Improving Bariatric Patient Aftercare Outcome by Improved Detection of a Functional Vitamin B12 Deficiency

Smelt, Hendrika J.M.; Smulders, J. F.; Said, M.; Nienhuijs, S W; Boer, Arjen‐Kars

doi:10.1007/s11695-015-1952-8

Cited by 12 publications

(14 citation statements)

References 27 publications

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“…Some of the cases reported in this article, as well as the study by Smelt et al 66 mentioned previously, suggest that supplementation of vitamin B 12 itself, regardless of the actual vitamin B 12 status, improves clinical symptoms. This hypothesis may put our thinking on the pathophysiology of vitamin B 12 deficiency in a different perspective.…”

Section: Just a Vitamin Or More?supporting

confidence: 65%

“…Bariatric surgery has become one of the major treatments for (morbid) obesity, and reduced production of both IF and gastric acid, as well as reduced intake of vitamin B 12 –containing foods, contribute to the development of vitamin B 12 deficiency (patient F). A recent study from The Netherlands reported a 60% incidence of post–bariatric surgery vitamin B 12 deficiency, defined as a serum MMA level greater than 300 pmol/L 66 . Interestingly, these investigators also reported that positive results of parenteral vitamin B 12 administration were reported by patients without functional vitamin B 12 deficiency (MMA <300 nmol/L), suggesting that supplementation itself, regardless of the actual vitamin B 12 status, improves clinical symptoms 66 .…”

Section: Possible Causes Of Vitamin B12 Deficiencymentioning

confidence: 99%

“…A recent study from The Netherlands reported a 60% incidence of post–bariatric surgery vitamin B 12 deficiency, defined as a serum MMA level greater than 300 pmol/L 66 . Interestingly, these investigators also reported that positive results of parenteral vitamin B 12 administration were reported by patients without functional vitamin B 12 deficiency (MMA <300 nmol/L), suggesting that supplementation itself, regardless of the actual vitamin B 12 status, improves clinical symptoms 66 . Finally, severe cases of vitamin B 12 deficiency have been reported in young individuals using nitrous oxide as a recreational drug 67, 68, 69…”

Section: Possible Causes Of Vitamin B12 Deficiencymentioning

confidence: 99%

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The Many Faces of Cobalamin (Vitamin B12) Deficiency

Wolffenbuttel

Wouters

Heiner‐Fokkema

et al. 2019

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

142

143

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Although cobalamin (vitamin B 12 ) deficiency was described over a century ago, it is still difficult to establish the correct diagnosis and prescribe the right treatment. Symptoms related to vitamin B 12 deficiency may be diverse and vary from neurologic to psychiatric. A number of individuals with vitamin B 12 deficiency may present with the classic megaloblastic anemia. In clinical practice, many cases of vitamin B 12 deficiency are overlooked or sometimes even misdiagnosed. In this review, we describe the heterogeneous disease spectrum of patients with vitamin B 12 deficiency in whom the diagnosis was either based on low serum B 12 levels, elevated biomarkers like methylmalonic acid and/or homocysteine, or the improvement of clinical symptoms after the institution of parenteral vitamin B 12 therapy. We discuss the possible clinical signs and symptoms of patients with B 12 deficiency and the various pitfalls of diagnosis and treatment.

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Section: Just a Vitamin Or More?supporting

confidence: 65%

Section: Possible Causes Of Vitamin B12 Deficiencymentioning

confidence: 99%

Section: Possible Causes Of Vitamin B12 Deficiencymentioning

confidence: 99%

See 1 more Smart Citation

The Many Faces of Cobalamin (Vitamin B12) Deficiency

Wolffenbuttel

Wouters

Heiner‐Fokkema

et al. 2019

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

142

143

View full text Add to dashboard Cite

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“…Vitamin B12 levels are not a good predictor of deficiency because methodological problems affect sensitivity and specificity 97 . In view of this, methylmalonic acid (MMA) has been proposed as a better indicator, but this requires a sensitive plasma assay not routinely available in the United Kingdom 98,99 . If there is doubt about vitamin B12 deficiency, it is better to treat 97 …”

Section: Postoperative Care and Biochemical Monitoringmentioning

confidence: 99%

British Obesity and Metabolic Surgery Society Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery—2020 update

et al. 2020

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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, Rouxen-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,

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“…[6][7][8] Conversely, functional deficiencies could be absent with serum vitamin B 12 concentrations between 90 and 140 pmol/L. 8,9 Although it is difficult to diagnose vitamin B 12 deficiencies, treatment should not be initiated too late as neurological manifestations may be irreversible.…”

Section: Introductionmentioning

confidence: 99%

Improved testing for vitamin B₁₂ deficiency: correcting MMA for eGFR reduces the number of patients classified as vitamin B₁₂ deficient

et al. 2018

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Background Methylmalonic acid (MMA) can detect functional vitamin B deficiencies as it accumulates early when intracellular deficits arise. However, impaired clearance of MMA from blood due to decreased glomerular filtration rate (eGFR) also results in elevated plasma MMA concentrations. Alternative to clinical trials, a data mining approach was chosen to quantify and compensate for the effect of decreased eGFR on MMA concentration. Methods Comprehensive data on patient's vitamin B, eGFR and MMA concentrations were collected ( n = 2906). The relationship between vitamin B, renal function (eGFR) and MMA was modelled using weighted multiple linear regression. The obtained model was used to estimate the influence of decreased eGFR on MMA. Clinical impact was examined by comparing the number of patients labelled vitamin B deficient with and without adjustment in MMA. Results Adjusting measured MMA concentrations for eGFR in the group of patients with low-normal vitamin B concentrations (90-300 pmol/L) showed that the use of unadjusted MMA concentrations overestimates vitamin B deficiency by 40%. Conclusions Through a data mining approach, the influence of eGFR on the relation between MMA and vitamin B can be quantified and used to correct the measured MMA concentration for decreased eGFR. Especially in the elderly, eGFR-based correction of MMA may prevent over-diagnosis of vitamin B deficiency and corresponding treatment.

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Improving Bariatric Patient Aftercare Outcome by Improved Detection of a Functional Vitamin B12 Deficiency

Abstract: This study shows that all bariatric patients with vitamin B12 levels between 140 and 200 pmol/L benefit clinical and biochemical from vitamin B12 supplementation, regardless the MMA levels.

Cited by 12 publications

References 27 publications

The Many Faces of Cobalamin (Vitamin B12) Deficiency

The Many Faces of Cobalamin (Vitamin B12) Deficiency

British Obesity and Metabolic Surgery Society Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery—2020 update

Improved testing for vitamin B₁₂ deficiency: correcting MMA for eGFR reduces the number of patients classified as vitamin B₁₂ deficient

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Improving Bariatric Patient Aftercare Outcome by Improved Detection of a Functional Vitamin B12 Deficiency

Abstract: This study shows that all bariatric patients with vitamin B12 levels between 140 and 200 pmol/L benefit clinical and biochemical from vitamin B12 supplementation, regardless the MMA levels.

Cited by 12 publications

References 27 publications

The Many Faces of Cobalamin (Vitamin B12) Deficiency

The Many Faces of Cobalamin (Vitamin B12) Deficiency

British Obesity and Metabolic Surgery Society Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery—2020 update

Improved testing for vitamin B12 deficiency: correcting MMA for eGFR reduces the number of patients classified as vitamin B12 deficient

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Improved testing for vitamin B₁₂ deficiency: correcting MMA for eGFR reduces the number of patients classified as vitamin B₁₂ deficient