Determinants of Hyperhomocysteinemia After Gastric Bypass Surgery in Obese Subjects

Ledoux, Séverine; Coupaye, Muriel; Bogard, Catherine; Clerici, C; Msika, Simon

doi:10.1007/s11695-010-0269-x

Cited by 16 publications

(9 citation statements)

References 37 publications

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“…However, no difference in the serum homocysteine concentrations between obese and nonobese subjects has also been reported [7,8]. Gomez-Ambrosi et al [9], Ledoux et al [10], and our group [6] did not observe significant changes in serum homocysteine concentrations after bariatric surgery, while other studies showed decrease [11,12] or increase [13][14][15][16][17] in serum homocysteine concentrations after bariatric surgery. Such variation in serum homocysteine concentration after bariatric surgery suggests that serum homocysteine concentrations are affected by factors such as different compositions and amounts of food intake.…”

Section: Introductioncontrasting

confidence: 39%

Decreased Serum Betaine Concentrations in Patients after Bariatric Surgery

et al. 2011

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Bariatric surgery significantly reduces the risk of cardiovascular diseases but has no effects on hyperhomocysteinemia, the risk factor for atherogenesis. We hypothesize that the decrease in serum betaine (involved in homocysteine metabolism) concentrations, after bariatric surgery, impairs conversion of homocysteine to methionine, leading to hyperhomocysteinemia. If this is true, it may be desirable to supply patients after bariatric surgery with betaine. Serum betaine and homocysteine concentrations were measured by liquid chromatography/mass spectrometry, in 16 obese patients, before and 6 months after bariatric surgery. Ten healthy individuals with normal body mass index served as controls. Serum betaine concentrations decreased to the values lower than in controls after bariatric surgery, whereas serum homocysteine concentrations remained elevated. In patients supplemented with B(12) and folate, no effect of bariatric surgery on serum concentrations of vitamins involved in homocysteine metabolism was observed. These results suggest that betaine deficit could be responsible for maintenance of hyperhomocysteinemia after bariatric surgery. We postulate that supplementation with betaine could be of therapeutic value for the treatment of hyperhomocysteinemia after bariatric surgery.

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Section: Introductioncontrasting

confidence: 39%

Decreased Serum Betaine Concentrations in Patients after Bariatric Surgery

et al. 2011

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“…These data collectively suggest that elevated plasma Hcy levels may be associated with increased adiposity in this animal model. In fact, the association between HHcy and obesity has been reported, although conflicting results exist (6,19,21,32). Long-term time course studies are required to establish a potential causal connection between increased Hcy and obesity.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, our in vivo observations may not extend to other experimental models. This heterogeneity may also account for controversial reports on the association between HHcy and obesity (6,19,21,32).…”

Section: Discussionmentioning

confidence: 99%

Homocysteine suppresses lipolysis in adipocytes by activating the AMPK pathway

Wang

Pini

Tong

et al. 2011

American Journal of Physiology-Endocrinology and Metabolism

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Hyperhomocysteinemia (HHcy) is an independent risk factor for coronary artery disease. Emerging evidence suggests that HHcy is also associated with adipocyte tissue dysfunction. One of the principal functions of adipose tissue is to provide energy substrate via lipolysis. In the present study, we investigated the effects of homocysteine (Hcy) on lipolysis in adipocytes. We found that Hcy inhibited release of glycerol and fatty acids, two typical indicators of the lipolytic response, in primary adipocytes and fully differentiated 3T3-L1 adipocytes in a dose-dependent manner under both basal and isoproterenol-stimulated conditions. In differentiated 3T3-L1 adipocytes, decreased glycerol and free fatty acid (FFA) release was associated with elevation of intracellular TG content. Further studies showed that Hcy-mediated antilipolytic responses were independent of the cyclic AMP-PKA and MEK-ERK1/2 pathways. However, Hcy increased phosphorylation levels of AMP-activated protein kinase (AMPK) and its downstream enzyme acetyl-CoA carboxylase. Compound C, an AMPK inhibitor, abolished Hcy-induced reduction of glycerol and FFA release under both basal and isoproterenol-stimulated conditions. Furthermore, AMPKα1 siRNA reversed Hcy-inhibited glycerol release. Supplementation of exogenous Hcy in the diet for 2 wk lowered circulating glycerol and FFA levels. Moreover, Hcy supplementation was associated with elevated leptin levels and reduced adiponectin levels in plasma. These results show that Hcy inhibits lipolysis through a pathway that involves AMPK activation.

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“…Guidelines for treating iron deficiency in bariatric surgery patients are reviewed by Munoz et al (278 [EL 4, review]). Guidelines for folic acid and B 12 are based on maintenance of biochemical and functional markers (e.g., homocysteine, RBC folate, and methylmalonic acid) within target ranges (279 [EL 2, PCS]; 280 [EL 3, SCR]). Calcium intake primarily in the form of food is advocated in LAGB given recent reports linking calcium supplementation with increased incidence of MI risk in postoperative women (281 [EL 2, PCS])).…”

Section: Evidence Basementioning

confidence: 99%

Clinical Practice Guidelines For The Perioperative Nutritional, Metabolic, And Nonsurgical Support Of The Bariatric Surgery Patient2013 Update: Cosponsored By American Association Of Clinical Endocrinologists, The Obesity Society, And American Society For Metabolic & Bariatric Surgery

et al. 2013

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The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2010 protocol for standardized production of clinical practice guidelines (CPG). Each recommendation was re-evaluated and updated based on the evidence and subjective factors per protocol. Examples of expanded topics in this update include: the roles of sleeve gastrectomy, bariatric surgery in patients with type-2 diabetes, bariatric surgery for patients with mild obesity, copper deficiency, informed consent, and behavioral issues. There are 74 recommendations (of which 56 are revised and 2 are new) in this 2013 update, compared with 164 original recommendations in 2008. There are 403 citations, of which 33 (8.2%) are EL 1, 131 (32.5%) are EL 2, 170 (42.2%) are EL 3, and 69 (17.1%) are EL 4. There is a relatively high proportion (40.4%) of strong (EL 1 and 2) studies, compared with only 16.5% in the 2008 AACE- TOS-ASMBS CPG. These updated guidelines reflect recent additions to the evidence base. Bariatric surgery remains a safe and effective intervention for select patients with obesity. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.

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Determinants of Hyperhomocysteinemia After Gastric Bypass Surgery in Obese Subjects

Abstract: The main determinants of homocysteine concentration identified in this study are folate and serum creatinine. Multivitamin supplementation with a high dose of folate prevents hyperhomocysteinemia after GBP.

Cited by 16 publications

References 37 publications

Decreased Serum Betaine Concentrations in Patients after Bariatric Surgery

Decreased Serum Betaine Concentrations in Patients after Bariatric Surgery

Homocysteine suppresses lipolysis in adipocytes by activating the AMPK pathway

Clinical Practice Guidelines For The Perioperative Nutritional, Metabolic, And Nonsurgical Support Of The Bariatric Surgery Patient2013 Update: Cosponsored By American Association Of Clinical Endocrinologists, The Obesity Society, And American Society For Metabolic & Bariatric Surgery

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