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Vieira de Sousa JP, Santos-Sousa H, Vieira S, Nunes R, Nogueiro J, Pereira A, Resende F, Costa-Pinho A, Preto J, Sousa-Pinto B, Carneiro S, Lima-da-Costa E. Assessing Nutritional Deficiencies in Bariatric Surgery Patients: A Comparative Study of Roux-en-Y Gastric Bypass versus Sleeve Gastrectomy. J Pers Med 2024; 14:650. [PMID: 38929871 PMCID: PMC11204764 DOI: 10.3390/jpm14060650] [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: 04/27/2024] [Revised: 06/09/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
Obesity is a worldwide epidemic, and bariatric surgery is considered the primary treatment for long-term weight loss and managing obesity-related health issues. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the most performed procedures. Nutritional deficiencies are a significant concern following bariatric surgery and can have serious consequences. This study aims to compare the incidence of nutritional deficiencies in patients undergoing RYGB and SG. A retrospective analysis was conducted on the nutritional status of 505 consecutive patients who underwent either RYGB or SG between January and December 2019. Data were collected regarding vitamin B12, folic acid, vitamin D, calcium, PTH, magnesium, hemoglobin, iron, ferritin, and transferrin at preoperative, 6-month, and 12-month intervals post-surgery. The RYGB group showed significantly higher excess weight loss. Vitamin B12, hemoglobin, and ferritin levels were consistently higher in the SG group throughout the study. Vitamin D deficiency was prevalent, with no significant difference between the groups. Vitamin B12 deficiency was significantly more common in the RYGB group (6 months: 17.46% vs. 4.69%, p < 0.001; 12 months: 16.74% vs. 0.93%, p < 0.001). Despite differences in their mechanisms, bariatric surgeries were associated with nutritional deficiencies. It is crucial to efficiently assess, prevent, and manage these deficiencies tailored to each surgical procedure.
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Affiliation(s)
- José P. Vieira de Sousa
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (J.P.V.d.S.); (S.V.); (R.N.); (J.N.); (A.P.); (F.R.); (A.C.-P.); (B.S.-P.); (S.C.); (E.L.-d.-C.)
- Surgery Department, São João University Medical Center, 4200-319 Porto, Portugal
| | - Hugo Santos-Sousa
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (J.P.V.d.S.); (S.V.); (R.N.); (J.N.); (A.P.); (F.R.); (A.C.-P.); (B.S.-P.); (S.C.); (E.L.-d.-C.)
- Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, 4200-319 Porto, Portugal;
| | - Sofia Vieira
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (J.P.V.d.S.); (S.V.); (R.N.); (J.N.); (A.P.); (F.R.); (A.C.-P.); (B.S.-P.); (S.C.); (E.L.-d.-C.)
| | - Rita Nunes
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (J.P.V.d.S.); (S.V.); (R.N.); (J.N.); (A.P.); (F.R.); (A.C.-P.); (B.S.-P.); (S.C.); (E.L.-d.-C.)
| | - Jorge Nogueiro
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (J.P.V.d.S.); (S.V.); (R.N.); (J.N.); (A.P.); (F.R.); (A.C.-P.); (B.S.-P.); (S.C.); (E.L.-d.-C.)
- Surgery Department, São João University Medical Center, 4200-319 Porto, Portugal
| | - André Pereira
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (J.P.V.d.S.); (S.V.); (R.N.); (J.N.); (A.P.); (F.R.); (A.C.-P.); (B.S.-P.); (S.C.); (E.L.-d.-C.)
- Surgery Department, São João University Medical Center, 4200-319 Porto, Portugal
| | - Fernando Resende
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (J.P.V.d.S.); (S.V.); (R.N.); (J.N.); (A.P.); (F.R.); (A.C.-P.); (B.S.-P.); (S.C.); (E.L.-d.-C.)
- Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, 4200-319 Porto, Portugal;
| | - André Costa-Pinho
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (J.P.V.d.S.); (S.V.); (R.N.); (J.N.); (A.P.); (F.R.); (A.C.-P.); (B.S.-P.); (S.C.); (E.L.-d.-C.)
- Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, 4200-319 Porto, Portugal;
| | - John Preto
- Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, 4200-319 Porto, Portugal;
| | - Bernardo Sousa-Pinto
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (J.P.V.d.S.); (S.V.); (R.N.); (J.N.); (A.P.); (F.R.); (A.C.-P.); (B.S.-P.); (S.C.); (E.L.-d.-C.)
- MEDCIDS—Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
- CINTESIS—Center for Health Technology and Services Research, 4200-450 Porto, Portugal
| | - Silvestre Carneiro
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (J.P.V.d.S.); (S.V.); (R.N.); (J.N.); (A.P.); (F.R.); (A.C.-P.); (B.S.-P.); (S.C.); (E.L.-d.-C.)
- Surgery Department, São João University Medical Center, 4200-319 Porto, Portugal
| | - Eduardo Lima-da-Costa
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (J.P.V.d.S.); (S.V.); (R.N.); (J.N.); (A.P.); (F.R.); (A.C.-P.); (B.S.-P.); (S.C.); (E.L.-d.-C.)
- Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, 4200-319 Porto, Portugal;
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Soheilipour F, Eskandari D, Abolghasemi J. Anemia Status Changes Among Patients With Obesity Following Bariatric Surgery. Cureus 2024; 16:e60500. [PMID: 38764702 PMCID: PMC11101909 DOI: 10.7759/cureus.60500] [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: 05/17/2024] [Indexed: 05/21/2024] Open
Abstract
Objective This study aims to investigate trends in anemia severity among patients with pre-existing anemia who underwent bariatric surgery due to obesity. It also examines how different bariatric surgery techniques impact anemia outcomes. Methods This prospective study included 280 patients aged 18 to 65 with obesity who underwent bariatric surgery. The patients were categorized into three groups based on the type of surgery: sleeve gastrectomy, one-anastomosis gastric bypass, and Roux-en-Y gastric bypass. Anemia severity was evaluated over a 12-month follow-up period. Chi-square tests were used to assess the homogeneity of baseline factors among the groups, and McNemar tests along with generalized estimating equations were used to compare anemia outcomes. Results Before surgery, the rates of moderate anemia across the three surgical groups ranged from 18.2% to 22.4%, with no cases of severe anemia observed. There was no significant difference among the groups (p=0.949). During the 12-month follow-up, the odds ratio for reducing anemia severity in the sleeve gastrectomy and Roux-en-Y gastric bypass groups were 2.13 and 1.91, respectively, compared to the one-anastomosis gastric bypass group. Additionally, the odds ratio for reducing anemia severity in patients with hypothyroidism was 1.84 compared to those without hypothyroidism. Conclusion The choice of bariatric surgery technique significantly affects anemia outcomes, with sleeve gastrectomy showing a higher success rate in reducing anemia severity. The role of hypothyroidism in anemia management also appears to be significant.
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Affiliation(s)
- Fahimeh Soheilipour
- Minimally Invasive Surgery Research Center, Department of Pediatric Endocrinology, Iran University of Medical Sciences, Tehran, IRN
| | - Delaram Eskandari
- Medicine, Iran University of Medical Sciences, Hazrat Rasoul Hospital, Tehran, IRN
| | - Jamileh Abolghasemi
- Department of Biostatistics, Iran University of Medical Sciences, Tehran, IRN
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Bahardoust M, Mousavi S, Ziafati H, Alipour H, Haghmoradi M, Olamaeian F, Tayebi A, Tizmaghz A. Vitamin B12 deficiency after total gastrectomy for gastric cancer, prevalence, and symptoms: a systematic review and meta-analysis. Eur J Cancer Prev 2024; 33:208-216. [PMID: 37669168 DOI: 10.1097/cej.0000000000000838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
PURPOSE Nutrient deficiency is one of the common complications in patients who undergo gastrectomy, especially those vitamins and minerals absorbed in the stomach or by substances in the gastric juice, such as vitamin B12. Hence, this systematic review and meta-analysis were conducted for the first time to investigate the prevalence of vitamin B12 deficiency and its symptoms in gastric cancer (GC) patients who underwent gastrectomy. METHOD PubMed, Scopus, Google Scholar, and Web of Science databases were searched to find related studies. After screening, studies were selected based on the abstract and title of related studies. The heterogeneity and inconsistency between studies were evaluated using Cochran's Q, I 2 tests. Egger's test analyzed publication bias for studies. A 95% confidence interval (95% CI) was used to estimate the overall prevalence of vitamin B12 deficiency. RESULTS Fourteen studies, including 2627 GC patients who underwent surgery, were included in the study. The mean age of the patients in this study was 61.2 ± 4.93 years. The pooled estimate of meta-analysis results showed that the prevalence of vitamin B12 deficiency after gastrectomy in patients with GC was 48.8% (95% CI:32.4, 65.2%, I 2 : 98.85, τ 2 = 0.05, Q (13) = 1127.8, P < 0.001). The most important symptoms were anemia, fatigability, cold feet or legs, numbness, and dizziness. CONCLUSION AND RECOMMENDATION Vitamin B12 deficiency has a high prevalence among patients who have undergone gastrectomy, and it is necessary to pay enough attention to treating these patients after surgery to prevent its complications.
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Affiliation(s)
- Mansour Bahardoust
- Department of General Surgery, School of Medicine, Firoozabadi Hospital, Iran University of Medical Sciences
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Safa Mousavi
- Department of Public Health, College of Health and Human Services, California State University, Fresno, California, USA
| | - Hassan Ziafati
- Department of General Surgery, School of Medicine, Firoozabadi Hospital, Iran University of Medical Sciences
| | | | - Meisam Haghmoradi
- Department of Orthopedic Surgery, Urmia University of Medical Sciences, Urmia, Iran
| | - Faranak Olamaeian
- Department of General Surgery, School of Medicine, Firoozabadi Hospital, Iran University of Medical Sciences
| | - Ali Tayebi
- Department of General Surgery, School of Medicine, Firoozabadi Hospital, Iran University of Medical Sciences
| | - Adnan Tizmaghz
- Department of General Surgery, School of Medicine, Firoozabadi Hospital, Iran University of Medical Sciences
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Pang WS, Loo GH, Tan GJ, Mardan M, Rajan R, Kosai NR. Comparative evaluation of early diabetic outcomes in southeast asian patients with type 2 diabetes mellitus undergoing Roux-en-Y gastric bypass (RYGB) versus sleeve gastrectomy (LSG). Sci Rep 2024; 14:614. [PMID: 38182725 PMCID: PMC10770027 DOI: 10.1038/s41598-024-51384-1] [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: 04/07/2023] [Accepted: 01/04/2024] [Indexed: 01/07/2024] Open
Abstract
Obesity and type 2 diabetes mellitus (T2DM) is an alarming problem globally and a growing epidemic. Metabolic surgery has been shown to be successful in treating both obesity and T2DM, usually after other treatments have failed. This study aims to compare Roux-Y gastric bypass and sleeve gastrectomy in determining early diabetic outcomes in obese Malaysian patients with T2DM following surgery. A total of 172 obese patients with T2DM who were assigned to either laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) were analysed up to a year post-procedure. The patients' T2DM severity were stratified using the Individualized Metabolic Surgery (IMS) score into mild, moderate and severe. Remission rates of diabetes were compared between surgical techniques and within diabetic severity categories. T2DM remission for patients who underwent either surgical technique for mild, moderate or severe disease was 92.9%, 56.2% and 14.7% respectively. Both surgical techniques improved T2DM control for patients in the study. Comparing baseline with results 1 year postoperatively, median HbA1c reduced from 7.40% (IQR 2.60) to 5.80% (IQR 0.80) (p < 0.001), mean total antidiabetic medications use reduced from 1.48 (SD 0.99) to 0.60 (SD 0.86) [p < 0.001], insulin usage reduced from 27.9 to 10.5% (p < 0.001), and T2DM control improved from 27.9 to 82% (p < 0.001). The patients had a median excess BMI loss of 69.4% (IQR 34%) and 53.2% (IQR 36.0%) for RYGB and SG respectively (p = 0.016). At one year following surgery, there is no difference between LRYGB and LSG in terms of diabetic remission. LSG is not inferior to LRYGB in terms of early diabetic outcomes. Milder T2DM shows a better response. LSG is a simpler procedure with a lower risk profile and should be considered as an early treatment option for obese patients with T2DM.
