Perioperative management of bariatric surgery patients: Focus on metabolic bone disease

Williams, Susan E.; Cooper, Karen; Richmond, Bradford J.; Schauer, Philip R.

doi:10.3949/ccjm.75.5.333

Cited by 38 publications

(31 citation statements)

References 53 publications

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“…23 In addition, a decrease in hepatic production of 25-hydroxy vitamin D due to hepatic steatosis and a decrease in synthesis of vitamin D through the skin may also intervene. 19,24 A US study showed that individuals with the most severe obesity were those whose ethnicity was African-American and those with low sun exposure appeared to be most at risk of deficiency in vitamin D. 19 In this latest study, it was highlighted that for each increase of one kg/m 2 of BMI, there was a decrease of 1.3 nanomole/ l of serum 25 -OHD. 19 Hyperparathyroidism is also common in obese subjects, and although this anomaly may be secondary to vitamin D deficiency, an independent association of vitamin D between parathyroid hormone and obesity has been reported.…”

Section: Nutritional Deficiency Of Vitamin D In the Obesementioning

confidence: 99%

Vitamin D alteration associated with obesity and bariatric surgery

Lespessailles

Toumi

2017

Exp Biol Med (Maywood)

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Obesity and severe obesity constitute growing serious health problems reaching epidemic proportion in most countries with a prevalence increasing from 6.4 in 1975 to 14.9% in 2014. This present review summarizes currently available data on vitamin D deficiencies in the obese population before and after bariatric surgery. The important evidence emerging from our evaluation confirms that obese patients are at risk of multiple nutritional deficiencies, especially vitamin D deficiency, before bariatric surgery. Our survey confirms that the precise role of the gut microbiome and its associated changes on the vitamin D metabolism after the different bariatric surgery procedures has not yet been studied. Furthermore, whether differences in the microbiota may alter the therapeutic responses to vitamin D is not known. AbstractObesity and severe obesity constitute growing serious health problems reaching epidemic proportion in most countries. Interactions and relationships between obesity and bone tissue and its metabolism are complex but are more and more studied and recognized. Obesity is associated with an altered hormonal profile including particularly bone-regulating hormones like vitamin D. Bariatric surgery procedures, thanks to their effectiveness to achieve therapeutic endpoints for comorbidities associated with obesity, have had an increasing success. However, these surgeries by producing mechanical restriction and or malabsorption syndrome lead to nutritional deficiencies including vitamin D. In this review, we aim to (1) discuss the nutritional deficiency of vitamin D in the obese, (2) to summarize the different surgical options in bariatric surgery and to present the evidence concerning these procedures and their associated profile in vitamin D post-operative insufficiency, (3) to present the different recommendations in clinical practice to prevent or treat vitamin D deficiencies or insufficiencies in patients treated by bariatric surgery and finally to introduce emerging assumptions on the relationship between vitamin D, microbiota composition and circulating bile acids.

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Section: Nutritional Deficiency Of Vitamin D In the Obesementioning

confidence: 99%

Vitamin D alteration associated with obesity and bariatric surgery

Lespessailles

Toumi

2017

Exp Biol Med (Maywood)

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“…The number of operations for obesity has increased in recent years 5,47 and its success is founded on the effective weight loss, control of comorbidities and increased quality of life 1,5,9,29,47 . However, some negative effects have also been reported in several studies, such as hyperparathyroidism and osteoporosis 39,55,57,59 chronic regurgitation, nutritional deficiencies 2,6,28,30,59 , kidney problems 3,16 and oral problems 22,23,31,49 . The objective of this review was to identify the consequences of postoperative bariatric surgery (as vitamin deficiency, gastroesophageal reflux, kidney disturbances, psychological alterations, reduction of diabetes mellitus, improvement in obstructive sleep apnea and, also, to check its impact on oral health and dental caries, xerostomy, erosion and bone resorption.…”

Section: Introductionmentioning

confidence: 99%

Consequências sistêmicas da cirurgia bariátrica e suas repercussões na saúde bucal

Moura-Grec

Assis

Cannabrava

et al. 2012

ABCD, arq. bras. cir. dig.

