professionals working in specialist and non-specialist care as well as patient representatives. In addition, in these updated guidelines, the current evidence has been systematically reviewed for adults and adolescents undergoing the following procedures: adjustable gastric band, sleeve gastrectomy, Roux-en-Y gastric bypass and biliopancreatic diversion/duodenal switch. Using methods based on Scottish Intercollegiate Guidelines Network methodology, the levels of evidence and recommendations have been graded. These guidelines are comprehensive, encompassing preoperative and postoperative biochemical monitoring, vitamin and mineral supplementation and correction of nutrition deficiencies before, and following bariatric surgery, and make recommendations for safe clinical practice in the U.K. setting.
Collapse
Affiliation(s)
- Mary O'Kane
- Dietetic Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Jonathan Pinkney
- Faculty of Health and Human Sciences, Peninsula Schools of Medicine and Dentistry, Plymouth, UK.,Department of Endocrinology, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Richard Welbourn
- Department of Upper GI and Bariatric Surgery, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - Carly A Hughes
- Norwich Medical School, University of East Anglia, Norwich, UK.,Fakenham Weight Management Service, Fakenham Medical Practice, Fakenham, UK
| | - Jessica Mok
- Centre for Obesity Research, Rayne Institute, Department of Medicine, University College London, London, UK
| | - Nerissa Walker
- School of Biosciences, Sutton Bonington Campus, University of Nottingham, Nottingham, UK
| | - Denise Thomas
- Department of Nutrition and Dietetics, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Jennifer Devin
- Specialist Weight Management Service, Betsi Cadwaladr University Health Board, Wales, UK
| | - Karen D Coulman
- Population Health Sciences, Bristol Medical School. University of Bristol, Bristol, UK.,Obesity and Bariatric Surgery Service, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | | | - Rachel L Batterham
- Centre for Obesity Research, Rayne Institute, Department of Medicine, University College London, London, UK.,Bariatric Centre for Weight Management and Metabolic Surgery, UCLH, University College London Hospital (UCLH), London, UK.,National Institute of Health Research, UCLH Biomedical Research Centre, London, UK
| | - Kamal K Mahawar
- Department of General Surgery, Sunderland Royal Hospital, Sunderland, UK
| | - Manisha Sharma
- Department of Clinical Biochemistry & Bariatric Surgery, Homerton University Hospital NHS Trust, London, UK
| | - Alex I Blakemore
- Department of Life Sciences, Brunel University, London, UK.,Department of Medicine, Imperial College, London, UK
| | | | - Julian H Barth
- Department of Chemical Pathology & Metabolic Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| |
Collapse
|
45
|
Changes in Body Composition and Biochemical Parameters Following Laparoscopic One Anastomosis Gastric Bypass: 1-Year Follow-Up. Obes Surg 2020; 31:232-238. [PMID: 32892256 DOI: 10.1007/s11695-020-04901-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND/AIM Little data is available on body composition and biochemical parameter changes after one anastomosis gastric bypass (OAGB) surgery. This study was therefore conducted to assess body composition and biochemical parameter changes in patients who underwent OAGB. The relationship between the percentage of total weight loss (%TWL) with percentage changes in body composition and biochemical parameters was measured in the first year after surgery. MATERIALS AND METHODS This retrospective study was carried out on 363 patients (mean age 39.93 ± 9.98 years) who underwent OAGB between January 2011 and November 2018. Anthropometric, body composition and biochemical measurements were recorded before and 1 year after surgery. For paired data, a paired sample t test or Wilcoxon test was used. Spearman or Pearson correlation test was used to evaluate the relationship between % TWL and changes in body composition and biochemical parameters. RESULTS The average %TWL at 1 year following surgery was 35.72 ± 6.85. Fat and muscle tissue and also serum levels of glycemic parameters, low density lipoprotein, triglycerides (TG), total cholesterol, zinc, albumin, hemoglobin, hematocrit, and platelet had decreased a year after OAGB (P < 0.05). The postoperative levels of HDL-c, vitamins D, B12, and folic acid were dramatically higher than the preoperative values. Higher %TWL significantly correlated to greater decreases in body fat, muscle mass, and serum TG at 1 year post-surgery, compared to preoperative values. CONCLUSION OAGB may be effective over a follow-up period of 1 year in achieving weight, fat mass reduction, and improved serum levels of glycemic parameters and lipid profiles.
