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Bretón I, Velasco C, Cuerda C, Motilla M, Serrano C, Morales Á, Carrascal ML, Lopez Lazareno N, Gonzalez-Estecha M, Ballesteros-Pomar MD, Rubio-Herrera MÁ. Minerals and trace elements in pregnancy in women with previous bariatric surgery consequences on maternal and foetal health. J Trace Elem Med Biol 2024; 85:127458. [PMID: 38772250 DOI: 10.1016/j.jtemb.2024.127458] [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: 06/20/2023] [Revised: 03/10/2024] [Accepted: 04/16/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Bariatric surgery (BS) may decrease the risk of these obesity-related complications; however, due to its effect on nutrient intake and absorption, it can also have adverse consequences on maternal and foetal health. The aim of this study is to describe the evolution of electrolytes and trace elements serum levels throughout pregnancy after BS, according to the surgical technique and to evaluate the effect of nutritional deficiencies on the risk of maternal-foetal complications. METHODS This is a retrospective observational study of the clinical evolution and maternal-foetal complications in a group of women with pregnancies that occurred after BS. Clinical evolution during pregnancy, body weight, and plasma electrolytes, vitamins, and trace elements, as well as their influence on maternal-foetal outcomes were evaluated. Composite neonatal variable (CNV) was defined to evaluate unfavourable foetal outcome. Published reference values for micronutrients during pregnancy have been used. RESULTS The study includes data on 164 singleton pregnancies in 91 women. A hundred and twenty-seven pregnancies got to full term. The average birth weight was 2966 (546) g., 26.8% < P10 and 13.8% < P3 of a reference population. New-born of gestations after malabsorptive bariatric surgery had a higher risk of having a percentile of birth weight < P3. Plasma electrolytes, trace elements and vitamins throughout pregnancy showed differences depending on the surgical technique, with lower haemoglobin, ferritin, calcium, zinc, copper, vitamin A and vitamin E in the malabsorptive techniques. A high percentage of deficiency was observed, especially in the third trimester (Hb < 11 g/dl: 31.8%; ferritin < 30 mg/ml: 85.7%; zinc < 50 μg/dl: 32.4%, vitamin D < 30 ng/ml: 75.5% and < 20 ng/ml: 53.3%). A decreased plasma copper in the first trimester or zinc in the third trimester were associated with a lower percentile of new-born birth weight. A higher risk of CNV was observed in predominant malabsorptive BS and in pregnancies that had presented at least one vitamin D level lower than 20 ng/ml throughout pregnancy (30.4% vs. 7.1%, p=0.018). CONCLUSIONS Trace elements and vitamin deficiencies are common in pregnant women after bariatric surgery, especially of iron, zinc, and vitamin D. These deficiencies might negatively affect foetal development. Further studies are needed to better define the role of micronutrients in maternal-foetal health after bariatric surgery.
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Affiliation(s)
- Irene Bretón
- Department of Endocrinology and Nutrition. Hospital General Universitario Gregorio Marañón. Madrid, IiSGGM, Calle del Dr. Esquerdo, 46, Madrid 28007, Spain; Faculty of Medicine. Department of Medicine, Universidad Complutense, Madrid, Spain.
