Pharmacotherapy Prevention and Management of Nutritional Deficiencies Post Roux-en-Y Gastric Bypass

Levinson, Radmila; Silverman, Jon; Catella, Jennifer; Rybak, Iwona; Jolin, Hina; Isom, Kellene

doi:10.1007/s11695-013-0922-2

Cited by 43 publications

(25 citation statements)

References 54 publications

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“…It showed a high prevalence of hypovitaminosis D pre and postoperatively, with no specific information on vitamin D supplementation dose, response to therapy, or analysis by type of surgery [112]. Several other reviews summarize the available evidence on various nutrient deficiencies following bariatric surgery, but none of them focused specifically on vitamin D nutritional status [20,21,34,113]. …”

Section: Discussionmentioning

confidence: 99%

“…However, bariatric surgery leads to various nutritional and vitamin deficiencies, including vitamin D and others, requiring adequate follow up postoperatively [20,21]. Vitamin D deficiency in the bariatric surgery population is multifactorial, some factors being related to obesity, and might not resolve completely after surgery, and others may be related to the type of the surgical procedure and/or its consequences.…”

Section: Introductionmentioning

confidence: 99%

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Hypovitaminosis D in bariatric surgery: A systematic review of observational studies

et al. 2016

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Background Obesity is a public health problem that carries global and substantial social and economic burden. Relative to non-surgical interventions, bariatric surgery has the most substantial and lasting impact on weight loss. However, it leads to a number of nutritional deficiencies requiring long term supplementation. Objectives The aims of this paper are to review 25-hydroxyvitamin D [25(OH)D] status pre and post - bariatric surgery, describe the dose response of vitamin D supplementation, and assess the effect of the surgical procedure on 25(OH)D level following supplementation. Methods We searched Medline, PubMed, the Cochrane Library and EMBASE, for relevant observational studies published in English, from 2000–April 2015. The identified references were reviewed, in duplicate and independently, by two reviewers. Results We identified 51 eligible observational studies assessing 25(OH)D status pre and/or post bariatric surgery. Mean pre-surgery 25(OH)D level was below 30 ng/ml in 29 studies and 17 of these studies showed mean 25(OH)D levels ≤ 20 ng/ml. Mean 25(OH)D levels remained below 30 ng/ml following bariatric surgery despite various vitamin D replacement regimens, with only few exceptions. The increase in postoperative 25(OH)D levels tended to parallel increments in vitamin D supplementation dose but varied widely across studies. An increase in 25(OH)D level by 9–13 ng/ml was achieved when vitamin D deficiency was corrected using vitamin D replacement doses of 1,100–7,100 IU/day, in addition to the usual maintenance equivalent daily dose of 400 – 2,000 IU (total equivalent daily dose 1,500–9,150 IU). There was no difference in mean 25(OH)D level following supplementation between malabsorptive/ combination procedures and restrictive procedures. Conclusion Hypovitaminosisis D persists in obese patients undergoing bariatric surgery, despite various vitamin D supplementation regimens. Further research is needed to determine the optimal vitamin D dose to reach desirable 25(OH)D levels in this population, and to demonstrate whether this dose varies according to the surgical procedure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hypovitaminosis D in bariatric surgery: A systematic review of observational studies

et al. 2016

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“…Despite the fact that WE was described so early, it took more than half a century to recognize the relation between the disease and the RYGB. [24][25][26], [27], [28], [29], [13]. Following SG for morbid obesity more particularly, several factors, However, because of the technical difficulty and lack of specificity of these tests, which additionally require several days to perform, their aid in the process of decision-making is limited.…”

Section: Discussionmentioning

confidence: 99%

Wernicke encephalopathy after sleeve gastrectomy. A review of the literature

Angelou

Athanasiou

Diamantis

et al. 2017

JDDD

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Objectives:Bariatric surgery has been established as the cornerstone of treatment of morbid obesity with good immediate and long-term results. Nutrient deficiencies though, can be an important long-term complication and may lead to hematological, metabolic and especially neurological disorders which are not always reversible. Thiamine (vitamin B1) deficiency has been reported both after restrictive and malabsorptive procedures. The aim of this study is to review all cases that presented with Wernicke Encephalopathy after sleeve gastrectomy. Methods:A review of the literature was conducted to evaluate all sleeve gastrectomies performed till today and caused Wernicke encephalopathy to the patients. Demographic data, operative parameters, postoperative outcomes were collected and assessed. Results:A total of 13 studies, including 13 patients were analyzed. Patients ranged in age from 17 to 55 years. The onset of Wernicke encephalopathy occurred as early as 3 weeks after surgery to as late as 60 weeks after surgery. When symptoms of Wernicke encephalopathy developed, patients had lost from 19 kg up to 60 kg of body weight. Conclusions:Micronutrient deficiencies and particularly B1 deficiency can occur after LSG, although rarely. Preoperative nutritional assessment and postoperative follow-up plan, should signs of Wernicke's encephalopathy be traced, is recommended in all patients.

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“…Recommendations for prophylactic vitamin and trace element supplementation include oral or sublingual administration of 1 mg of B 12 daily or intramuscular administration of 1 mg of B 12 monthly, 800 μg to 1 mg of folic acid daily, up to 60 mg of oral zinc daily, 36-65 mg of elemental iron daily, at least 3,500 IU of vitamin A daily, 2,000 IU of vitamin D 3 along with 1,500 mg of calcium daily and vitamin D 2 at a dose of 50,000 IU weekly [11] and at least 55 μg of selenium daily [12]. Occasionally, skin lesions are the first indication of vitamin or trace element deficiency and should trigger further research from a dermatological perspective.…”

Section: Discussionmentioning

confidence: 99%

Dermatological Complications after Bariatric Surgery: Report of Two Cases and Review of the Literature

Zouridaki¹,

Papafragkaki²,

Papafragkakis³

et al. 2014

Dermatology

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Bariatric surgery aims at weight reduction of severely obese patients. The Roux-en-Y technique is one of the most common bariatric procedures and is occasionally accompanied by nutrient insufficiencies and metabolic changes. According to the literature, skin architecture and immunity change after bariatric surgery and may lead to inflammation and increased susceptibility to pathogens. Additionally, vitamin and mineral deficiencies frequently develop in these patients and affect the skin's defense mechanisms, possibly contributing to dermatological complications. Knowledge and recognition of skin changes after bariatric surgery make an important asset for the dermatologist and help in the proper treatment of these patients. We report 2 cases of infectious skin lesions where vitamin and trace element deficiencies have possibly contributed to their persistence and resistance to traditional treatments.

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Pharmacotherapy Prevention and Management of Nutritional Deficiencies Post Roux-en-Y Gastric Bypass

Cited by 43 publications

References 54 publications

Hypovitaminosis D in bariatric surgery: A systematic review of observational studies

Hypovitaminosis D in bariatric surgery: A systematic review of observational studies

Wernicke encephalopathy after sleeve gastrectomy. A review of the literature

Dermatological Complications after Bariatric Surgery: Report of Two Cases and Review of the Literature

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