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Affiliation(s)
- Wei Soon Pang
- Department of Surgery, Pusat Perubatan Universiti Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia
| | - Guo Hou Loo
- Department of Surgery, Pusat Perubatan Universiti Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia.
| | - Guo Jeng Tan
- Department of Internal Medicine, Pusat Perubatan Universiti Kebangsaan Malaya, 59100, Kuala Lumpur, Malaysia
| | - Mardiana Mardan
- Department of Surgery, Pusat Perubatan Universiti Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia
| | - Reynu Rajan
- Department of Surgery, Pusat Perubatan Universiti Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia
| | - Nik Ritza Kosai
- Department of Surgery, Pusat Perubatan Universiti Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia
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Steenackers N, Van der Schueren B, Augustijns P, Vanuytsel T, Matthys C. Development and complications of nutritional deficiencies after bariatric surgery. Nutr Res Rev 2023; 36:512-525. [PMID: 36426645 DOI: 10.1017/s0954422422000221] [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: 11/27/2022]
Abstract
The clinical effectiveness of bariatric surgery has encouraged the use of bariatric procedures for the treatment of morbid obesity and its comorbidities, with sleeve gastrectomy and Roux-en-Y gastric bypass being the most common procedures. Notwithstanding its success, bariatric procedures are recognised to predispose the development of nutritional deficiencies. A framework is proposed that provides clarity regarding the immediate role of diet, the gastrointestinal tract and the medical state of the patient in the development of nutritional deficiencies after bariatric surgery, while highlighting different enabling resources that may contribute. Untreated, these nutritional deficiencies can progress in the short term into haematological, muscular and neurological complications and in the long term into skeletal complications. In this review, we explore the development of nutritional deficiencies after bariatric surgery through a newly developed conceptual framework. An in-depth understanding will enable the optimisation of the post-operative follow-up, including detecting clinical signs of complications, screening for laboratory abnormalities and treating nutritional deficiencies.
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Affiliation(s)
- Nele Steenackers
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Bart Van der Schueren
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Patrick Augustijns
- Drug Delivery and Disposition, Department of Pharmaceutical and Pharmacological Sciences, KU 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 and Metabolism, KU Leuven, Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
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Hoffman K, Shah R, Ismail M, Satyavada S, Alkhayyat M, Mansoor E, Cooper G. Incidence of Kidney Stones After Bariatric Surgeries: Comparing Roux-en-Y Gastric Bypass and Sleeve Gastrectomy. J Gastrointest Surg 2023; 27:2336-2341. [PMID: 37783913 DOI: 10.1007/s11605-023-05849-9] [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: 07/20/2023] [Accepted: 09/08/2023] [Indexed: 10/04/2023]
Abstract
INTRODUCTION/PURPOSE The two most common procedures performed to treat obesity are Roux-En-Y gastric bypass (RNYGB) and laparoscopic sleeve gastrectomy (LSG). Due to changes in enteric absorption, bariatric surgery increases rates of nephrolithiasis. As population-based data are limited, we aimed to compare the incidence of kidney stones after RNYGB and LSG. MATERIALS AND METHODS We queried Explorys (Cleveland, OH), a database that aggregated data from 26 healthcare systems. We identified patients who were newly diagnosed with nephrolithiasis 3, 6, and 12 months after their RNYGB or LSG. Additionally, a multivariate analysis was conducted to investigate the association of nephrolithiasis with RNYGB as compared to LSG. This analysis adjusted for other risk factors, including age above 65, male gender, Caucasian race, diabetes mellitus, hypertension, primary hyperparathyroidism, gout, and obesity. RESULTS From 1999 to 2019, there were 11,480 patients who underwent RNYGB and 22,770 patients who underwent LSG. The incidence of nephrolithiasis in the RNYGB cohort at all three time points was higher than in the LSG cohort (3 months, 7.1% vs. 2.4%; 6 months, 6.6% vs. 2.0%; 1 year, 5.8% vs. 1.4%; P < 0.001). After the multivariate analysis, it was found that, though both RNYGB and LSG were independently associated with the development of nephrolithiasis, the risk of nephrolithiasis was higher in those who underwent RNYGB compared to those who underwent LSG (OR 1.594, 95% CI 1.494 to 1.701, P < 0.001). CONCLUSION RNYGB is associated with a higher risk of nephrolithiasis when compared to LSG.
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Affiliation(s)
- Kyle Hoffman
- Division of Gastroenterology, Hepatology, and Nutrition, UPMC, Mezzanine Level, C-Wing, PUH, 200 Lothrop St, Pittsburgh, PA, 15213, USA.
- Department of Medicine, University Hospitals, Cleveland, OH, USA.
| | - Raj Shah
- Division of Gastroenterology, Hepatology, and Endoscopy, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Mayada Ismail
- Division of Gastroenterology, Hepatology, and Nutrition, University at Buffalo, Buffalo, NY, USA
| | - Sagarika Satyavada
- Division of Gastroenterology and Hepatology, University of Texas at Austin, Austin, TX, USA
| | - Mo'tasem Alkhayyat
- Department of Gastroenterology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Emad Mansoor
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Gastroenterology and Hepatology Section, VA Northeast Ohio Healthcare System, Cleveland, OH, USA
| | - Gregory Cooper
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Digestive Health Institute, University Hospitals Cleveland Medical Center/Seidman Cancer Center, Cleveland, OH, USA
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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.
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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
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Ba DM, Hu A, Shen C, Leslie DL, Chinchilli VM, Rogers AM, Al-Shaar L. Trends and predictors of nutritional deficiencies after bariatric surgeries: analysis of real-world data. Surg Obes Relat Dis 2023; 19:935-943. [PMID: 37005153 DOI: 10.1016/j.soard.2023.02.013] [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: 09/17/2022] [Revised: 01/30/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Bariatric surgery (BS) can lead to postoperative nutritional deficiencies (NDs) due to restrictive and malabsorptive mechanisms, but there is limited literature quantifying NDs' prevalence over time and their predictors among patients undergoing BS. OBJECTIVE To characterize time trends and predictors of postoperative NDs. SETTING This retrospective cohort study used the U.S. IBM MarketScan commercial claims database (2005-2019) to include adults who underwent BS with continuous enrollment. METHODS BS included Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), adjustable gastric band (AGB), and biliopancreatic diversion with duodenal switch. NDs included protein malnutrition, deficiencies in vitamins D and B12, and anemia that may be related to NDs. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of NDs across BS types after adjusting for other patient factors. RESULTS Within 83,635 patients (mean age [SD], 44.5 [9.5] yr; 78% female patients), 38.7%, 32.9%, and 28% underwent RYGB, SG, and AGB, respectively. Age-adjusted prevalence of any NDs within 1, 2, and 3 years after BS ranged from 23%, 34%, and 42%, respectively (in 2006) to 44%, 54%, and 61%, respectively (in 2016). Relative to the AGB group, the adjusted OR of any 3-year postoperative NDs was 3.00 (95% CI, 2.89-3.11) for the RYGB group and 2.42 (95% CI, 2.33-2.51) for the SG group. CONCLUSIONS RYGB and SG were associated with 2.4- to 3.0-fold odds of developing 3-year postoperative NDs compared with AGB, independent of baseline ND status. Pre- and postoperative nutritional assessments are recommended for all patients undergoing BS to optimize postoperative outcomes.
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Affiliation(s)
- Djibril M Ba
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania.
| | - Antoinette Hu
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Chan Shen
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania; Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Douglas L Leslie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Vernon M Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Ann M Rogers
- Department of Surgery - Division of Minimally Invasive and Bariatric Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Laila Al-Shaar
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania.
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Vargas CM, Gómez D, Madrigal V, Guilbert L, Sepúlveda EM, Rodríguez FM, Zerrweck C. Women with Anemia Refractory to Oral Iron Treatment Following Bariatric Surgery: a Short-Term Analysis. Obes Surg 2023; 33:846-850. [PMID: 36602723 DOI: 10.1007/s11695-022-06447-5] [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: 08/12/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Iron deficiency and anemia are common after bariatric surgery. Women have a higher risk of developing such long-term complications. Though oral supplementation is indicated, intravenous iron therapy is required in some cases. METHODS This retrospective study included patients who underwent bariatric surgery between 2012 and 2018. Postoperative anemia patients receiving parental iron therapy were assessed during the first 24 months. Their baseline characteristics, surgery type, and laboratory test results were analyzed. A follow-up analysis included a subgroup of women with and without gynecological disorders. Patients with vitamin B12 or folic acid deficiencies were excluded. RESULTS Six hundred eleven (63.3%) met the inclusion criteria: 525 underwent gastric bypass, of which 79.6% were women. Overall, postoperative anemia was 28.9% (24.5% related to gastric bypass), especially among women (84%). Anemia refractory to oral iron therapy was observed in 12.9% of patients. All the patients requiring iron infusions (n = 54) were women, and half of them (51.8%) reported abnormal uterine bleeding. Postsurgical hemogram values were significantly lower in patients with abnormal uterine bleeding (despite the same number of infusions) than in those without gynecological disorders; 89.2% of these women had preoperative anemia. CONCLUSION Anemia is frequent in bariatric surgery patients despite supplementation. Women undergoing gastric bypass with a history of gynecological disorders are prone to require more iron infusions. Consulting with the patient about a higher risk is important, and probably knowing the plan or including the opinion of an OBGYN to determine as a team the assessment, treatment, and prognosis.
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Affiliation(s)
- César M Vargas
- The Obesity Clinic, Hospital General Tláhuac, Avenida La Turba #655, Col. Villa Centroamericana Y del Caribe, Del. Tláhuac, 13250, Mexico City, Mexico
| | - Dalio Gómez
- The Obesity Clinic, Hospital General Tláhuac, Avenida La Turba #655, Col. Villa Centroamericana Y del Caribe, Del. Tláhuac, 13250, Mexico City, Mexico
| | - Violeta Madrigal
- The Obesity Clinic, Hospital General Tláhuac, Avenida La Turba #655, Col. Villa Centroamericana Y del Caribe, Del. Tláhuac, 13250, Mexico City, Mexico
| | - Lizbeth Guilbert
- The Obesity Clinic, Hospital General Tláhuac, Avenida La Turba #655, Col. Villa Centroamericana Y del Caribe, Del. Tláhuac, 13250, Mexico City, Mexico
| | - Elisa M Sepúlveda
- The Obesity Clinic, Hospital General Tláhuac, Avenida La Turba #655, Col. Villa Centroamericana Y del Caribe, Del. Tláhuac, 13250, Mexico City, Mexico
| | - Fátima M Rodríguez
- The Obesity Clinic, Hospital General Tláhuac, Avenida La Turba #655, Col. Villa Centroamericana Y del Caribe, Del. Tláhuac, 13250, Mexico City, Mexico
| | - Carlos Zerrweck
- The Obesity Clinic, Hospital General Tláhuac, Avenida La Turba #655, Col. Villa Centroamericana Y del Caribe, Del. Tláhuac, 13250, Mexico City, Mexico.
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10
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Perez SC, Alessi IG, Wheeler AA. Hypoalbuminemia as a risk factor for complications in revisional/conversional bariatric surgery: an MBSAQIP analysis. Surg Obes Relat Dis 2022; 19:555-561. [PMID: 36604225 DOI: 10.1016/j.soard.2022.12.010] [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: 10/07/2022] [Revised: 11/22/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hypoalbuminemia (HA) is a risk factor for serious complications after elective bariatric surgery. Patients undergoing revisional/conversional bariatric surgery may represent a higher-risk group who often have underlying co-morbid medical illnesses and more complex surgery. OBJECTIVES This study investigated the postoperative complications in patients with HA undergoing revisional/conversional bariatric surgery. SETTING Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), years 2015-2019. METHODS The MBSAQIP database was used to evaluate patients undergoing non-banding revisional/conversional bariatric surgery between 2015 and 2019. Patients were categorized by serum albumin (≤3.5 g/dL). Variables were assessed via bivariate analysis and multivariable regression. Propensity score matching was conducted to compare gastric bypass (RYGB) to sleeve gastrectomy (VSG). RESULTS One hundred forty-seven thousand four hundred thirty patients underwent revisional/conversional procedures. After applied exclusions, 58,777 patients were available for analysis. The HA group had a significantly (P < .05) higher prevalence of being black (22.95% versus 17.76%), renal insufficiency (1.08% versus .36%), smoking history (9.47% versus 6.91%), chronic obstructive pulmonary disease (COPD) (2.54% versus 1.33%), and history of deep vein thrombosis (DVT) (4.03% versus 2.3%). Postoperative complications associated with HA included perioperative blood transfusion (3.1% versus 1.27%; P < .001), 30day readmission (10.87 versus 6.77%; P < .001), 30day reoperation (4.9% versus 3.18%; P < .001), and 30day mortality (.40% versus .14%; P < .0001). HA was a significant predictor of 30day readmission in the RYGB versus VSG matched cohort (odds ratio [OR], 1.30; 95% confidence interval [CI], [1.14, 1.48]; P < .001). CONCLUSIONS HA is a risk factor requiring attention for patients undergoing revisional/conversional bariatric surgery and optimization of nutritional status or medical comorbidities associated with HA prior to bariatric surgery may help avoid postoperative complications.