| | - Cristina Velasco
- Department of Endocrinology and Nutrition. Hospital General Universitario Gregorio Marañón. Madrid, IiSGGM, Calle del Dr. Esquerdo, 46, Madrid 28007, Spain
| | - Cristina Cuerda
- Department of Endocrinology and Nutrition. Hospital General Universitario Gregorio Marañón. Madrid, IiSGGM, Calle del Dr. Esquerdo, 46, Madrid 28007, Spain; Faculty of Medicine. Department of Medicine, Universidad Complutense, Madrid, Spain
| | - Marta Motilla
- Department of Endocrinology and Nutrition. Hospital General Universitario Gregorio Marañón. Madrid, IiSGGM, Calle del Dr. Esquerdo, 46, Madrid 28007, Spain
| | - Clara Serrano
- Department of Endocrinology and Nutrition. Hospital General Universitario Gregorio Marañón. Madrid, IiSGGM, Calle del Dr. Esquerdo, 46, Madrid 28007, Spain
| | - Ángela Morales
- Department of Endocrinology and Nutrition. Hospital General Universitario Gregorio Marañón. Madrid, IiSGGM, Calle del Dr. Esquerdo, 46, Madrid 28007, Spain
| | - Maria Luisa Carrascal
- Department of Endocrinology and Nutrition. Hospital General Universitario Gregorio Marañón. Madrid, IiSGGM, Calle del Dr. Esquerdo, 46, Madrid 28007, Spain
| | - Nieves Lopez Lazareno
- Department of Laboratory Medicine, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, Madrid 28007, Spain; Department of Endocrinology and Nutrition. Complejo Asistencial Universitario de León, Calle Altos de Nava, s/n, León 24008, Spain
| | - Montserrat Gonzalez-Estecha
- Department of Laboratory Medicine, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, Madrid 28007, Spain; Department of Endocrinology and Nutrition. Complejo Asistencial Universitario de León, Calle Altos de Nava, s/n, León 24008, Spain
| | - Maria D Ballesteros-Pomar
- Department of Endocrinology and Nutrition. Hospital Universitario Clínico San Carlos, IdISSC, Calle del Prof. Martín Lagos s.n., Madrid 28040, Spain
| | - Miguel Ángel Rubio-Herrera
- Department of Endocrinology and Nutrition. Hospital Universitario Clínico San Carlos, IdISSC, Calle del Prof. Martín Lagos s.n., Madrid 28040, Spain
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Huang HX, Hobson K, Benedetti C, Kennedy S. Water-soluble vitamins and trace elements in children with chronic kidney disease stage 5d. Pediatr Nephrol 2024; 39:1405-1419. [PMID: 37698654 DOI: 10.1007/s00467-023-06132-4] [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: 04/20/2023] [Revised: 07/19/2023] [Accepted: 08/09/2023] [Indexed: 09/13/2023]
Abstract
Children receiving maintenance dialysis (chronic kidney disease (CKD) stage 5d) have unique risk factors for micronutrient deficiency or toxicity. Children receiving chronic dialysis often require specialized diet plans that may provide more than the recommended daily allowance (RDA) of water-soluble vitamins and micronutrients, with or without the addition of a kidney-friendly vitamin. The following is a comprehensive review of current literature on disorders of micronutrients in this population including those of water-soluble vitamins (vitamin C and vitamin B complexes) and trace elements (copper, selenium, and zinc) and has three areas of focus: (1) the risk factors and clinical presentations of disorders of micronutrients, both deficiency and toxicity, (2) the tools to evaluate micronutrient status, and (3) the central role of renal dietitians in optimizing nutritional status from a micronutrient perspective.
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Affiliation(s)
| | - Kimberly Hobson
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, USA
| | | | - Sabina Kennedy
- Division of Nephrology, Emory University School of Medicine, 2015 Uppergate Drive, Office 316J, Atlanta, GA, 30322, USA.
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Watanabe LM, Pereira VAB, Noronha NY, de Souza Pinhel MA, Wolf LS, de Oliveira CC, Plaça JR, Noma IHY, da Silva Rodrigues G, de Souza VCO, Júnior FB, Nonino CB. The influence of serum selenium in differential epigenetic and transcriptional regulation of CPT1B gene in women with obesity. J Trace Elem Med Biol 2024; 83:127376. [PMID: 38183920 DOI: 10.1016/j.jtemb.2023.127376] [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: 01/22/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/08/2024]
Abstract
INTRODUCTION The increasing prevalence of obesity has become a major health problem worldwide. The causes of obesity are multifactorial and could be influenced by dietary patterns and genetic factors. Obesity has been associated with a decrease in micronutrient intake and consequently decreased blood concentrations. Selenium is an essential micronutrient for human health, and its metabolism could be affected by obesity, especially severe obesity. This study aimed to identify differential methylation genes associated with serum selenium concentration in women with and without obesity. METHODOLOGY Thirty-four patients were enrolled in the study and divided into two groups: Obese (Ob) n = 20 and Non-Obese (NOb) n = 14, according to the Body Mass Index (BMI). Anthropometry, body composition, serum selenium, selenium intake, and biochemical parameters were evaluated. DNA extraction and bisulfite conversion were performed to hybridize the samples on the 450k Methylation Chip Infinium Beadchip (Illumina). Bioinformatics analysis was performed using the R program and the Champ package. The differentially methylated regions (DMRs) were identified using the Bumphunter method. In addition, logarithmic conversion was performed for the analysis of serum selenium and methylation. RESULTS In the Ob group, the body weight, BMI, fat mass, and free fat mass were higher than in the NOb group, as expected. Interestingly, the serum selenium was lower in the Ob than in the NOb group without differences in selenium intake. One DMR corresponding to the CPT1B gene, involved in lipid oxidation, was related to selenium levels. This region was hypermethylated in the Ob group, indicating that the intersection between selenium deficiency and hypermethylation could influence the expression of the CPT1B gene. The transcriptional analysis confirmed the lower expression of the CPT1B gene in the Ob group. CONCLUSION Studies connecting epigenetics to environmental factors could offer insights into the mechanisms involving the expression of genes related to obesity and its comorbidities. Here we demonstrated that the mineral selenium might play an essential role in lipid oxidation via epigenetic and transcriptional regulation of the CPT1B gene in obesity.