Collapse
|
46
|
Abstract
Bariatric surgery (BS) is today the most effective therapy for inducing long-term weight loss and for reducing comorbidity burden and mortality in patients with severe obesity. On the other hand, BS may be associated to new clinical problems, complications and side effects, in particular in the nutritional domain. Therefore, the nutritional management of the bariatric patients requires specific nutritional skills. In this paper, a brief overview of the nutritional management of the bariatric patients will be provided from pre-operative to post-operative phase. Patients with severe obesity often display micronutrient deficiencies when compared to normal weight controls. Therefore, nutritional status should be checked in every patient and correction of deficiencies attempted before surgery. At present, evidences from randomized and retrospective studies do not support the hypothesis that pre-operative weight loss could improve weight loss after BS surgery, and the insurance-mandated policy of a preoperative weight loss as a pre-requisite for admission to surgery is not supported by medical evidence. On the contrary, some studies suggest that a modest weight loss of 5-10% in the immediate preoperative period could facilitate surgery and reduce the risk of complications. Very low calories diet (VLCD) and very low calories ketogenic diets (VLCKD) are the most frequently used methods for the induction of a pre-operative weight loss today. After surgery, nutritional counselling is recommended in order to facilitate the adaptation of the eating habits to the new gastro-intestinal physiology. Nutritional deficits may arise according to the type of bariatric procedure and they should be prevented, diagnosed and eventually treated. Finally, specific nutritional problems, like dumping syndrome and reactive hypoglycaemia, can occur and should be managed largely by nutritional manipulation. In conclusion, the nutritional management of the bariatric patients requires specific nutritional skills and the intervention of experienced nutritionists and dieticians.
Collapse
Affiliation(s)
- Silvia Bettini
- Luca Busetto Center for the Study and the Integrated Management of Obesity, Padova University Hospital, Padova, Italy
| | - Anna Belligoli
- Luca Busetto Center for the Study and the Integrated Management of Obesity, Padova University Hospital, Padova, Italy
| | - Roberto Fabris
- Luca Busetto Center for the Study and the Integrated Management of Obesity, Padova University Hospital, Padova, Italy
| | - Luca Busetto
- Luca Busetto Center for the Study and the Integrated Management of Obesity, Padova University Hospital, Padova, Italy.
- Clinica Medica 3, Azienda Ospedaliera di Padova, Via Giustiniani 2, Padova, 35128, Italy.
| |
Collapse
|
47
|
Ben-Porat T, Sherf-Dagan S, Elazary R. Authors' Response. J Acad Nutr Diet 2020; 120:1453-1454. [PMID: 32829775 DOI: 10.1016/j.jand.2020.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Tair Ben-Porat
- Registered Dietitian, Department of Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Department of Human Metabolism and Nutrition, Braun School of Public Health, Hebrew University, Jerusalem, Israel
| | - Shiri Sherf-Dagan
- Registered Dietitian and Epidemiologist, Department of Nutritional Sciences, School of Health Sciences, Ariel University, Ariel, Israel; Department of Nutrition, Assuta Medical Center, Tel Aviv, Israel
| | - Ram Elazary
- Senior Surgeon, Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| |
Collapse
|
48
|
Iron, Vitamin B 12, Folate and Copper Deficiency After Bariatric Surgery and the Impact on Anaemia: a Systematic Review. Obes Surg 2020; 30:4542-4591. [PMID: 32785814 DOI: 10.1007/s11695-020-04872-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/19/2020] [Accepted: 07/22/2020] [Indexed: 12/20/2022]
Abstract
Bariatric surgery may increase the risk of iron, vitamin B12, folate and copper deficiencies, which can cause anaemia. This review aims to critique the evidence on the prevalence of these nutritional deficiencies and the impact on anaemia in the first 12 months after surgery. PRISMA and MOOSE frameworks, the NHMRC evidence hierarchy and The Academy of Nutrition and Dietetics bias tool were used to systematically critique current literature. Seventeen studies reported on deficiency prevalence with the majority being of low quality. Important confounders to serum micronutrient levels were not adequately considered. Results on the prevalence of nutritional anaemias were also lacking. Further investigation into the prevalence of iron, vitamin B12, folate and copper deficiency and its impact on anaemia in bariatric surgery is needed.
Collapse
|
49
|
Nutritional Status of Obese Taiwanese Before Bariatric-Metabolic Surgery and Their Serum 25-Hydroxyvitamin D Concentrations for Maximal Suppression of Parathyroid Hormone. Obes Surg 2020; 30:3940-3946. [PMID: 32638247 DOI: 10.1007/s11695-020-04759-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/31/2020] [Accepted: 05/31/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND This is the first report from Taiwan using laboratory tests to assess nutritional status of patients with obesity before bariatric-metabolic surgery. Moreover, the 25(OH)D threshold for maximal suppression of parathyroid hormone (PTH) was evaluated to offer a reference value for preoperative nutritional care. METHODS Inclusion criteria were Taiwanese, 18-65 years old, and with BMI ≥ 27.5 kg/m2 awaiting bariatric-metabolic surgery. Anthropometric data and blood samples were collected before surgery. Serum concentrations of protein; vitamins B1, B12, folate, A, D, and E; calcium; iron; zinc; copper; selenium; PTH; and erythrocyte glutathione reductase activity coefficient (vitamin B2 status) were measured. RESULTS For 52 participants with a mean BMI 37.6 ± 6.4 kg/m2, vitamin D deficiency (25(OH)D < 20 ng/mL) and insufficiency (20 < 25(OH)D < 30 ng/mL) were at 73 and 22% prevalence, respectively. Secondary hyperparathyroidism (PTH ≧ 65 pg/mL) was 24% and hypocalcemia was 50% (ionized Ca < 4.5 mg/dL). Deficiency of other nutrients was sporadic (< 10%) or nil. When participants were stratified according to 25(OH)D concentrations (< 10, 10-15, 15-20, and ≥ 20 ng/mL), PTH increased at 25(OH)D < 10 ng/mL (β = 48.34, p = 0.001) after adjusting for age, gender, and BMI. CONCLUSION For patients with obesity before bariatric-metabolic surgery, vitamin D/calcium deficiency was the only nutritional issue that needs to be addressed in Taiwan. However, a lower cutoff point of 25(OH)D, i.e., 10 ng/mL, for vitamin D deficiency may be considered for patients before surgery. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03915158.