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Affiliation(s)
- Samuel C Perez
- Department of Surgery, University of Missouri School of Medicine, Columbia, Missouri.
| | - Isabella G Alessi
- Department of Surgery, University of Missouri School of Medicine, Columbia, Missouri
| | - Andrew A Wheeler
- Department of Surgery, University of Missouri School of Medicine, Columbia, Missouri
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11
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Kang M, Li W. Time-in-range: a promising glycemic control metric for bariatric surgery. Surg Obes Relat Dis 2022; 18:1416-1423. [PMID: 36089462 DOI: 10.1016/j.soard.2022.08.002] [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: 02/07/2022] [Revised: 06/02/2022] [Accepted: 08/01/2022] [Indexed: 01/12/2023]
Abstract
As a complication of obesity, type 2 diabetes (T2D) is a chronic disease that is difficult to manage. However, bariatric surgery makes it possible to alleviate T2D. While the existing generic index glycosylated hemoglobin (HbA1c) is a powerful tool for examining overall blood glucose levels, it still has some limitations as a daily measure of blood glucose levels and as a judge of the effectiveness of bariatric surgery. Using the time-in-range (TIR) measurement and its derivatives is a better way to evaluate short-term blood glucose fluctuations and can be used as a supplement to HbA1c. In this article, we discuss the utility and limitations of HbA1c and other indicators used during surgery. In addition, we mentioned TIR as a novel metric that can act as an accurate predictor of the risk of T2D complications and an index of preoperative risk assessment in bariatric surgery. In contrast to previous indicators, TIR has the advantage that it cannot be affected by caloric restriction to better reflect the patient's glucose level and the level of pancreatic islet function. On this basis, TIR is a promising indicator for both the diagnosis of diabetes and the preoperative and postoperative prediction and evaluation.
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Affiliation(s)
- Meng Kang
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Weizheng Li
- Department of General Surgery, Third Xiangya Hospital, Central South University, Hunan, People's Republic of China.
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12
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Berger MM, Shenkin A, Schweinlin A, Amrein K, Augsburger M, Biesalski HK, Bischoff SC, Casaer MP, Gundogan K, Lepp HL, de Man AME, Muscogiuri G, Pietka M, Pironi L, Rezzi S, Cuerda C. ESPEN micronutrient guideline. Clin Nutr 2022; 41:1357-1424. [PMID: 35365361 DOI: 10.1016/j.clnu.2022.02.015] [Citation(s) in RCA: 205] [Impact Index Per Article: 102.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/16/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Trace elements and vitamins, named together micronutrients (MNs), are essential for human metabolism. Recent research has shown the importance of MNs in common pathologies, with significant deficiencies impacting the outcome. OBJECTIVE This guideline aims to provide information for daily clinical nutrition practice regarding assessment of MN status, monitoring, and prescription. It proposes a consensus terminology, since many words are used imprecisely, resulting in confusion. This is particularly true for the words "deficiency", "repletion", "complement", and "supplement". METHODS The expert group attempted to apply the 2015 standard operating procedures (SOP) for ESPEN which focuses on disease. However, this approach could not be applied due to the multiple diseases requiring clinical nutrition resulting in one text for each MN, rather than for diseases. An extensive search of the literature was conducted in the databases Medline, PubMed, Cochrane, Google Scholar, and CINAHL. The search focused on physiological data, historical evidence (published before PubMed release in 1996), and observational and/or randomized trials. For each MN, the main functions, optimal analytical methods, impact of inflammation, potential toxicity, and provision during enteral or parenteral nutrition were addressed. The SOP wording was applied for strength of recommendations. RESULTS There was a limited number of interventional trials, preventing meta-analysis and leading to a low level of evidence. The recommendations underwent a consensus process, which resulted in a percentage of agreement (%): strong consensus required of >90% of votes. Altogether the guideline proposes sets of recommendations for 26 MNs, resulting in 170 single recommendations. Critical MNs were identified with deficiencies being present in numerous acute and chronic diseases. Monitoring and management strategies are proposed. CONCLUSION This guideline should enable addressing suboptimal and deficient status of a bundle of MNs in at-risk diseases. In particular, it offers practical advice on MN provision and monitoring during nutritional support.
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Affiliation(s)
- Mette M Berger
- Department of Adult Intensive Care, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
| | - Alan Shenkin
- Institute of Aging and Chronic Disease, University of Liverpool, Liverpool, UK.
| | - Anna Schweinlin
- Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany.
| | - Karin Amrein
- Medical University of Graz, Department of Internal Medicine, Division of Endocrinology and Diabetology, Austria.
| | - Marc Augsburger
- University Centre of Legal Medicine Lausanne-Geneva, Lausanne University Hospital and University of Lausanne, Geneva University Hospital and University of Geneva, Lausanne-Geneva, Switzerland.
| | | | - Stephan C Bischoff
- Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany.
| | - Michael P Casaer
- KU Leuven, Department of Cellular and Molecular Medicine, Laboratory of Intensive Care Medicine, Leuven, Belgium.
| | - Kursat Gundogan
- Division of Intensive Care Medicine, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkey.
| | | | - Angélique M E de Man
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), Amsterdam Cardiovascular Science (ACS), Amsterdam Infection and Immunity Institute (AI&II), Amsterdam Medical Data Science (AMDS), Amsterdam UMC, Location VUmc, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.
| | - Giovanna Muscogiuri
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università di Napoli (Federico II), Naples, Italy; United Nations Educational, Scientific and Cultural Organization (UNESCO) Chair for Health Education and Sustainable Development, Federico II, University, Naples, Italy.
| | - Magdalena Pietka
- Pharmacy Department, Stanley Dudrick's Memorial Hospital, Skawina, Poland.
| | - Loris Pironi
- Alma Mater Studiorum - University of Bologna, Department of Medical and Surgical Sciences, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Centre for Chronic Intestinal Failure - Clinical Nutrition and Metabolism Unit, Italy.
| | - Serge Rezzi
- Swiss Nutrition and Health Foundation (SNHf), Epalinges, Switzerland.
| | - Cristina Cuerda
- Departamento de Medicina, Universidad Complutense de Madrid, Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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13
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Kwon Y, Ha J, Lee YH, Kim D, Lee CM, Kim JH, Park S. Comparative risk of anemia and related micronutrient deficiencies after Roux-en-Y gastric bypass and sleeve gastrectomy in patients with obesity: An updated meta-analysis of randomized controlled trials. Obes Rev 2022; 23:e13419. [PMID: 35048495 DOI: 10.1111/obr.13419] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 12/12/2022]
Abstract
Although Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the most prevalent bariatric surgical procedures, high-level evidence is scarce regarding the assessment of postoperative nutritional risk in RYGB versus SG. Therefore, we performed a systematic review and meta-analysis to compare the risk of anemia and related micronutrient deficiencies after RYGB and SG. We analyzed 10 randomized controlled trials that compared RYGB and SG with reported incidence of postoperative anemia and/or anemia-related micronutrient deficiencies (iron, vitamin B12 , or folate). There were no significant differences in the risk of postoperative anemia (moderate level of evidence), iron deficiency (high level of evidence), or folate deficiency (moderate level of evidence). Patients undergoing RYGB had a higher risk of postoperative vitamin B12 deficiency than those undergoing SG (relative risk, 1.86; 95% confidence interval, 1.15-3.02; p = 0.012; high level of evidence). Our findings imply that patients undergoing RYGB require more stringent vitamin B12 supplementation and surveillance than those undergoing SG. Additionally, our results may aid patients with high concern for anemia and related micronutrient deficiencies in making informed decisions regarding surgical methods based on nutritional risk.
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Affiliation(s)
- Yeongkeun Kwon
- Division of Foregut Surgery, Korea University College of Medicine, Seoul, South Korea.,Center for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, South Korea
| | - Jane Ha
- Center for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, South Korea.,Department of Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Yong-Hoon Lee
- Center for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, South Korea.,Department of Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Dohyang Kim
- Department of Statistics, Daegu University, Gyeongsan, South Korea
| | - Chang Min Lee
- Division of Foregut Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Jong-Han Kim
- Division of Foregut Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Sungsoo Park
- Division of Foregut Surgery, Korea University College of Medicine, Seoul, South Korea.,Center for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, South Korea
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14
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Riva-Moscoso A, Martinez-Rivera RN, Cotrina-Susanibar G, Príncipe-Meneses FS, Urrunaga-Pastor D, Salinas-Sedo G, Toro-Huamanchumo CJ. Factors Associated with Nutritional Deficiency Biomarkers in Candidates for Bariatric Surgery: A Cross-Sectional Study in a Peruvian High-Resolution Clinic. Nutrients 2021; 14:nu14010082. [PMID: 35010957 PMCID: PMC8747094 DOI: 10.3390/nu14010082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 11/16/2022] Open
Abstract
Previous studies have described multiple nutritional deficiencies after bariatric surgery (BS). However, few studies have evaluated these deficiencies prior to BS, specifically in Latin America. This study aimed to determine the factors associated with nutritional deficiency biomarkers in candidates for BS in Peru. We included adults of both sexes, aged 18 to 59 years, admitted to a Peruvian clinic with a body mass index (BMI) ≥30 kg/m2; they were candidates for BS from 2017 to 2020. We considered the serum levels of hemoglobin and albumin (in tertiles) as the nutritional deficiency biomarkers. In order to assess the associated factors, we calculated crude (cPR) and adjusted prevalence ratios (aPR) with their respective 95% confidence intervals (95%CI). We analyzed 255 patients: 63.1% were males, with a mean age of 37.1 ± 10.3 years and mean hemoglobin and albumin values of 14.0 ± 1.5 g/dL and 4.6 ± 0.4 g/dL, respectively. We found that males (aPR = 1.86; 95%CI: 1.26–2.73; p = 0.002), participants between 30 and 49 (aPR = 2.02; 95%CI: 1.24–3.28; p = 0.004) or 50 years or more (aPR = 2.42; 95%CI: 1.35–4.35; p = 0.003), participants with a BMI ≥40 kg/m2 (aPR = 1.68; 95%CI: 1.09–2.60; p = 0.018), participants with impaired high-density lipoprotein levels (aPR = 1.43; 95%CI: 1.01–2.05; p = 0.049) and individuals in the high tertile of C-reactive protein (aPR = 6.94; 95%CI: 3.37–14.32; p < 0.003) had a higher probability of being in the lower tertile of albumin. In addition, we found that the male sex (aPR = 6.94; 95%CI: 3.37–14.32; p < 0.001) and elevated cholesterol levels (aPR = 0.71; 95%CI: 0.52–0.97; p = 0.034) were associated with the lowest hemoglobin tertile. In our setting, nutritional deficiency biomarkers were associated with sociodemographic, anthropometric and laboratory markers. The pre-bariatric surgery correction of nutritional deficiencies is essential, and can prevent major complications after surgery.
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Affiliation(s)
- Adrian Riva-Moscoso
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima 15067, Peru; (A.R.-M.); (F.S.P.-M.)
| | - Raisa N. Martinez-Rivera
- Facultad de Ciencias de la salud, Escuela Profesional de Medicina Humana, Universidad Nacional de Piura, Piura 20002, Peru;
| | | | | | - Diego Urrunaga-Pastor
- Facultad de Ciencias de la Salud, Universidad Científica del Sur, Carrera de Medicina Humana, Lima 15067, Peru
- Correspondence: (D.U.-P.); (C.J.T.-H.)
| | | | - Carlos J. Toro-Huamanchumo
- Unidad de Investigación Multidisciplinaria, Clínica Avendaño, Lima 15074, Peru;
- Unidad para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima 15012, Peru
- Correspondence: (D.U.-P.); (C.J.T.-H.)