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Affiliation(s)
- Lígia Moriguchi Watanabe
- Department of Health Sciences, Division of Nutrition and Metabolism, Ribeirão Preto Medical School, University of São Paulo, FMRP/USP, Brazil.
| | - Vanessa Aparecida Batista Pereira
- Department of Health Sciences, Division of Nutrition and Metabolism, Ribeirão Preto Medical School, University of São Paulo, FMRP/USP, Brazil
| | - Natalia Yumi Noronha
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, FMRP/USP, Brazil
| | - Marcela Augusta de Souza Pinhel
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, FMRP/USP, Brazil; Departament of Molecular Biology - São Jose do Rio Preto Medical School, Sao Jose do Rio Preto, São Paulo, Brazil
| | - Leticia Santana Wolf
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, FMRP/USP, Brazil
| | | | - Jessica Rodrigues Plaça
- National Institute of Science and Technology in Stem Cell and Cell Therapy (INCT/CNPq) and Center for Cell-Based Therapy, CEPID/FAPESP, Ribeirão Preto, São Paulo, Brazil
| | - Isabella Harumi Yonehara Noma
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | | | - Vanessa Cristina Oliveira de Souza
- Department of Clinical and Toxicological Analyses and Bromatology, Faculty of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, FCFRP/USP, Brazil
| | - Fernando Barbosa Júnior
- Department of Clinical and Toxicological Analyses and Bromatology, Faculty of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, FCFRP/USP, Brazil
| | - Carla Barbosa Nonino
- Department of Health Sciences, Division of Nutrition and Metabolism, Ribeirão Preto Medical School, University of São Paulo, FMRP/USP, Brazil; Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, FMRP/USP, Brazil
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Snow S, Gabrielson D, Lim H, Tehfe M, Brezden-Masley C. Best Practices for Managing Patients with Unresectable Metastatic Gastric and Gastroesophageal Junction Cancer in Canada. Curr Oncol 2024; 31:2552-2565. [PMID: 38785472 PMCID: PMC11120513 DOI: 10.3390/curroncol31050191] [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: 03/13/2024] [Revised: 04/15/2024] [Accepted: 04/20/2024] [Indexed: 05/25/2024] Open
Abstract
Gastric cancer (GC) is one of the most common types of cancer and is associated with relatively low survival rates. Despite its considerable burden, there is limited guidance for Canadian clinicians on the management of unresectable metastatic GC and gastroesophageal junction cancer (GEJC). Therefore, we aimed to discuss best practices and provide expert recommendations for patient management within the current Canadian unresectable GC and GEJC landscape. A multidisciplinary group of Canadian healthcare practitioners was assembled to develop expert recommendations via a working group. The often-rapid progression of unresectable GC and GEJC and the associated malnutrition have a significant impact on the patient's quality of life and ability to tolerate treatment. Hence, recommendations include early diagnosis, identification of relevant biomarkers to improve personalized treatment, and relevant support to manage comorbidities. A multidisciplinary approach including early access to registered dietitians, personal support networks, and palliative care services, is needed to optimize possible outcomes for patients. Where possible, patients with unresectable GC and GEJC would benefit from access to clinical trials and innovative treatments.