Collapse
|
50
|
Martínez-Ortega AJ, Olveira G, Pereira-Cunill JL, Arraiza-Irigoyen C, García-Almeida JM, Irles Rocamora JA, Molina-Puerta MJ, Molina Soria JB, Rabat-Restrepo JM, Rebollo-Pérez MI, Serrano-Aguayo MP, Tenorio-Jiménez C, Vílches-López FJ, García-Luna PP. Recommendations Based on Evidence by the Andalusian Group for Nutrition Reflection and Investigation (GARIN) for the Pre- and Postoperative Management of Patients Undergoing Obesity Surgery. Nutrients 2020; 12:nu12072002. [PMID: 32640531 PMCID: PMC7400832 DOI: 10.3390/nu12072002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/24/2020] [Accepted: 07/02/2020] [Indexed: 12/13/2022] Open
Abstract
In order to develop evidence-based recommendations and expert consensus for nutrition management of patients undergoing bariatric surgery and postoperative follow-up, we conducted a systematic literature search using PRISMA methodology plus critical appraisal following the SIGN and AGREE-II procedures. The results were discussed among all members of the GARIN group, and all members answered a Likert scale questionnaire to assess the degree of support for every recommendation. Patients undergoing bariatric surgery should be screened preoperatively for some micronutrient deficiencies and treated accordingly. A VLCD (Very Low-Calorie Diet) should be used for 4–8 weeks prior to surgery. Postoperatively, a liquid diet should be maintained for a month, followed by a semi-solid diet also for one month. Protein requirements (1–1.5 g/kg) should be estimated using adjusted weight. Systematic use of specific multivitamin supplements is encouraged. Calcium citrate and vitamin D supplements should be used at higher doses than are currently recommended. The use of proton-pump inhibitors should be individualised, and vitamin B12 and iron should be supplemented in case of deficit. All patients, especially pregnant women, teenagers, and elderly patients require a multidisciplinary approach and specialised follow-up. These recommendations and suggestions regarding nutrition management when undergoing bariatric surgery and postoperative follow-up have direct clinical applicability.
Collapse
Affiliation(s)
- Antonio J. Martínez-Ortega
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain; (A.J.M.-O.); (J.L.P.-C.); (M.P.S.-A.); (P.P.G.-L.)
- Endocrine Diseases Research Group, Institute of Biomedicine of Seville (IBiS), 41007 Sevilla, Spain
| | - Gabriel Olveira
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga/Universidad de Málaga, 29010 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain;
- CIBERDEM (CB07/08/0019), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-951-29-0343
| | - José L. Pereira-Cunill
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain; (A.J.M.-O.); (J.L.P.-C.); (M.P.S.-A.); (P.P.G.-L.)
- Endocrine Diseases Research Group, Institute of Biomedicine of Seville (IBiS), 41007 Sevilla, Spain
| | | | - José M. García-Almeida
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain;
- Unidad de gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
| | | | - María J. Molina-Puerta
- UGC Endocrinología y Nutrición, Hospital Universitario Reina Sofía, 14004 Córdoba, Spain;
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain
| | | | | | - María I. Rebollo-Pérez
- Servicio de Endocrinología y Nutrición, Hospital Juan Ramón Jiménez, 21005 Huelva, Spain;
| | - María P. Serrano-Aguayo
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain; (A.J.M.-O.); (J.L.P.-C.); (M.P.S.-A.); (P.P.G.-L.)
- Endocrine Diseases Research Group, Institute of Biomedicine of Seville (IBiS), 41007 Sevilla, Spain
| | - Carmen Tenorio-Jiménez
- Endocrinology and Nutrition Clinical Management Unit, University Hospital Virgen de las Nieves, 18014 Granada, Spain;
| | | | - Pedro P. García-Luna
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain; (A.J.M.-O.); (J.L.P.-C.); (M.P.S.-A.); (P.P.G.-L.)
- Endocrine Diseases Research Group, Institute of Biomedicine of Seville (IBiS), 41007 Sevilla, Spain
- GARIN Group Coordinator, 41007 Seville, Spain
| |
Collapse
|