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15
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Winckelmann LA, Gribsholt SB, Madsen LR, Richelsen B, Svensson E, Jørgensen NB, Kristiansen VB, Pedersen SB. Roux-en-Y gastric bypass versus sleeve gastrectomy: nationwide data from the Danish quality registry for treatment of severe obesity. Surg Obes Relat Dis 2021; 18:511-519. [DOI: 10.1016/j.soard.2021.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/10/2021] [Accepted: 12/09/2021] [Indexed: 10/19/2022]
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16
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Král J, Machytka E, Horká V, Selucká J, Doleček F, Špičák J, Kovářová V, Haluzík M, Bužga M. Endoscopic Treatment of Obesity and Nutritional Aspects of Bariatric Endoscopy. Nutrients 2021; 13:nu13124268. [PMID: 34959819 PMCID: PMC8703836 DOI: 10.3390/nu13124268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/14/2021] [Accepted: 11/26/2021] [Indexed: 11/25/2022] Open
Abstract
Obesity is a significant problem worldwide. Several serious diseases that decrease patient quality of life and increase mortality (high blood pressure, dyslipidaemia, type 2 diabetes etc.) are associated with obesity. Obesity treatment is a multidisciplinary and complex process that requires maximum patient compliance. Change of lifestyle is fundamental in the treatment of obesity. While pharmacotherapeutic options are available, their efficacy is limited. Surgical treatment though highly effective, carries the risk of complications and is thus indicated mostly in advanced stages of obesity. Endoscopic treatments of obesity are less invasive than surgical options, and are associated with fewer complications and nutritional deficits. Currently, there is a large spectrum of endoscopic methods based on the principles of gastric volume reduction, size restriction and gastric or small bowel bypass being explored with only few available in routine practice. The aim of this publication is to present an up-to-date summary of available endoscopic methods for the treatment of obesity focusing on their efficacy, safety and nutritional aspects.
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Affiliation(s)
- Jan Král
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, 14021 Prague, Czech Republic; (E.M.); (J.S.); (J.Š.)
- Correspondence:
| | - Evžen Machytka
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, 14021 Prague, Czech Republic; (E.M.); (J.S.); (J.Š.)
- Faculty of Medicine and Dentistry, Palacký University Olomouc, 77147 Olomouc, Czech Republic
- Department of Internal Medicine-Gastroenterology and Geriatrics, University Hospital Olomouc, 77900 Olomouc, Czech Republic
| | - Veronika Horká
- Research Obesity Centre, Department of Human Movement Studies, Faculty of Medicine, University of Ostrava, 70300 Ostrava, Czech Republic;
| | - Jana Selucká
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, 14021 Prague, Czech Republic; (E.M.); (J.S.); (J.Š.)
| | - Filip Doleček
- Department of Surgical Studies, Faculty of Medicine, University of Ostrava, 70300 Ostrava, Czech Republic;
| | - Julius Špičák
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, 14021 Prague, Czech Republic; (E.M.); (J.S.); (J.Š.)
| | - Viktorie Kovářová
- Department of Diabetology, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, 14021 Prague, Czech Republic; (V.K.); (M.H.)
| | - Martin Haluzík
- Department of Diabetology, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, 14021 Prague, Czech Republic; (V.K.); (M.H.)
| | - Marek Bužga
- Department of Physiology and Pathophysiology, Faculty of Medicine, University of Ostrava, 70103 Ostrava, Czech Republic;
- Institute of Laboratory Medicine, University Hospital Ostrava, 70800 Ostrava, Czech Republic
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17
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Sasaki A, Yokote K, Naitoh T, Fujikura J, Hayashi K, Hirota Y, Inagaki N, Ishigaki Y, Kasama K, Kikkawa E, Koyama H, Masuzaki H, Miyatsuka T, Nozaki T, Ogawa W, Ohta M, Okazumi S, Shimabukuro M, Shimomura I, Nishizawa H, Saiki A, Seki Y, Shojima N, Tsujino M, Ugi S, Watada H, Yamauchi T, Yamaguchi T, Ueki K, Kadowaki T, Tatsuno I. Metabolic surgery in treatment of obese Japanese patients with type 2 diabetes: a joint consensus statement from the Japanese Society for Treatment of Obesity, the Japan Diabetes Society, and the Japan Society for the Study of Obesity. Diabetol Int 2021; 13:1-30. [PMID: 34777929 PMCID: PMC8574153 DOI: 10.1007/s13340-021-00551-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Indexed: 12/20/2022]
Abstract
Bariatric surgery has been shown to have a variety of metabolically beneficial effects for patients with type 2 diabetes (T2D), and is now also called metabolic surgery. At the 2nd Diabetes Surgery Summit held in 2015 in London, the indication for bariatric and metabolic surgery was included in the “algorithm for patients with type T2D”. With this background, the Japanese Society for Treatment of Obesity (JSTO), the Japan Diabetes Society (JDS) and the Japan Society for the Study of Obesity (JASSO) have formed a joint committee to develop a consensus statement regarding bariatric and metabolic surgery for the treatment of Japanese patients with T2D. Eventually, the consensus statement was announced at the joint meeting of the 38th Annual Meeting of JSTO and the 41st Annual Meeting of JASSO convened in Toyama on March 21, 2021. In preparing the consensus statement, we used Japanese data as much as possible as scientific evidence to consider the indication criteria, and set two types of recommendation grades, “recommendation” and “consideration”, for items for which recommendations are possible. We hope that this statement will be helpful in providing evidence-based high-quality care through bariatric and metabolic surgery for the treatment of obese Japanese patients with T2D.
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Affiliation(s)
- Akira Sasaki
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695 Japan
| | - Koutaro Yokote
- Department of Endocrinology Hematology, and Gerontology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takeshi Naitoh
- Department of Lower Gastrointestinal Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Junji Fujikura
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Karin Hayashi
- Department of Neuropsychiatry, Toho University Sakura Medical Center, Sakura, Chiba Japan
| | - Yushi Hirota
- Division of Diabetes and Endocrinology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nobuya Inagaki
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasushi Ishigaki
- Division of Diabetes and Metabolism, Department of Internal Medicine, Iwate Medical University, Yahaba, Japan
| | - Kazunori Kasama
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Eri Kikkawa
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Hidenori Koyama
- Department of Diabetes, Endocrinology and Clinical Immunology, Hyogo College of Medicine, Nishinomiya, Hyogo Japan
| | - Hiroaki Masuzaki
- Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology, Department of Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Takeshi Miyatsuka
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takehiro Nozaki
- Clinical Trial Center, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, Japan
| | - Wataru Ogawa
- Division of Diabetes and Endocrinology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masayuki Ohta
- Global Oita Medical Advanced Research Center for Health, Oita University, Oita, Japan
| | - Shinichi Okazumi
- Department of Surgery, Toho University Sakura Medical Center, Sakura, Chiba Japan
| | - Michio Shimabukuro
- Department of Diabetes, Endocrinology and Metabolism, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Iichiro Shimomura
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hitoshi Nishizawa
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Atsuhito Saiki
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
| | - Yosuke Seki
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Nobuhiro Shojima
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Motoyoshi Tsujino
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Satoshi Ugi
- Division of Endocrinology and Metabolism, Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Hiroaki Watada
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Yamaguchi
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
| | - Koujiro Ueki
- Department of Molecular Diabetic Medicine, Diabetes Research Center, National Center for Global Health and Medicine, Tokyo, Japan
| | | | - Ichiro Tatsuno
- Chiba Prefectural University of Health Sciences, Chiba, Japan
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Seo HS, Na Y, Jung J. Analysis of the Occurrence of Diseases Following Gastrectomy for Early Gastric Cancer: a Nationwide Claims Study. J Gastric Cancer 2021; 21:279-297. [PMID: 34691812 PMCID: PMC8505120 DOI: 10.5230/jgc.2021.21.e29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/17/2021] [Accepted: 09/17/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose Various changes in nutrition, metabolism, immunity, and psychological status occur through multiple mechanisms after gastrectomy. The purpose of this study was to predict disease status after gastrectomy by analyzing diseases pattern that occur or change after gastrectomy. Materials and Methods A retrospective cohort study was conducted using nationwide claims data. Patients with gastric cancer who underwent gastrectomy or endoscopic resection were included in the study. Eighteen target diseases were selected and categorized based on their underlying mechanism. The incidence of each target disease was compared by dividing the study sample into those who underwent gastrectomy (cases) and those who underwent endoscopic resection for early gastric cancer (controls). The cases were matched with controls using propensity score matching. Thereafter, Cox proportional hazard models were used to evaluate intergroup differences in disease incidence after gastrectomy. Results A total of 97,634 patients who underwent gastrectomy (84,830) or endoscopic resection (12,804) were included. The incidence of cholecystitis (P<0.0001), pancreatitis (P=0.034), acute kidney injury (P=0.0083), anemia (P<0.0001), and inguinal hernia (P=0.0007) were higher after gastrectomy, while incidence of dyslipidemia (P<0.0001), vascular diseases (ischemic heart disease, stroke, and atherosclerosis; P<0.0001, P<0.0001, and P=0.0005), and Parkinson's disease (P=0.0093) were lower after gastrectomy. Conclusions This study identifies diseases that may occur after gastrectomy in patients with gastric cancer.
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Affiliation(s)
- Ho Seok Seo
- Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yewon Na
- Artificial Intelligence and Big-Data Convergence Center, Gil Medical Center, Gachon University College of Medicine and Science, Incheon, Korea.,Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Jaehun Jung
- Artificial Intelligence and Big-Data Convergence Center, Gil Medical Center, Gachon University College of Medicine and Science, Incheon, Korea.,Departement of Preventive Medicine, Gachon University College of Medicine, Incheon, Korea
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19
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Çağlar TR, Seyit H, Çalışkan P, Vural M, Kural A. Serum Vitamin and Trace Element Levels of Patients Undergoing Laparoscopic Sleeve Gastrectomy. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2020.0061] [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)
- Tuba Rana Çağlar
- Medical Biochemistry Department, Faculty of Medicine, University of Health Sciences, Istanbul, Turkey
| | - Hakan Seyit
- General Surgery Department, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Pinar Çalışkan
- Medical Biochemistry Department, Faculty of Medicine, University of Health Sciences, Istanbul, Turkey
| | - Meltem Vural
- Physical Medicine and Rehabilitation Department, Faculty of Medicine, University of Health Sciences, Istanbul, Turkey
| | - Alev Kural
- Medical Biochemistry Department, Faculty of Medicine, University of Health Sciences, Istanbul, Turkey
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20
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Svagera Z, Machytka E, Machackova J, Blaho M, Vasura A, Stejskal D, Huberty V, Buzga M. Nutritional consequences of endoluminal gastroplasty in the treatment of morbidly obese patients. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021; 165:258-263. [PMID: 34040264 DOI: 10.5507/bp.2021.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/12/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The Endoscopic sleeve gastroplasty (ESG) is one of the new advanced restrictive techniques of bariatric endoscopy. The principle of this bariatric technique is the reduction of stomach volume through endoscopic plication. The long-term efficacy and metabolic effects of this procedure are the subject of this study. METHODS 20 patients were enrolled; four men, sixteen women. Then they were followed for 24 months in terms of glycemic control, body composition, vitamin, and nutritional status. Observed parameters included glucose, triacylglycerols, high- and low-density lipoprotein cholesterol, micro and macro nutrients, fat mass, and lean body mass. RESULTS We observed significant weight loss and a decrease body composition resulted from procedure vs. baseline, with levels of blood glucose also showing statistically significant reductions. The most notable decline in measured values was observed in period six months after the procedure. No significant changes were observed in measurement of micronutrients. CONCLUSIONS Good restriction results were obtained following ESG, which might be mediated via altered glucose metabolism. The ESG method has shown a positive effect on fat and muscle mass. Unlike surgical methods, there were no deficits or deficiencies, especially in terms of essential vitamin levels.
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Affiliation(s)
- Zdenek Svagera
- Institute of Laboratory Medicine, University Hospital Ostrava, Ostrava, Czech Republic
| | - Evzen Machytka
- Department of Gastroenterology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Jitka Machackova
- Department of Gastroenterology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Martin Blaho
- Department of Gastroenterology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Adam Vasura
- Department of Gastroenterology, University Hospital Ostrava, Ostrava, Czech Republic
| | - David Stejskal
- Institute of Laboratory Medicine, University Hospital Ostrava, Ostrava, Czech Republic
| | - Vincent Huberty
- Department of Gastroenterology, Erasme Hospital, Universite Libre de Bruxelle, Belgium
| | - Marek Buzga
- Institute of Laboratory Medicine, University Hospital Ostrava, Ostrava, Czech Republic.,Department of Physiology and Pathophysiology, Research Obesity Centre, Faculty of Medicine, University of Ostrava, Czech Republic
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21
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Calcaterra V, Cena H, Pelizzo G, Porri D, Regalbuto C, Vinci F, Destro F, Vestri E, Verduci E, Bosetti A, Zuccotti G, Stanford FC. Bariatric Surgery in Adolescents: To Do or Not to Do? CHILDREN (BASEL, SWITZERLAND) 2021; 8:453. [PMID: 34072065 PMCID: PMC8204230 DOI: 10.3390/children8060453] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/04/2021] [Accepted: 05/25/2021] [Indexed: 01/19/2023]
Abstract
Pediatric obesity is a multifaceted disease that can impact physical and mental health. It is a complex condition that interweaves biological, developmental, environmental, behavioral, and genetic factors. In most cases lifestyle and behavioral modification as well as medical treatment led to poor short-term weight reduction and long-term failure. Thus, bariatric surgery should be considered in adolescents with moderate to severe obesity who have previously participated in lifestyle interventions with unsuccessful outcomes. In particular, laparoscopic sleeve gastrectomy is considered the most commonly performed bariatric surgery worldwide. The procedure is safe and feasible. The efficacy of this weight loss surgical procedure has been demonstrated in pediatric age. Nevertheless, there are barriers at the patient, provider, and health system levels, to be removed. First and foremost, more efforts must be made to prevent decline in nutritional status that is frequent after bariatric surgery, and to avoid inadequate weight loss and weight regain, ensuring successful long-term treatment and allowing healthy growth. In this narrative review, we considered the rationale behind surgical treatment options, outcomes, and clinical indications in adolescents with severe obesity, focusing on LSG, nutritional management, and resolution of metabolic comorbidities.