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Affiliation(s)
- Stephanie Snow
- Division of Medical Oncology, Department of Medicine, Dalhousie University, QEII-Bethune Building, Suite 449 Bethune Building, 1276 South Park Street, Halifax, NS B3H 2Y9, Canada
| | - Denise Gabrielson
- Division of Hematology/Oncology, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada
| | - Howard Lim
- Division of Medical Oncology, BC Cancer Vancouver, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
| | - Mustapha Tehfe
- Centre Hospitalier de l’Université de Montréal, 1000 Saint-Denis St, Montréal, QC H2X 0C1, Canada;
| | - Christine Brezden-Masley
- School of Medicine University of Toronto, Mount Sinai Hospital, 1284-600, University Avenue, Toronto, ON M5G 1X5, Canada;
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Zolfaghari F, Khorshidi Y, Moslehi N, Golzarand M, Asghari G. Nutrient Deficiency After Bariatric Surgery in Adolescents: A Systematic Review and Meta-Analysis. Obes Surg 2024; 34:206-217. [PMID: 37991712 DOI: 10.1007/s11695-023-06955-y] [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: 04/08/2023] [Revised: 11/04/2023] [Accepted: 11/13/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE This systematic review and meta-analysis study aimed to estimate changes in blood nutrient concentrations and nutrient deficiencies in adolescents following bariatric surgery. METHODS We searched PubMed, Scopus, and the Web of Science to find studies published between January 2000 and August 2023. Observational studies reporting the mean blood concentration of nutrients before and after bariatric surgery or the proportion of nutrient deficiencies after the surgery in healthy adolescents were selected. RESULTS Fifteen studies were included. Gastric bypass and sleeve gastrostomy were the most common types of surgery. Vitamin D, iron, or ferritin, vitamin B12, calcium, and folic acid were the most studied nutrients, respectively. Other nutrients examined in the studies included zinc, phosphorus, and albumin. The serum ferritin increased by 21 mcg/L (95% CI = 10.0, 32.0 mcg/L) after the surgery, but there were no significant alterations in other nutrients. The postoperative prevalence of low albumin, ferritin, vitamin D, and vitamin B12 levels was 10%, 49%, 41%, and 20%, respectively. Also, 23% had an iron deficiency, and 10% had a calcium deficiency after bariatric surgery. CONCLUSIONS The serum ferritin level increased following bariatric surgery in adolescents. Vitamin D and ferritin deficiencies were estimated to be present in more than one-third of adolescents after the surgery.
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Affiliation(s)
- Faraneh Zolfaghari
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-4741, Tehran, Iran
| | - Yasaman Khorshidi
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-4741, Tehran, Iran
| | - Nazanin Moslehi
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-4763, Tehran, Iran.
| | - Mahdieh Golzarand
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-4763, Tehran, Iran
| | - Golaleh Asghari
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-4741, Tehran, Iran.
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Alexander J, Olsen AK. Selenium - a scoping review for Nordic Nutrition Recommendations 2023. Food Nutr Res 2023; 67:10320. [PMID: 38187789 PMCID: PMC10770655 DOI: 10.29219/fnr.v67.10320] [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] [Received: 10/03/2022] [Revised: 07/21/2023] [Accepted: 10/25/2023] [Indexed: 01/09/2024] Open
Abstract
Selenium is an essential trace element in humans, critical to the normal physiology in all animal species. The main form of selenium in food is selenomethionine, selenocysteine and a variety of organic compounds, while inorganic salts mainly occur in food supplements. In animals and humans, selenium occurs as selenocysteine in selenoproteins encoded by 25 genes (specific selenium pool). Several selenoproteins are part of the antioxidant enzyme system and serve as oxido-reductases and in thyroid hormone regulation. SelenoproteinP (SELENOP) transports selenium to peripheral tissues, is the main plasma selenoprotein, and has been used as biomarker of selenium status and intake. SELENOP in plasma represents a saturable pool of selenium and is maximised at a selenium concentration in plasma of about 110 µg/L or an intake of selenomethionine at about 1.2 µg/kg body weight in adults. In Finland, with an estimated selenium intake of 88 µg/day in men and 68 µg/day in women, the average selenium concentration in plasma is about 110 µg/L. Imported wheat from selenium rich areas is an important dietary source in Norway. Dietary intakes in the Nordic and Baltic area vary from 39 to 88 µg/day in men and 22 to 68 µg/day in women, the highest levels were from Finland. Most intervention trials on the effect of selenium supplementation on health outcomes have been carried out in 'selenium-replete'-populations and show no beneficial effect, which from a nutritional point of view would rather not be expected. Some intervention studies conducted in populations low in selenium have showed a beneficial effect. Observational studies suggest an inverse relationship between selenium status and risk of cardiovascular diseases (CVDs), cancer and all-cause mortality, and some other outcomes at low levels of intake (<55 µg/day) or in plasma or serum (<100 µg/L). However, a lack of quantitative data and inconsistencies between studies precludes these studies to be used to derive dietary reference values. At high intakes above 330 to 450 µg/day selenium may cause toxic effects affecting liver, peripheral nerves, skin, nails, and hair. An upper tolerable level (UL) of 255 µg selenium/day in adults was established by EFSA.