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-Introduction -Morbid obesity control can be done by bariatric surgery that restricts or reduces the amount of food absorption. The objective of this review was to identify the consequences of bariatric surgery and its repercussions on oral health. Method -It was used the Virtual Library of Health, which included articles that had any direct or indirect connection between bariatric surgery and oral health, and published in the last ten years. Results -Some complications of the surgery are chronicle reflux and nutritional deficiency, which may bring repercussions on the oral cavity, such as tooth erosion, bone loss and dental caries. On the other hand, there are also positive impacts, such as the decrease of diabetes, apnea and improvement on self-esteem, that makes the patients less vulnerable to complications regarding oral health, for example xerostomy and periodontal disease. Conclusion -Maintaining proper oral health in patients undergoing bariatric surgery contributes to success after surgery protecting benefits and minimizing side effects. ABCDDV/868RESUMO -Introdução -O controle da obesidade mórbida pode ser realizado através da cirurgia bariátrica que leva à restrição e/ou à má-absorção de alimentos. O objetivo dessa revisão foi identificar consequências desse procedimento e suas repercussões na saúde bucal. Método -Foi realizada busca na Biblioteca Virtual em Saúde, sendo incluídos artigos com relação direta ou indireta entre cirurgia bariátrica e saúde bucal e publicados nos últimos dez anos. Resultados -Verificaram-se algumas complicações decorrentes dessa operação, como regurgitação crônica e deficiências nutricionais, que podem trazer repercussões na cavidade bucal como erosão dentária, perda óssea e cárie dentária. Por outro lado, existem consequências positivas como controle da diabetes, da apnéia e melhora da auto-estima, que tornam os pacientes menos susceptíveis à complicações na cavidade oral, como xerostomia e doença periodontal. Conclusão -A manutenção da saúde bucal adequada em pacientes submetidos à cirurgia bariátrica contribui para o sucesso após a operação, resguardando os benefícios e minimizando os efeitos colaterais.

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“…Voluntary weight loss of about 10% leads to bone loss of around 1-2% at all sites [31]. It appears that more than 70% of patients who have had a malabsorptive procedure may develop metabolic bone disease; significant bone resorption becomes evident as soon as 3 months after bariatric surgery independently of the type of the procedure [32].…”

Section: Metabolic Bone Disease Managementmentioning

confidence: 99%

“…Inappropriate supplementation post-operatively results in a significant bone disease 8 weeks to 32 years after surgery [31].…”

Section: Metabolic Bone Disease Managementmentioning

confidence: 99%

Management of the post-bariatric surgery patient – what an internist needs to know

Handzlik-Orlik

Holecki

Kędzierski

et al. 2016

noms

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Bariatric surgery is the most effective method of achieving long-lasting weight loss and improving metabolic and cardiovascular outcomes in selected obese patients (i.e. with body mass index [BMI] ≥ 40 kg/m 2 without coexisting morbidities or BMI ≥ 35 kg/m 2 with severe obesity-related diseases). As the epidemic of obesity grows, it is estimated that by 2030 around 11% of the population will be severely obese. Therefore, the number of bariatric procedures performed increases year after year, and it reached 179,000 in 2013. Bariatric procedures can be divided into three main types: restrictive, malabsorptive, and mixed procedures. While, careful multi-disciplinary preoperative assessment of the patient is an inseparable part of bariatric procedures, there is also a need for multi-disciplinary management after bariatric surgery. This should include surveillance by an internist, surgeon and registered dietician. However, treatment outcome is primarily dependent on the patient's compliance and awareness of the need for regular follow-up. This cannot be achieved without proper behavioral and psychological support, as it is as vital as other surveillance aspects. In this review we discuss early and late complications of bariatric surgery, its influence on obesity-related diseases, and changes in body composition and metabolism. According to recent guidelines and recommendations of American and European medical societies, we summarize available standards of post-bariatric management.

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Perioperative management of bariatric surgery patients: Focus on metabolic bone disease

Cited by 38 publications

References 53 publications

Vitamin D alteration associated with obesity and bariatric surgery

Vitamin D alteration associated with obesity and bariatric surgery

Consequências sistêmicas da cirurgia bariátrica e suas repercussões na saúde bucal

Management of the post-bariatric surgery patient – what an internist needs to know

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