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Affiliation(s)
- Valeria Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy;
- Pediatric Department, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy; (E.V.); (A.B.); (G.Z.)
| | - Hellas Cena
- Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, 27100 Pavia, Italy; (H.C.); (D.P.)
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Gloria Pelizzo
- Pediatric Surgery Department, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy; (F.D.); (E.V.)
| | - Debora Porri
- Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, 27100 Pavia, Italy; (H.C.); (D.P.)
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Corrado Regalbuto
- Pediatric Unit, Fond. IRCCS Policlinico S. Matteo and University of Pavia, 27100 Pavia, Italy; (C.R.); (F.V.)
| | - Federica Vinci
- Pediatric Unit, Fond. IRCCS Policlinico S. Matteo and University of Pavia, 27100 Pavia, Italy; (C.R.); (F.V.)
| | - Francesca Destro
- Pediatric Surgery Department, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy; (F.D.); (E.V.)
| | - Elettra Vestri
- Pediatric Surgery Department, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy; (F.D.); (E.V.)
| | - Elvira Verduci
- Pediatric Department, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy; (E.V.); (A.B.); (G.Z.)
- Department of Health Sciences, University of Milan, 20146 Milan, Italy
| | - Alessandra Bosetti
- Pediatric Department, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy; (E.V.); (A.B.); (G.Z.)
| | - Gianvincenzo Zuccotti
- Pediatric Department, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy; (E.V.); (A.B.); (G.Z.)
- “L. Sacco” Department of Biomedical and Clinical Science, University of Milan, 20146 Milan, Italy
| | - Fatima Cody Stanford
- Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA;
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22
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Iron deficiency following bariatric surgery: a retrospective cohort study. Blood Adv 2021; 4:3639-3647. [PMID: 32766854 DOI: 10.1182/bloodadvances.2020001880] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/29/2020] [Indexed: 02/07/2023] Open
Abstract
Iron deficiency is a common consequence of bariatric surgery and frequently leads to anemia. Our study reports the incidence and predictors of iron deficiency, iron deficiency anemia (IDA), and IV iron use after bariatric surgery. We conducted a retrospective study of all adult patients who underwent bariatric surgery from January to December 2012 at the regional bariatric surgery center in Hamilton, Ontario, Canada, and were followed for at least 6 months. Time-to-event data were presented as Kaplan-Meier curves. Cox regression analysis was used to identify outcome predictors. A total of 388 patients met the inclusion criteria. Iron deficiency, IDA, and the use of IV iron were reported in 43%, 16%, and 6% of patients, respectively, with a mean follow-up of 31 months. The cumulative incidence of iron deficiency and IDA increased with longer follow-up, and there was a significant increase in IV iron use starting 3 years after surgery. Malabsorptive procedures (hazard ratio [HR], 1.92; 95% confidence interval [CI], 1.20-3.06; P = .006) and low baseline ferritin (HR, 0.96; 95% CI, 0.95-0.97; P < .001) were associated with an increased risk of iron deficiency. Young age (HR, 0.90; 95% CI, 0.82-0.99; P = .028), baseline anemia (HR, 19.6; 95% CI, 7.85-48.9; P < .001), and low baseline ferritin (HR, 0.96; 95% CI, 0.95-0.98; P < .001) were associated with an increased risk of IDA. Our results suggest that IDA is a delayed consequence of bariatric surgery and that preoperative assessment of patient risk may be possible.
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23
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Asiri AA, Aljarallah SA, Alayed KM. Polyneuropathy and Korsakoff syndrome complicating sleeve gastrectomy. Obes Res Clin Pract 2021; 15:293-296. [PMID: 33934996 DOI: 10.1016/j.orcp.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
We report a case of a 36 year old gentleman presenting with polyneuropathy and Korsakkoff Syndrome complicating Sleeve Gastrectomy.
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Affiliation(s)
- Alanood A Asiri
- Department of Internal Medicine, King Saud University Medical City and College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Salman A Aljarallah
- Department of Internal Medicine, King Saud University Medical City and College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Khalid M Alayed
- Department of Internal Medicine, King Saud University Medical City and College of Medicine, King Saud University, Riyadh, Saudi Arabia
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24
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Long-Term Iron and Vitamin B12 Deficiency Are Present after Bariatric Surgery, Despite the Widespread Use of Supplements. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094541. [PMID: 33922904 PMCID: PMC8123142 DOI: 10.3390/ijerph18094541] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/09/2021] [Accepted: 04/22/2021] [Indexed: 12/23/2022]
Abstract
There are few long-term nutritional studies in subjects undergoing bariatric surgery that have assessed weight regain and nutritional deficiencies. In this study, we report data 8 years after surgery on weight loss, use of dietary supplements and deficit of micronutrients in a cohort of patients from five centres in central and northern Italy. The study group consisted of 52 subjects (age: 38.1 ± 10.6 y, 42 females): 16 patients had Roux-en-Y gastric bypass (RYGB), 25 patients had sleeve gastrectomy (SG) and 11 subjects had adjustable gastric banding (AGB). All three bariatric procedures led to sustained weight loss: the average percentage excess weight loss, defined as weight loss divided by excess weight based on ideal body weight, was 60.6% ± 32.3. Despite good adherence to prescribed supplements, 80.7% of subjects (72.7%, AGB; 76.7%, SG; 93.8 %, RYGB) reported at least one nutritional deficiency: iron (F 64.3% vs. M 30%), vitamin B12 (F 16.6% vs. M 10%), calcium (F 33.3% vs. M 0%) and vitamin D (F 38.1% vs. M 60%). Long-term nutritional deficiencies were greater than the general population among men for iron and among women for vitamin B12.
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25
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Bjørklund G, Peana M, Pivina L, Dosa A, Aaseth J, Semenova Y, Chirumbolo S, Medici S, Dadar M, Costea DO. Iron Deficiency in Obesity and after Bariatric Surgery. Biomolecules 2021; 11:biom11050613. [PMID: 33918997 PMCID: PMC8142987 DOI: 10.3390/biom11050613] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/10/2021] [Accepted: 04/16/2021] [Indexed: 02/06/2023] Open
Abstract
Iron deficiency (ID) is particularly frequent in obese patients due to increased circulating levels of acute-phase reactant hepcidin and adiposity-associated inflammation. Inflammation in obese subjects is closely related to ID. It induces reduced iron absorption correlated to the inhibition of duodenal ferroportin expression, parallel to the increased concentrations of hepcidin. Obese subjects often get decreased inflammatory response after bariatric surgery, accompanied by decreased serum hepcidin and therefore improved iron absorption. Bariatric surgery can induce the mitigation or resolution of obesity-associated complications, such as hypertension, insulin resistance, diabetes mellitus, and hyperlipidemia, adjusting many parameters in the metabolism. However, gastric bypass surgery and sleeve gastrectomy can induce malabsorption and may accentuate ID. The present review explores the burden and characteristics of ID and anemia in obese patients after bariatric surgery, accounting for gastric bypass technique (Roux-en-Y gastric bypass-RYGB) and sleeve gastrectomy (SG). After bariatric surgery, obese subjects' iron status should be monitored, and they should be motivated to use adequate and recommended iron supplementation.
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Affiliation(s)
- Geir Bjørklund
- Council for Nutritional and Environmental Medicine, Toften 24, 8610 Mo i Rana, Norway
- Correspondence: (G.B.); (M.P.)
| | - Massimiliano Peana
- Department of Chemistry and Pharmacy, University of Sassari, Via Vienna 2, 07100 Sassari, Italy;
- Correspondence: (G.B.); (M.P.)
| | - Lyudmila Pivina
- Department of Neurology, Ophthalmology and Otolaryngology, Semey Medical University, 071400 Semey, Kazakhstan; (L.P.); (Y.S.)
- CONEM Kazakhstan Environmental Health and Safety Research Group, Semey Medical University, 071400 Semey, Kazakhstan
| | - Alexandru Dosa
- Faculty of Medicine, Ovidius University of Constanta, 900470 Constanta, Romania; (A.D.); (D.-O.C.)
| | - Jan Aaseth
- Research Department, Innlandet Hospital Trust, 2380 Brumunddal, Norway;
| | - Yuliya Semenova
- Department of Neurology, Ophthalmology and Otolaryngology, Semey Medical University, 071400 Semey, Kazakhstan; (L.P.); (Y.S.)
- CONEM Kazakhstan Environmental Health and Safety Research Group, Semey Medical University, 071400 Semey, Kazakhstan
| | - Salvatore Chirumbolo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy;
- CONEM Scientific Secretary, 37134 Verona, Italy
| | - Serenella Medici
- Department of Chemistry and Pharmacy, University of Sassari, Via Vienna 2, 07100 Sassari, Italy;
| | - Maryam Dadar
- Razi Vaccine and Serum Research Institute, Agricultural Research, Education and Extension Organization (AREEO), Karaj 31975/148, Iran;
| | - Daniel-Ovidiu Costea
- Faculty of Medicine, Ovidius University of Constanta, 900470 Constanta, Romania; (A.D.); (D.-O.C.)
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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.
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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.)
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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).
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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
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28
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van Berckel MMG, van Loon SLM, Boer AK, Scharnhorst V, Nienhuijs SW. Visual Analysis of Biomarkers Reveals Differences in Lipid Profiles and Liver Enzymes before and after Gastric Sleeve and Bypass. Obes Facts 2021; 14:1-11. [PMID: 33550283 PMCID: PMC7983690 DOI: 10.1159/000510401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 07/22/2020] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Bariatric surgery results in both intentional and unintentional metabolic changes. In a high-volume bariatric center, extensive laboratory panels are used to monitor these changes pre- and postoperatively. Consecutive measurements of relevant biochemical markers allow exploration of the health state of bariatric patients and comparison of different patient groups. OBJECTIVE The objective of this study is to compare biomarker distributions over time between 2 common bariatric procedures, i.e., sleeve gastrectomy (SG) and gastric bypass (RYGB), using visual analytics. METHODS Both pre- and postsurgical (6, 12, and 24 months) data of all patients who underwent primary bariatric surgery were collected retrospectively. The distribution and evolution of different biochemical markers were compared before and after surgery using asymmetric beanplots in order to evaluate the effect of primary SG and RYGB. A beanplot is an alternative to the boxplot that allows an easy and thorough visual comparison of univariate data. RESULTS In total, 1,237 patients (659 SG and 578 RYGB) were included. The sleeve and bypass groups were comparable in terms of age and the prevalence of comorbidities. The mean presurgical BMI and the percentage of males were higher in the sleeve group. The effect of surgery on lowering of glycated hemoglobin was similar for both surgery types. After RYGB surgery, the decrease in the cholesterol concentration was larger than after SG. The enzymatic activity of aspartate aminotransferase, alanine aminotransferase, and alkaline phosphate in sleeve patients was higher presurgically but lower postsurgically compared to bypass values. CONCLUSIONS Beanplots allow intuitive visualization of population distributions. Analysis of this large population-based data set using beanplots suggests comparable efficacies of both types of surgery in reducing diabetes. RYGB surgery reduced dyslipidemia more effectively than SG. The trend toward a larger decrease in liver enzyme activities following SG is a subject for further investigation.
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Affiliation(s)
| | - Saskia L M van Loon
- Department of Clinical Chemistry, Catharina Hospital, Eindhoven, The Netherlands
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Arjen-Kars Boer
- Department of Clinical Chemistry, Catharina Hospital, Eindhoven, The Netherlands
| | - Volkher Scharnhorst
- Department of Clinical Chemistry, Catharina Hospital, Eindhoven, The Netherlands
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Simon W Nienhuijs
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
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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.