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Dixit D, Rodriguez VI, Naumann AA, Kamel AY. Multiple micronutrient deficiencies as a long-term complication of bariatric surgery. BMJ Case Rep 2023; 16:e254775. [PMID: 38061845 PMCID: PMC10711813 DOI: 10.1136/bcr-2023-254775] [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] [Indexed: 12/18/2023] Open
Abstract
Micronutrient deficiencies may develop as a long-term complication of bariatric surgery due to alteration of gut anatomy and disruption of normal gut absorption. Inadequate repletion of essential vitamin and mineral deficiencies can lead to multisystem dysfunction. We present a case of a woman in her 50s, with a history of Roux-en-Y gastric bypass over 10 years ago, who presented with generalised weakness and a diffuse desquamating rash. A punch biopsy performed was compatible with nutritional deficiency. Labs revealed low levels of micronutrients A, B1, B6, C, E, zinc and copper. The patient received intravenous micronutrients and an oral regimen, which improved her symptoms. Unfortunately, the patient died from cardiac arrest secondary to pulmonary oedema. This report highlights the importance of high suspicion of micronutrient deficiency in patients with a history of bariatric surgery and maintaining lifelong nutritional follow-up.
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Affiliation(s)
- Devika Dixit
- Internal Medicine, University of Florida, Gainesville, Florida, USA
| | | | - Ashton A Naumann
- Internal Medicine, Washington University, St Louis, Missouri, USA
| | - Amir Y Kamel
- Pharmacy, UF Health Shands Hospital, Gainesville, Florida, USA
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Bretón I, Ballesteros-Pomar MD, Calle-Pascual A, Alvarez-Sala LA, Rubio-Herrera MA. Micronutrients in Pregnancy after Bariatric Surgery: A Narrative Review. J Clin Med 2023; 12:5429. [PMID: 37629473 PMCID: PMC10455502 DOI: 10.3390/jcm12165429] [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: 06/12/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Bariatric surgery is increasingly used in women of childbearing age due to the rising prevalence of obesity and the effectiveness and availability of this treatment. Pregnancy in women with previous bariatric surgery deserves special attention. Weight loss induced by surgery reduces the risks that obesity poses to pregnancy. But on the other hand, decreased intake and malabsorption may increase the risk of malnutrition and micronutrient deficiency and negatively affect maternal and foetal health. The aim of this narrative review is to provide an updated analysis of the impact of different bariatric surgery techniques on mineral and micronutrient nutritional status during pregnancy and the possible effect on maternal-foetal health.
