Vitamin B-12 deficiency after gastric surgery for obesity

Rhode, Barbara; Arseneau, P; Cooper, Bernard A.; Katz, Max; Gilfix, Brian M.; MacLean, Lloyd D.

doi:10.1093/ajcn/63.1.103

Cited by 133 publications

(53 citation statements)

References 28 publications

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“…The majority of studies report deficiencies of ϳ35% (114,119 -121). Supplementation with crystalline B 12 has been found to prevent deficiency (119). A daily multivitamin is known to prevent folic acid deficiency (122), a problem that was reported in up to 38% of GBP patients (114,116,122,123) prior to food fortification with folate.…”

Section: Micronutrientsmentioning

confidence: 99%

Criteria for Patient Selection and Multidisciplinary Evaluation and Treatment of the Weight Loss Surgery Patient

et al. 2005

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Criteria for patient selection and multidisciplinary evaluation and treatment of the weight loss surgery patient. Obes Res. 2005;13:234 -243. Objective: To provide evidence-based guidelines for patient selection and to recommend the medical and nutritional aspects of multidisciplinary care required to minimize perioperative and postoperative risks in patients with severe obesity who undergo weight loss surgery (WLS). Research Methods and Procedures: Members of the Multidisciplinary Care Task Group conducted searches of MEDLINE and PubMed for articles related to WLS in general and medical and nutritional care in particular. Pertinent abstracts and literature were reviewed for references. Multiple searches were carried out for various aspects of multidisciplinary care published between 1980 and 2004. A total of 3000 abstracts were identified; 242 were reviewed in detail. Results: We recommended multidisciplinary screening of WLS patients to ensure appropriate selection; preoperative assessment for cardiovascular, pulmonary, gastrointestinal, endocrine, and other obesity-related diseases associated with increased risk for complications or mortality; preoperative weight loss and cessation of smoking; perioperative prophylaxis for deep vein thrombosis and pulmonary embolism (PE); preoperative and postoperative education and counseling by a registered dietitian; and a well-defined postsurgical diet progression. Discussion: Obesity-related diseases are often undiagnosed before WLS, putting patients at increased risk for complications and/or early mortality. Multidisciplinary assessment and care to minimize short-and long-term risks include: comprehensive medical screening; appropriate pre-, peri-, and postoperative preparation; collaboration with multiple patient care disciplines (e.g., anesthesiology, pulmonary medicine, cardiology, and psychology); and long-term nutrition education/counseling.

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Section: Micronutrientsmentioning

confidence: 99%

Criteria for Patient Selection and Multidisciplinary Evaluation and Treatment of the Weight Loss Surgery Patient

et al. 2005

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“…Vitamin B 12 de®ciency has been reported after gastric bypass surgery, but is uncommon after gastric reduction surgery. 17,18 This study focused on measurement of these parameters, party because of the dif®culty of assessing intake. These are in fact two of a limited range of biochemical markers of nutritional status 19 which are easy to measure.…”

Section: Nutritional Effects Of Gastroplasty Pl Cooper Et Almentioning

confidence: 99%

Nutritional consequences of modified vertical gastroplasty in obese subjects

et al. 1999

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BACKGROUND: Gastroplasty results in a considerable reduction in food intake and dramatic weight loss. This is likely to have a nutritional impact, although it is expected that this may be minimised by good advice and supplement use. METHODS: Twenty six obese subjects were studied in detail before and after modi®ed long vertical gastroplasty (MLVG), in a setting where comprehensive nutritional advice on symptom avoidance was readily available and multivitamin supplements advised. Nutritional intake and anthropometry were measured preoperatively and at 2, 5 (n 22) and 12 months (n 11) postoperatively. RESULTS: Mean weight loss was 13%, 22% and 31% of initial body weight at the respective time points. Energy intake (EI) was signi®cantly reduced postoperatively, with the mean protein intake being only 40 gad. At 2 months, mean intakes of iron, calcium and zinc from food were 40%, 71% and 39%, respectively, of the Australian recommended dietary intake (RDI), and iron and zinc intake remained below half the RDI at 5 months. Only regular adherence to the vitaminamineral supplement, brought iron and calcium intakes close to RDI, but zinc remained low. Haemoglobin and serum ferritin concentrations did not alter signi®cantly and remained within the reference range, but serum folate fell signi®cantly between 5 months and 12 months. By 5 months, 60% of subjects never regurgitated or regurgitated less than once a week. Fresh bread was the least tolerated food. Frequency of regurgitation was not correlated with adequacy of nutrient intake. CONCLUSIONS: The results emphasise the need for regular follow-up of MLVG patients, and nutritional advice which includes diet quality as well as symptom management, and regular intake of the vitaminamineral supplement for at least a year postoperatively. Low protein intakes, however, remain of potential long-term concern.

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“…Despite these preventive measures, 7% of patients undergoing this surgical treatment develop bone demineralization, usually between the second and fifth postoperative years 19 . Since vitamin B12, in its protein-bound form, is poorly absorbed in these patients, Rhode 30 has recently suggested daily administration of the crystalline form of vitamin B12 at very high dosage. Indeed, at least 350 ug of crystalline vitamin B12 are necessary to normalize the serum levels of this vitamin, and a dosage as high as 500 ug/day has been recommended 16 .…”

Section: Gastric Surgery -Related Risks and Complicationsmentioning

confidence: 99%

Surgical treatment for morbid obesity

Kolanowski

1997

British Medical Bulletin

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Since severe obesity is frequently associated with serious metabolic, cardiovascular and psychological co-morbid conditions, and given the usually unsuccessful results of conservative therapeutic approaches, surgical treatment based on gastric restriction procedures is increasingly recognized as a treatment of choice for morbidly obese persons. Among several surgical approaches designed to promote a substantial loss of weight, two gastric restriction procedures, i.e. the vertical banded gastroplasty and the gastric bypass, have been increasingly used during the past years. Both techniques induce an impressive loss of weight, and are surprisingly well tolerated, even by severely obese persons.The usual 50-75% reduction of initial weight excess, is followed by a clear-cut reduction, or even disappearance of, obesity-related co-morbidity, such as hypertension, diabetes mellitus or sleep apnea syndrome.While serious peri-and postoperative risks are very limited, the intractable vomiting occurring after gastroplasty, and potential sequelae related to iron and calcium malabsorption after the gastric bypass, represent much more frequent complications of the surgical treatment of obesity. There is also a tendency towards a late regain of weight, but the benefit in terms of improvement in the obesity-associated co-morbidity is in general maintained despite this partial increase in weight.Gastric procedures are, therefore, an effective treatment of severe obesity and of its co-morbid conditions. However, careful medical and nutritional supervision is necessary during the follow-up after surgery, to prevent potential nutritional or digestive complications.

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Vitamin B-12 deficiency after gastric surgery for obesity

Cited by 133 publications

References 28 publications

Criteria for Patient Selection and Multidisciplinary Evaluation and Treatment of the Weight Loss Surgery Patient

Criteria for Patient Selection and Multidisciplinary Evaluation and Treatment of the Weight Loss Surgery Patient

Nutritional consequences of modified vertical gastroplasty in obese subjects

Surgical treatment for morbid obesity

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