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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
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30
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Shipton MJ, Johal NJ, Dutta N, Slater C, Iqbal Z, Ahmed B, Ammori BJ, Senapati S, Akhtar K, Summers LKM, New JP, Soran H, Adam S, Syed AA. Haemoglobin and Hematinic Status Before and After Bariatric Surgery over 4 years of Follow-Up. Obes Surg 2021; 31:682-693. [PMID: 32875517 PMCID: PMC7847875 DOI: 10.1007/s11695-020-04943-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Bariatric surgery is associated with deficiencies of vitamins and minerals, and patients are routinely advised supplements postoperatively. We studied prevalence of vitamin B12, folate and iron deficiencies and anaemia before and after bariatric surgery over 4 years of follow-up. MATERIALS AND METHODS We performed a retrospective cohort analysis of 353 people with obesity, including 257 (72.8%) women, who underwent gastric bypass (252, 71.4%) or sleeve gastrectomy (101, 28.6%) at our National Health Service bariatric centre in Northwest England. RESULTS At baseline, mean (standard error) age was 46.0 (0.6) years, body mass index 53.1 (0.4) kg/m2, serum vitamin B12 400.2 (16.4) pg/L, folate 7.7 (0.2) μg/L, iron 12.0 (0.3) μmol/L, ferritin 118.3 (8.4) μg/L and haemoglobin 137.9 (0.8) g/L. Frequency of low vitamin B12 levels reduced from 7.5% preoperatively to 2.3% at 48 months (P < 0.038). Mean folate levels increased from baseline to 48 months by 5.3 μg/L (P < 0.001) but frequency of low folate levels increased from 4.7% preoperatively to 10.3% (P < 0.048). Ferritin levels increased from baseline to 48 months by 51.3 μg/L (P < 0.009). Frequency of low ferritin levels was greater in women (39.1%) than in men (8.9%) at baseline (P < 0.001) and throughout the study period. Haemoglobin was low in 4.6% of all patients at baseline with no significant change over the study period. CONCLUSION There were notable rates of haematinic insufficiencies in bariatric surgical candidates preoperatively. Our study lends further support to regular supplementation with vitamin B12, folic acid, and iron in people undergoing bariatric surgery.
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Affiliation(s)
| | | | - Neel Dutta
- Salford Royal NHS Foundation Trust, Salford, UK
| | | | - Zohaib Iqbal
- Salford Royal NHS Foundation Trust, Salford, UK
- University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Babur Ahmed
- Salford Royal NHS Foundation Trust, Salford, UK
| | - Basil J Ammori
- Salford Royal NHS Foundation Trust, Salford, UK
- University of Manchester, Manchester, UK
| | - Siba Senapati
- Salford Royal NHS Foundation Trust, Salford, UK
- Manchester Metropolitan University, Manchester, UK
| | | | - Lucinda K M Summers
- Salford Royal NHS Foundation Trust, Salford, UK
- University of Manchester, Manchester, UK
| | - John P New
- Salford Royal NHS Foundation Trust, Salford, UK
- University of Manchester, Manchester, UK
| | - Handrean Soran
- University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Safwaan Adam
- Salford Royal NHS Foundation Trust, Salford, UK
- University of Manchester, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, UK
| | - Akheel A Syed
- Salford Royal NHS Foundation Trust, Salford, UK.
- University of Manchester, Manchester, UK.
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31
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Carabotti M, Annibale B, Lahner E. Common Pitfalls in the Management of Patients with Micronutrient Deficiency: Keep in Mind the Stomach. Nutrients 2021; 13:nu13010208. [PMID: 33450823 PMCID: PMC7828248 DOI: 10.3390/nu13010208] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 12/31/2020] [Accepted: 01/08/2021] [Indexed: 02/05/2023] Open
Abstract
Micronutrient deficiencies are relatively common, in particular iron and cobalamin deficiency, and may potentially lead to life-threatening clinical consequences when not promptly recognized and treated, especially in elderly patients. The stomach plays an important role in the homeostasis of some important hematopoietic micronutrients like iron and cobalamin, and probably in others equally important such as ascorbic acid, calcium, and magnesium. A key role is played by the corpus oxyntic mucosa composed of parietal cells whose main function is gastric acid secretion and intrinsic factor production. Gastric acid secretion is necessary for the digestion and absorption of cobalamin and the absorption of iron, calcium, and probably magnesium, and is also essential for the absorption, secretion, and activation of ascorbic acid. Several pathological conditions such as Helicobacter pylori-related gastritis, corpus atrophic gastritis, as well as antisecretory drugs, and gastric surgery may interfere with the normal functioning of gastric oxyntic mucosa and micronutrients homeostasis. Investigation of the stomach by gastroscopy plus biopsies should always be considered in the management of patients with micronutrient deficiencies. The current review focuses on the physiological and pathophysiological aspects of gastric acid secretion and the role of the stomach in iron, cobalamin, calcium, and magnesium deficiency and ascorbate homeostasis.
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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] [MESH Headings] [Grants] [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.
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Affiliation(s)
- Mary O'Kane
- Dietetic DepartmentLeeds Teaching Hospitals NHS TrustLeedsUK
| | | | - Jonathan Pinkney
- Faculty of Health and Human SciencesPeninsula Schools of Medicine and DentistryPlymouthUK
- Department of EndocrinologyPlymouth Hospitals NHS TrustPlymouthUK
| | - Richard Welbourn
- Department of Upper GI and Bariatric Surgery, Musgrove Park HospitalTaunton and Somerset NHS Foundation TrustTauntonUK
| | - Carly A. Hughes
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
- Fakenham Weight Management ServiceFakenham Medical PracticeFakenhamUK
| | - Jessica Mok
- Centre for Obesity Research, Rayne Institute, Department of MedicineUniversity College LondonLondonUK
| | - Nerissa Walker
- School of BiosciencesSutton Bonington Campus, University of NottinghamNottinghamUK
| | - Denise Thomas
- Department of Nutrition and DieteticsPortsmouth Hospitals NHS TrustPortsmouthUK
| | - Jennifer Devin
- Specialist Weight Management ServiceBetsi Cadwaladr University Health BoardWalesUK
| | - Karen D. Coulman
- Population Health SciencesBristol Medical School. University of BristolBristolUK
- Obesity and Bariatric Surgery ServiceSouthmead Hospital, North Bristol NHS TrustBristolUK
| | | | - Rachel L. Batterham
- Centre for Obesity Research, Rayne Institute, Department of MedicineUniversity College LondonLondonUK
- Bariatric Centre for Weight Management and Metabolic Surgery, UCLHUniversity College London Hospital (UCLH)LondonUK
- National Institute of Health ResearchUCLH Biomedical Research CentreLondonUK
| | - Kamal K. Mahawar
- Department of General SurgerySunderland Royal HospitalSunderlandUK
| | - Manisha Sharma
- Department of Clinical Biochemistry & Bariatric SurgeryHomerton University Hospital NHS TrustLondonUK
| | - Alex I. Blakemore
- Department of Life SciencesBrunel UniversityLondonUK
- Department of MedicineImperial CollegeLondonUK
| | | | - Julian H. Barth
- Department of Chemical Pathology & Metabolic MedicineLeeds Teaching Hospitals NHS TrustLeedsUK
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Ziogas IA, Zapsalis K, Giannis D, Tsoulfas G. Metabolic syndrome and liver disease in the era of bariatric surgery: What you need to know! World J Hepatol 2020; 12:709-721. [PMID: 33200011 PMCID: PMC7643217 DOI: 10.4254/wjh.v12.i10.709] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/10/2020] [Accepted: 09/01/2020] [Indexed: 02/06/2023] Open
Abstract
Metabolic syndrome (MS) is defined as the constellation of obesity, insulin resistance, high serum triglycerides, low high-density lipoprotein cholesterol, and high blood pressure. It increasingly affects more and more people and progressively evolves into a serious issue with widespread healthcare, cost, and quality of life associated consequences. MS is associated with increased morbidity and mortality due to cardiovascular or chronic liver disease. Conservative treatment, which includes diet, exercise, and antidiabetic agents, is the mainstay of treatment, but depends on patient compliance to medical treatment and adherence to lifestyle modification recommendations. Bariatric surgery has recently emerged as an appropriate alternative treatment with promising long-term results. Sleeve gastrectomy and Roux-en-Y gastric bypass constitute the most commonly performed procedures and have been proven both cost-effective and safe with low complication rates. Liver transplantation is the only definitive treatment for end-stage liver disease and its utilization in patients with non-alcoholic steatohepatitis has increased more than fivefold over the past 15 years. In this review, we summarize current state of evidence on the surgical treatment of MS.
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Affiliation(s)
- Ioannis A Ziogas
- Aristotle University School of Medicine, Thessaloniki 54124, Greece
| | | | - Dimitrios Giannis
- Center for Health Innovations and Outcomes Research (CHIOR), The Feinstein Institute for Medical Research, Manhasset, NY 11030, United States
| | - Georgios Tsoulfas
- The First Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
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Wang TY, Huang HH, Hsieh MS, Chen CY. Risk of anemia in morbidly obese patients after bariatric surgery in Taiwan. World J Diabetes 2020; 11:447-458. [PMID: 33133392 PMCID: PMC7582119 DOI: 10.4239/wjd.v11.i10.447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/02/2020] [Accepted: 09/08/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Bariatric surgery is one of most effective long-term treatments for morbid obesity. However, post-bariatric surgery anemia is identified as a common adverse effect and remains a challenge nowadays.
AIM To estimate the risk of post-bariatric surgery anemia and to stratify the association between age, gender, and types of surgery.
METHODS This study is a population-based cohort study. We conducted this nationwide study using claims data from National Health Insurance Research Database in Taiwan. There were 4373 morbidly obese patients in this study cohort.
RESULTS Among patients who were diagnosed with morbid obesity, 2864 received bariatric surgery. All obesity-associated comorbidities decreased in the surgical group. Increasing risk of post-bariatric surgery anemia among obese patients was found by Cox proportional hazards regression [adjusted hazard ratio (HR): 2.36]. Also, we found significantly increasing cumulative incidence rate of anemia among patients receiving bariatric surgery by log-rank test. After adjusting for age and gender, the increasing incidence of post-bariatric surgery anemia was found among women (adjusted HR: 2.48), patients in the 20–29-year-old group (adjusted HR: 3.83), and patients in the 30-64-year-old group (adjusted HR: 2.37). Moreover, malabsorptive and restrictive procedures had significantly higher adjusted HRs, 3.18 and 1.55, respectively.
CONCLUSION Bariatric surgery give rise to anemia risk among obese patients, specifically in women, young- and middle-aged patients, and patients undergoing malabsorptive procedures in our population-based cohort study in Taiwan.
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Affiliation(s)
- Tse-Yao Wang
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Hsien-Hao Huang
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
- College of Medicine, National Yang-Ming University of Medicine, Taipei 112, Taiwan
| | - Ming-Shun Hsieh
- College of Medicine, National Yang-Ming University of Medicine, Taipei 112, Taiwan
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan 330, Taiwan
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei 112, Taiwan
| | - Chih-Yen Chen
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Faculty of Medicine and Institute of Emergency and Critical Medicine, National Yang-Ming University School of Medicine, Taipei 112, Taiwan
- Chinese Taipei Society for the Study of Obesity, Taipei 110, Taiwan
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35
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Singh A, Koenen B, Kirby DF. Bariatric Surgery and Its Complications in Inflammatory Bowel Disease Patients. Inflamm Bowel Dis 2020; 26:1155-1165. [PMID: 31626698 DOI: 10.1093/ibd/izz246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Indexed: 12/14/2022]
Abstract
Recent data have suggested that bariatric procedures, especially laparoscopic sleeve gastrectomy (SG), are safe and effective weight loss measures in patients with inflammatory bowel disease (IBD). But most of the studies have looked at short-term outcomes, and there is a general lack of awareness of underlying disease processes and baseline comorbidities in IBD patients undergoing bariatric procedures. Postbariatric issues in IBD patients including diarrhea from dumping syndrome, choleretic diarrhea, a high prevalence of small intestinal bacterial overgrowth, gastroesophageal reflux disease, Barrett's esophagus, stomal ulcerations, stenosis, and renal and gallstones can complicate the natural history of IBD. This could lead to unnecessary hospitalizations, change of medical therapy, and poor surgical and quality of life outcomes. In this review, we will discuss major complications after common bariatric procedures (SG, Roux-en-Y gastric bypass, and gastric banding) and suggest possible management strategies.
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Affiliation(s)
- Amandeep Singh
- Department of Gastroenterology, Hepatology & Nutrition, Center for Human Nutrition, Center for Gut Rehabilitation and Intestinal Transplantation, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brian Koenen
- Department of Gastroenterology, Hepatology & Nutrition, Center for Human Nutrition, Center for Gut Rehabilitation and Intestinal Transplantation, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Donald F Kirby
- Department of Gastroenterology, Hepatology & Nutrition, Center for Human Nutrition, Center for Gut Rehabilitation and Intestinal Transplantation, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
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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:E2002. [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.