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Affiliation(s)
- Irene Bretón
- Department of Endocrinology and Nutrition, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- Department of Medicine, Facultad de Medicina, Universidad Complutense, 28040 Madrid, Spain
| | - María D. Ballesteros-Pomar
- Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, 24008 León, Spain
| | - Alfonso Calle-Pascual
- Department of Medicine, Facultad de Medicina, Universidad Complutense, 28040 Madrid, Spain
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029 Madrid, Spain
| | - Luis Antonio Alvarez-Sala
- Department of Medicine, Facultad de Medicina, Universidad Complutense, 28040 Madrid, Spain
- Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Miguel Angel Rubio-Herrera
- Department of Medicine, Facultad de Medicina, Universidad Complutense, 28040 Madrid, Spain
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, 28040 Madrid, Spain
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Quinn LA, Gilley SP, Ta AD, Frank BS, Foley CB, Moore JM. Case report: Pulmonary hypertensive crisis leading to cardiac arrest during endoscopic evaluation in a 6-year-old boy with autism, severe malnutrition, and undiagnosed scurvy. Front Pediatr 2022; 10:1008507. [PMID: 36389378 PMCID: PMC9650637 DOI: 10.3389/fped.2022.1008507] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/28/2022] [Indexed: 11/13/2022] Open
Abstract
Pediatric gastroenterologists are often responsible for the evaluation of malnutrition in the setting of selective eating. Endoscopic evaluation for conditions including eosinophilic esophagitis and celiac disease can help to identify and treat mucosal disease contributing to food selectivity. However, undiagnosed micronutrient deficiencies can cause cardiovascular derangements that significantly increase a patient's anesthetic risk. Vitamin C deficiency in particular, alone or in combination with severe malnutrition, is associated with a severe but reversible form of pulmonary arterial hypertension that, while life threatening in the acute phase, may significantly improve within days of starting ascorbic acid replacement therapy. Here we present a case of a 6-year-old boy with autism spectrum disorder (ASD), severe malnutrition, and undiagnosed chronic vitamin C deficiency who developed a pulmonary hypertensive crisis after induction of general anesthesia leading to cardiac arrest during endoscopic evaluation. While the association between food selectivity among youth with neurodevelopmental differences and vitamin C deficiency is well-described, and pulmonary hypertension is a recognized rare complication of scurvy, extant literature has not addressed next steps to improve patient outcomes. Using this case report as a foundation, we discuss specific patient populations to screen and treat for micronutrient deficiencies prior to anesthesia and propose a novel clinical algorithm for pre-anesthesia risk stratification and mitigation in patients specifically at risk for scurvy and associated pulmonary hypertension.
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Affiliation(s)
- Laura A. Quinn
- Department of Pediatrics, Section of Pediatric Gastroenterology, Hepatology and Nutrition, University of Colorado School of Medicine, Aurora, CO, United States
| | - Stephanie P. Gilley
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO, United States
| | - Allison D. Ta
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO, United States
| | - Benjamin S. Frank
- Department of Pediatrics, Section of Cardiology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Carolyn B. Foley
- Department of Anesthesiology, Division of Pediatric Anesthesiology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Jaime M. Moore
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO, United States
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B1 Vitamin Deficiency After Bariatric Surgery, Prevalence, and Symptoms: a Systematic Review and Meta-analysis. Obes Surg 2022; 32:3104-3112. [PMID: 35776243 DOI: 10.1007/s11695-022-06178-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 10/17/2022]
Abstract
B1 deficiency is a very prevalent complication of bariatric surgery. This study reviews prevalence and symptoms of B1 vitamin deficiency after bariatric surgery. PubMed, Scopus, and Web of Science published were searched up to 10 Feb 2022, with the following keywords: Roux-en-Y gastric bypass, one anastomosis gastric bypass, Omega bypass, Mini bypass, Bariatric surgery OR Bariatric surgery, metabolic surgery, Weight loss surgery, Classic gastric bypass, Loop gastric bypass, Gastric Bypass, thiamine OR thiamin, beriberi, B1. A total of 11 studies examining 1494 patients were included in this meta-analysis. Twenty-seven percent of patients who underwent bariatric surgeries experience vitamin B1 deficiency. Thiamine supplements should be prescribed for the patients for the rest of their lives, and also standard post-surgery follow-ups are necessary in terms of monitoring dietary factors.
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11
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Eksteen G, Steenackers N, Van der Schueren B, Vanuytsel T, Matthys C. Selenium Deficiency After Bariatric Surgery Is More Than Surface Deep. Obes Surg 2022; 32:2473-2475. [PMID: 35501636 DOI: 10.1007/s11695-022-06084-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 04/15/2022] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Gabriël Eksteen
- Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Nele Steenackers
- Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Bart Van der Schueren
- Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium.,Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Tim Vanuytsel
- Translational Research Center for Gastrointestinal Disorders, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Christophe Matthys
- Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium. .,Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium.
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Shahabi Shahmiri S, Eghbali F, Ismaeil A, Gholizadeh B, Khalooeifard R, Valizadeh R, Rokhgireh S, Kermansaravi M. Invited Response Letter: “Selenium Deficiency After Bariatric Surgery Is More Than Surface Deep”. Obes Surg 2022; 32:2476. [DOI: 10.1007/s11695-022-06085-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 04/22/2022] [Accepted: 04/26/2022] [Indexed: 11/24/2022]
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