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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
| | - 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
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Mahawar KK, Hayes C, Graham YN. Ascertaining Areas for Long-Term Follow-Up of Bariatric Surgical Patients for Primary Care: A Narrative Review. Bariatr Surg Pract Patient Care 2020. [DOI: 10.1089/bari.2019.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kamal K. Mahawar
- Bariatric Surgical Unit, Sunderland Royal Hospital, Sunderland, United Kingdom
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, United Kingdom
| | - Catherine Hayes
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, United Kingdom
| | - Yitka N.H. Graham
- Bariatric Surgical Unit, Sunderland Royal Hospital, Sunderland, United Kingdom
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, United Kingdom
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Abstract
Gastroparesis is characterized by delayed gastric emptying, with symptoms such as nausea, vomiting and abdominal pain, in the absence of mechanical obstruction. In most cases, it is idiopathic although diabetes mellitus is another leading cause. The physiology of gastric emptying is a complex process which is influenced by various inputs including the central nervous system, enteric nervous system and gut hormones. Developments in our understanding of gastroparesis have now demonstrated dysfunction in these systems, thus disrupting normal gastric emptying. Once mechanical obstruction is excluded, gastric scintigraphy remains the gold standard for diagnosis although wireless motility capsule and breath testing are alternative methods for diagnosis. Treatment for gastroparesis is challenging, and widely available therapies are often limited either by their poor evidence for efficacy or concerns over their long-term safety profile. Novel prokinetic agents have shown initial promise in clinical trials, and new endoscopic techniques such as gastric per-oral endoscopic myotomy are emerging. These new treatment modalities may provide an option in refractory gastroparesis with the adage of reduced morbidity compared to surgical treatments.
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Affiliation(s)
- A Sullivan
- Homerton University Hospital, London, UK
| | | | - A Ruban
- Department of Surgery and Cancer, Imperial College, London, UK.
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Syn NL, Lee PC, Kovalik JP, Tham KW, Ong HS, Chan WH, Tan CS, Lim CH. Associations of Bariatric Interventions With Micronutrient and Endocrine Disturbances. JAMA Netw Open 2020; 3:e205123. [PMID: 32515795 PMCID: PMC7284307 DOI: 10.1001/jamanetworkopen.2020.5123] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
IMPORTANCE Few studies have described the longitudinal trajectories of serum levels of micronutrients whose deficiencies are associated with serious sequelae following bariatric procedures, such as anemia, osteoporotic fractures, and neuropathies. Furthermore, previous studies comparing laparoscopic sleeve gastrectomy (LSG) vs Roux-en-Y gastric bypass (LRYGB) or one-anastomosis gastric bypass (OAGB) procedures may have been limited by selection and confounding biases. OBJECTIVE To appraise the spectrum and temporal course of micronutrient deficiencies associated with bone metabolism and erythropoiesis after LSG vs OAGB or LRYGB procedures, using the propensity score as a balancing score. DESIGN, SETTING, AND PARTICIPANTS This prospective, longitudinal comparative effectiveness study was conducted at a high-volume bariatric unit in Singapore from September 1, 2008, to November 30, 2017, with a cutoff date for analysis of September 2018. Patients who underwent adjustable gastric banding, biliopancreatic diversion procedures, and intragastric balloon procedures were excluded. All other patients who underwent bariatric procedures were included. Data were analyzed from September 23 to 30, 2018. MAIN OUTCOMES AND MEASURES Serial assessment of 13 biochemical parameters at 12 time points for up to 5 years after bariatric procedure. Inverse probability-of-treatment weights were used to obtain estimates of the mean associations of variables assessed with the bariatric surgical interventions. Longitudinal trajectories were analyzed using mixed-effects generalized linear models to apportion the temporal variation of serum micronutrients into fixed-effects and random-effects components. RESULTS A total of 688 patients were included in this study, of whom 499 underwent LSG (mean [SD] age, 41.5 [11.3] years; 318 [63.7%] women) and 189 underwent OAGB or LRYGB (mean [SD] age, 48.6 [9.4] years; 112 [59.3%] women). There were no differences during follow-up among patients who underwent LSG vs those who underwent OAGB or LRYGB in intact parathyroid hormone levels (mean difference, 7.05 [95% CI, -28.67 to 42.77] pg/mL; P = .70), serum 25-hydroxyvitamin D levels (mean difference, -0.72 [95% CI, -1.56 to 0.12] ng/mL; P = .09), or phosphate levels (mean difference, 0.006 [95% CI, -0.052 to 0.064] mg/dL; P = .83). Hemoglobin levels were a mean 0.63 (95% CI, 0.41 to 0.85) g/dL higher among patients who underwent LSG compared with those who underwent OAGB or LRYGB (P < .001), despite no differences in iron concentration levels (mean difference, 1.50 [95% CI, -1.39 to 4.39] µg/dL; P = .31), total iron-binding capacity (mean difference, 4.36 [95% CI, -5.25 to 13.98] µg/dL; P = .37), or ferritin levels (mean difference, 3.0 [95% CI, -13.0 to 18.9] ng/mL; P = .71). Compared with patients who underwent LSG procedures, patients who underwent OAGB or LRYGB had higher folate levels (mean difference, 2.376 [95% CI, 1.716 to 3.036] ng/mL; P < .001) but lower serum magnesium levels (mean difference, -0.25 [95% CI, -0.35 to -0.16] mg/dL; P < .001) and zinc levels (mean difference, -7.58 [95% CI, -9.92 to -5.24] µg/dL; P < .001). CONCLUSIONS AND RELEVANCE These findings suggest that LSG vs OAGB or LRYGB procedures have differential associations with various micronutrient and metabolic parameters. These differences should be recognized in guidelines for postbariatric nutritional surveillance and prevention.
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Affiliation(s)
- Nicholas L. Syn
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Phong Ching Lee
- Department of Endocrinology, Division of Medicine, Singapore General Hospital, Singapore
| | - Jean-Paul Kovalik
- Department of Endocrinology, Division of Medicine, Singapore General Hospital, Singapore
- Cardiovascular and Metabolic Diseases Programme, Duke-NUS Medical School, Singapore
| | - Kwang Wei Tham
- Department of Endocrinology, Division of Medicine, Singapore General Hospital, Singapore
| | - Hock Soo Ong
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore
| | - Weng Hoong Chan
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore
| | - Chuen Seng Tan
- Biostatistics and Modelling Domain, Saw Swee Hock School of Public Health, National University Health System, Singapore
| | - Chin Hong Lim
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore
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Vilallonga R, Pereira-Cunill JL, Morales-Conde S, Alarcón I, Breton I, Domínguez-Adame E, Ferrer JV, Ruiz-de-Gordejuela AG, Goday A, Lecube A, García-Almenta EM, Rubio MÁ, Tinahones FJ, García-Luna PP. A Spanish Society joint SECO and SEEDO approach to the Post-operative management of the patients undergoing surgery for obesity. Obes Surg 2020; 29:3842-3853. [PMID: 31342249 DOI: 10.1007/s11695-019-04043-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Bariatric surgery is the method of choice for the management or treatment of obesity. Bariatric surgery brings about several physiological changes in the body and is associated with set of complications. The aim of this study is to provide guidelines on post bariatric surgery management based on consensus by the Spanish society for Obesity Surgery (Sociedad Española de Cirugía de la Obesidad) (SECO) and the Spanish Society for the Study of Obesity (Sociedad Española para el Estudio de la Obesidad) (SEEDO). METHOD The boards proposed seven experts from each society. The experts provided the evidence and a grade of recommendation on the selected topics based on systematic reviews/meta-analysis. A list of clinical practical recommendations levels of evidence and grades of these recommendations was derived from the consensus statements from the members of these societies. RESULTS Seventeen topics related to post-operative management were reviewed after bariatric surgery. The experts came with 47 recommendations and statements. The mean number of persons voting at each statement was 54 (range 36-76). CONCLUSION In this consensus, we have designed a set of guidelines to be followed while managing patients after bariatric surgery. Expertise and knowledge of the clinicians are required to convey suitable considerations to the post-bariatric patients. There should also be extensive follow-up plans for the bariatric surgery patients.
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Affiliation(s)
- R Vilallonga
- Endocrine, metabolic and bariatric Unit, General Surgery Department, Hospital Vall d'Hebron, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - J L Pereira-Cunill
- Clinical Nutritión Unit, Endocrinology and Nutrition Service, University Hospital "Virgen del Rocío", Seville, Spain
| | - S Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of Surgery, University Hospital "Virgen del Rocío", Hospital Quironsalud Sagrado Corazón, University of Sevilla, Sevilla, Spain
| | - I Alarcón
- Unit of Innovation in Minimally Invasive Surgery, Department of Surgery, University Hospital "Virgen del Rocío", Hospital Quironsalud Sagrado Corazón, University of Sevilla, Sevilla, Spain
| | - I Breton
- Unidad de Nutrición Clínica y Dietética del Servicio de Endocrinología y Nutrición del Hospital Gregorio Marañón, Madrid, Spain
| | - E Domínguez-Adame
- UGC Cirugía General y Aparato Digestivo, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Sevilla, Spain
| | | | - A Garcia Ruiz-de-Gordejuela
- Endocrine, metabolic and bariatric Unit, General Surgery Department, Hospital Vall d'Hebron, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Goday
- Servicio de Endocrinología, Hospital del Mar de Barcelona, Departament de Medicina, CIBERobn, ISCIII, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Lecube
- Servicio deEndocrinología y Nutrición, Hospital Universitari Arnau de Vilanova de Lleida, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida (UdL), Avda. Rovira Roure, 80 25198, Lleida, Spain
| | - E Martín García-Almenta
- Unidad Cirugía Esófago-Gástrica, Metabólica y Bariátrica, Hospital Clínico San Carlos, Madrid, Spain
| | - M Á Rubio
- Servicio de Endocrinología y Nutrición, Hospital Clínico San Carlos, Idissc, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - F J Tinahones
- Service of Endocrinology and Nutrition, Hospital Clínico Universitario Virgen de Victoria de Malaga, Málaga, Spain
| | - P P García-Luna
- Unidad de Nutrición Clínica y de la Unidad de Obesidad Mórbida (Unidad de Gestión de Endocrinología y Nutrición, UGEN), Hospital Universitario Virgen del Rocío, Seville, Spain
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Is the Current Micronutrient Supplementation Adequate in Preventing Deficiencies in Indian Patients? Short- and Mid-Term Comparison of Sleeve Gastrectomy and Roux-en-Y Gastric Bypass. Obes Surg 2020; 30:3480-3488. [DOI: 10.1007/s11695-020-04674-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Nutritional Deficiencies in Patients after Roux-en-Y Gastric Bypass and Sleeve Gastrectomy during 12-Month Follow-Up. Obes Surg 2020; 29:3277-3284. [PMID: 31201694 DOI: 10.1007/s11695-019-03985-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are the two most frequently performed bariatric operations. These two types of metabolic surgery alter the anatomy and function of digestive tract producing significant weight loss in morbidly obese patients but may lead to malnutrition. AIM Analysis of incidence and severity of malnutrition after bariatric surgery in patients submitted to RYGB or LSG during 12 months of follow-up. MATERIAL AND METHODS Retrospective study of 98 patients after RYGB (n = 47) or LSG (n = 51) assessed for nutritional deficiencies during 12 months after surgery was conducted. The differences in body mass index (BMI) and blood tests including erythrocytes, haemoglobin, total protein, albumin, iron, ferritin, transferrin, vitamin B12, folic acid, calcium and phosphorus concentrations were compared between groups before the operations and at 1 and 12 months. RESULTS Nutritional deficiencies were common before surgery with prevalence up to 19.6% for albumin in the LSG group. Median preoperative BMI levels and albumin concentrations were higher in the RYGB group compared to the LSG group, but there was no difference in percent excess weight loss (%EWL) at 1 and 12 months between LSG and RYGB. One month after LSG erythrocyte count, haemoglobin, iron, ferritin and transferrin levels were significantly higher than in the RYGB group. These differences subsided at 12 months. At 12 months, only the prevalence of vitamin B12 deficiency was significantly higher in the RYGB group. CONCLUSION Both RYGB and LSG lead to nutritional deficiencies despite different properties of operations and similar %EWL during follow-up.
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Yeo C, Ahmed S, Oo AM, Koura A, Sanghvi K, Yeo D. COVID-19 and Obesity-the Management of Pre- and Post-bariatric Patients Amidst the COVID-19 Pandemic. Obes Surg 2020; 30:3607-3609. [PMID: 32385668 PMCID: PMC7210102 DOI: 10.1007/s11695-020-04670-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Charleen Yeo
- Department of Upper Gastrointestinal and Bariatric and Metabolic Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
| | - Saleem Ahmed
- Department of Upper Gastrointestinal and Bariatric and Metabolic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Aung Myint Oo
- Department of Upper Gastrointestinal and Bariatric and Metabolic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Aaryan Koura
- Department of Upper Gastrointestinal and Bariatric and Metabolic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Kaushal Sanghvi
- Department of Upper Gastrointestinal and Bariatric and Metabolic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Danson Yeo
- Department of Upper Gastrointestinal and Bariatric and Metabolic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
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Mechanick JI, Apovian C, Brethauer S, Timothy Garvey W, Joffe AM, Kim J, Kushner RF, Lindquist R, Pessah-Pollack R, Seger J, Urman RD, Adams S, Cleek JB, Correa R, Figaro MK, Flanders K, Grams J, Hurley DL, Kothari S, Seger MV, Still CD. Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures - 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Obesity (Silver Spring) 2020; 28:O1-O58. [PMID: 32202076 DOI: 10.1002/oby.22719] [Citation(s) in RCA: 145] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 10/09/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), American Society for Metabolic and Bariatric Surgery (ASMBS), Obesity Medicine Association (OMA), and American Society of Anesthesiologists (ASA) Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists. METHODS Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. RESULTS New or updated topics in this CPG include: contextualization in an adiposity-based chronic disease complications-centric model, nuance-based and algorithm/checklist-assisted clinical decision-making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). CONCLUSIONS Bariatric procedures remain a safe and effective intervention for higher-risk patients with obesity. Clinical decision-making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues.
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Affiliation(s)
- Jeffrey I Mechanick
- Guideline Task Force Chair (AACE); Professor of Medicine, Medical Director, Marie-Josée and Henry R. Kravis Center for Clinical Cardiovascular Health at Mount Sinai Heart; Director, Metabolic Support Divisions of Cardiology and Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York; Past President, AACE and ACE
| | - Caroline Apovian
- Guideline Task Force Co-Chair (TOS); Professor of Medicine and Director, Nutrition and Weight Management, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Stacy Brethauer
- Guideline Task Force Co-Chair (ASMBS); Professor of Surgery, Vice Chair of Surgery, Quality and Patient Safety; Medical Director, Supply Chain Management, Ohio State University, Columbus, Ohio
| | - W Timothy Garvey
- Guideline Task Force Co-Chair (AACE); Butterworth Professor, Department of Nutrition Sciences, GRECC Investigator and Staff Physician, Birmingham VAMC; Director, UAB Diabetes Research Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Aaron M Joffe
- Guideline Task Force Co-Chair (ASA); Professor of Anesthesiology, Service Chief, Otolaryngology, Oral, Maxillofacial, and Urologic Surgeries, Associate Medical Director, Respiratory Care, University of Washington, Harborview Medical Center, Seattle, Washington
| | - Julie Kim
- Guideline Task Force Co-Chair (ASMBS); Harvard Medical School, Mount Auburn Hospital, Cambridge, Massachusetts
| | - Robert F Kushner
- Guideline Task Force Co-Chair (TOS); Professor of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Richard Lindquist
- Guideline Task Force Co-Chair (OMA); Director, Medical Weight Management, Swedish Medical Center; Director, Medical Weight Management, Providence Health Services; Obesity Medicine Consultant, Seattle, Washington
| | - Rachel Pessah-Pollack
- Guideline Task Force Co-Chair (AACE); Clinical Associate Professor of Medicine, Division of Endocrinology, Diabetes and Metabolism, NYU Langone Health, New York, New York
| | - Jennifer Seger
- Guideline Task Force Co-Chair (OMA); Adjunct Assistant Professor, Department of Family and Community Medicine, Long School of Medicine, UT Health Science Center, San Antonio, Texas
| | - Richard D Urman
- Guideline Task Force Co-Chair (ASA); Associate Professor of Anesthesia, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stephanie Adams
- Writer (AACE); AACE Director of Clinical Practice Guidelines Development, Jacksonville, Florida
| | - John B Cleek
- Writer (TOS); Associate Professor, Department of Nutrition Sciences, University of Alabama, Birmingham, Alabama
| | - Riccardo Correa
- Technical Analysis (AACE); Assistant Professor of Medicine and Endocrinology, Diabetes and Metabolism Fellowship Director, University of Arizona College of Medicine, Phoenix, Arizona
| | - M Kathleen Figaro
- Technical Analysis (AACE); Board-certified Endocrinologist, Heartland Endocrine Group, Davenport, Iowa
| | - Karen Flanders
- Writer (ASMBS); Massachusetts General Hospital Weight Center, Boston, Massachusetts
| | - Jayleen Grams
- Writer (AACE); Associate Professor, Department of Surgery, University of Alabama at Birmingham; Staff Surgeon, Birmingham VA Medical Center, Birmingham, Alabama
| | - Daniel L Hurley
- Writer (AACE); Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - Shanu Kothari
- Writer (ASMBS); Fellowship Director of MIS/Bariatric Surgery, Gundersen Health System, La Crosse, Wisconsin
| | - Michael V Seger
- Writer (OMA); Bariatric Medical Institute of Texas, San Antonio, Texas, Clinical Assistant Professor, University of Texas Health Science Center, Houston, Texas
| | - Christopher D Still
- Writer (TOS); Medical Director, Center for Nutrition and Weight Management Director, Geisinger Obesity Institute; Medical Director, Employee Wellness, Geisinger Health System, Danville, Pennsylvania
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Kyio NH, Turgut S, Ozkan T, Cetin G. Evolution of Hematological Parameters During the First 2 Years After Laparoscopic Sleeve Gastrectomy: Results of a Retrospective Study. Obes Surg 2020; 30:2606-2611. [DOI: 10.1007/s11695-020-04528-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Coupaye M, Sami O, Calabrese D, Flamant M, Ledoux S. Prevalence and Determinants of Nutritional Deficiencies at Mid-Term After Sleeve Gastrectomy. Obes Surg 2020; 30:2165-2172. [PMID: 32016653 DOI: 10.1007/s11695-020-04425-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Vega C, Misra A, Schubert G, Arora R. Gradual onset of psychotic symptoms in an adolescent. J Paediatr Child Health 2020; 56:332-333. [PMID: 31482641 DOI: 10.1111/jpc.14610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 08/08/2019] [Accepted: 08/11/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Carolina Vega
- Pediatric Emergency Medicine, Children's Hospital of Michigan, Detroit, Michigan, United States
| | - Amrit Misra
- Department of Pediatric Cardiology, Children's Hospital of Michigan, Detroit, Michigan, United States
| | - Gena Schubert
- Pediatric Emergency Medicine, Phoenix Children's Hospital, Phoenix, Arizona, United States
| | - Rajan Arora
- Pediatric Emergency Medicine, Children's Hospital of Michigan, Detroit, Michigan, United States
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Ciobârcă D, Cătoi AF, Copăescu C, Miere D, Crișan G. Bariatric Surgery in Obesity: Effects on Gut Microbiota and Micronutrient Status. Nutrients 2020; 12:E235. [PMID: 31963247 PMCID: PMC7019602 DOI: 10.3390/nu12010235] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/30/2019] [Accepted: 01/13/2020] [Indexed: 02/07/2023] Open
Abstract
Obesity is associated with reduced gut microbial diversity and a high rate of micronutrient deficiency. Bariatric surgery, the therapy of choice for severe obesity, produces sustained weight loss and improvements in obesity-related comorbidities. Also, it significantly alters the gut microbiota (GM) composition and function, which might have an important impact on the micronutrient status as GM is able to synthesize certain vitamins, such as riboflavin, folate, B12, or vitamin K2. However, recent data have reported that GM is not fully restored after bariatric surgery; therefore, manipulation of GM through probiotics represents a promising therapeutic approach in bariatric patients. In this review, we discuss the latest evidence concerning the relationship between obesity, GM and micronutrients, the impact of bariatric surgery on GM in relation with micronutrients equilibrium, and the importance of the probiotics' supplementation in obese patients submitted to surgical treatment.
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Affiliation(s)
- Daniela Ciobârcă
- Department of Bromatology, Hygiene, Nutrition, Faculty of Pharmacy, “Iuliu Hatieganu” University of Medicine and Pharmacy, 23 Gheorghe Marinescu Street, 400337 Cluj-Napoca, Romania
| | - Adriana Florinela Cătoi
- Department of Physiopathology, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 3-4 Victor Babes Street, 400012 Cluj-Napoca, Romania
| | - Cătălin Copăescu
- General Surgery Department, Ponderas Hospital, 85A Nicolae G. Caramfil Street, 014142 Bucharest, Romania;
| | - Doina Miere
- Department of Bromatology, Hygiene, Nutrition, Faculty of Pharmacy, “Iuliu Hatieganu” University of Medicine and Pharmacy, 23 Gheorghe Marinescu Street, 400337 Cluj-Napoca, Romania
| | - Gianina Crișan
- Department of Pharmaceutical Botany, Faculty of Pharmacy, “Iuliu Hatieganu” University of Medicine and Pharmacy, 23 Gheorghe Marinescu Street, 400337 Cluj-Napoca, Romania;
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Yeo D, Yeo C, Low TY, Ahmed S, Phua S, Oo AM, Rao J, Koura A, Venkataraman K, Kaushal S. Outcomes After Metabolic Surgery in Asians-a Meta-analysis. Obes Surg 2020; 29:114-126. [PMID: 30196357 DOI: 10.1007/s11695-018-3484-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Obesity and type 2 diabetes mellitus (T2DM) are now increasingly epidemic in Asia. As obesity and T2DM have different disease patterns in Asians compared to Westerners, outcomes after metabolic surgery may differ. The aim of this meta-analysis was to gather the current available evidence on the outcomes after metabolic surgery in Asians. METHODS A literature search was conducted in September 2017. Four outcome measures were examined: (1) % excess weight loss (EWL), (2) post-intervention body mass index (BMI), (3) T2DM resolution or improvement, and (4) hypertension resolution. RESULTS Thirteen publications with a total of 1052 patients were analyzed, of which nine were randomized controlled trials, and four were case-matched studies. All the studies had a minimum follow-up duration of at least 1 year. % EWL was significantly higher in those who have undergone Roux-en-Y gastric bypass (RYGB) (SMD 0.53, 95% CI 0.12 to 0.94) versus sleeve gastrectomy (SG). T2DM resolution/improvement was favorable in those who have undergone RYGB (pooled OR 1.39, 95% CI 0.53 to 3.67) versus SG, although not statistically significant. Hypertension resolution was not significantly different between patients who have undergone SG versus RYGB (pooled OR 0.96, 95% CI 0.44 to 2.11). CONCLUSION RYGB results in better weight loss compared to SG in Asians, but the rate of T2DM resolution/improvement and improvement of hypertension appears to be similar. In Asian patients without symptoms of gastro-esophageal reflux disease in whom metabolic surgery is performed mainly for T2DM and metabolic syndrome, SG may be the surgery of choice.
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Affiliation(s)
- Danson Yeo
- Upper Gastrointestinal Surgery Unit, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
| | - Charleen Yeo
- Upper Gastrointestinal Surgery Unit, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Tze Yi Low
- Upper Gastrointestinal Surgery Unit, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Saleem Ahmed
- Upper Gastrointestinal Surgery Unit, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Sheena Phua
- Upper Gastrointestinal Surgery Unit, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Aung Myint Oo
- Upper Gastrointestinal Surgery Unit, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Jaideepraj Rao
- Upper Gastrointestinal Surgery Unit, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Aaryan Koura
- Upper Gastrointestinal Surgery Unit, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Kavita Venkataraman
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Sanghvi Kaushal
- Upper Gastrointestinal Surgery Unit, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
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Eroğlu HA, Adali Y, Beşeren H, Fındık Güvendi G, Binnetoğlu K. Association of Histopathology and Hemogram Findings Following Sleeve Gastrectomy. Bariatr Surg Pract Patient Care 2019. [DOI: 10.1089/bari.2019.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hüseyin Avni Eroğlu
- Department of Physiology, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale, Turkey
| | - Yasemen Adali
- Department of Pathology, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale, Turkey
| | - Hatice Beşeren
- Department of Pathology, Kafkas University Faculty of Veterinary Medicine, Kars, Turkey
| | - Gülname Fındık Güvendi
- Department of Pathology, Rize Recep Tayyip Erdoğan University Faculty of Medicine, Rize, Turkey
| | - Kenan Binnetoğlu
- Department of General Surgery, Kafkas University Faculty of Medicine, Kars, Turkey
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