Effectiveness of B Vitamin Supplementation Following Bariatric Surgery: Rapid Increases of Serum Vitamin B12

Moore, Carolyn E.; Sherman, Vadim

doi:10.1007/s11695-014-1441-5

Cited by 25 publications

(19 citation statements)

References 14 publications

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“…We identified 118 case descriptions in the published literature [ 9 – 101 ]. The most common bariatric procedure was Roux-en-Y gastric bypass [ 9 – 13 , 15 – 18 , 24 – 63 ], followed by sleeve gastrectomy [ 19 , 64 – 85 ] (see Fig. 1 for an overview on the characteristics of the identified bariatric cases that subsequently developed WE).…”

Section: Resultsmentioning

confidence: 99%

“…Descriptions of sleeve gastrectomy [ 19 , 64 – 85 ] had a more recent publishing date (median 2014) than papers on Roux-en-Y gastric bypass [ 9 – 13 , 15 – 18 , 24 – 63 ] (median 2006) ( U (85) = 301.5, p < .001), possibly reflecting the increasing popularity of sleeve gastrectomy in the last few years as the bariatric treatment of choice. Furthermore, the gastroplasty cases [ 20 , 86 – 94 ] were older (median 1997) than the Roux-en-Y gastric bypass cases [ 9 – 13 , 15 – 18 , 24 – 63 ] ( U (72) = 96, p < .001) and sleeve gastrectomy cases ( U (34) = 4.6, p < .001). The latency between bariatric surgery and onset of WE symptoms was not significantly different between the three most reported surgical procedures (χ 2 (93) = .299, n.s., median 2–3 months), despite the large surgical differences between the procedures (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Current guidelines for bariatric surgery suggest preventive thiamine suppletion (12 mg) in multivitamin treatment for all patients undergoing surgery, but higher doses for patients with suspicion for deficiency [ 8 ]. The aim of this paper is to review the clinical characteristics of WE after bariatric surgery, also referred to as “bariatric beriberi” [ 9 ] and to raise the clinician’s index of suspicion about this neuropsychiatric diagnosis and its preventability.…”

Section: Introductionmentioning

confidence: 99%

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Preventing Wernicke Encephalopathy After Bariatric Surgery

et al. 2018

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Half a million bariatric procedures are performed annually worldwide. Our aim was to review the signs and symptoms of Wernicke’s encephalopathy (WE) after bariatric surgery. We included 118 WE cases. Descriptions involved gastric bypass (52%), but also newer procedures like the gastric sleeve. Bariatric WE patients were younger (median = 33 years) than those in a recent meta-analysis of medical procedures (mean = 39.5 years), and often presented with vomiting (87.3%), ataxia (84.7%), altered mental status (76.3%), and eye movement disorder (73.7%). Younger age seemed to protect against mental alterations and higher BMI against eye movement disorders. The WE treatment was often insufficient, specifically ignoring low parenteral thiamine levels (77.2%). In case of suspicion, thiamine levels should be tested and treated adequately with parenteral thiamine supplementation.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Preventing Wernicke Encephalopathy After Bariatric Surgery

et al. 2018

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“…As decreased B12 transportation till the intestine by TCN1 is a consequence of gastric resection implied in RYGB procedure, purely malabsorptive techniques (which also result in B12 deficiency) may not induce the same genetic reprogramming. 30 , 31…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal Transcriptomic Response of Metabolic Vitamin B12 Pathways in Roux-en-Y Gastric Bypass

Sala

Belarmino

Torrinhas

et al. 2017

Clinical and Translational Gastroenterology

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Objectives:Vitamin B12 (B12) deficiency after Roux-en-Y gastric bypass (RYGB) is highly prevalent and may contribute to postoperative complications. Decreased production of intrinsic factor owing to gastric fundus removal is thought to have a major role, but other components of B12 metabolism may also be affected. We evaluated changes in the expression levels of multiple B12 pathway-encoding genes in gastrointestinal (GI) tissues to evaluate the potential roles in contributing to post-RYGB B12 deficiency.Methods:During double-balloon enteroscopy, serial GI biopsies were collected from 20 obese women (age, 46.9±6.2 years; body mass index, 46.5±5.3 kg/m2) with adult-onset type 2 diabetes (fasting plasma glucose ≥126 mg/dl; hemoglobin A1c≥6.5%) before and, at the same site, 3 months after RYGB. Gene expression levels were assessed by the Affymetrix Human GeneChip 1.0 ST microarray. Findings were validated by real-time quantitative PCR (RT–qPCR).Results:Gene expression levels with significant changes (P≤0.05) included: transcobalamin I (TCN1) in remnant (−1.914-fold) and excluded (−1.985-fold) gastric regions; gastric intrinsic factor (GIF) in duodenum (−0.725-fold); and cubilin (CUBN) in duodenum (+0.982-fold), jejunum (+1.311-fold), and ileum (+0.685-fold). Validation by RT–qPCR confirmed (P≤0.05) observed changes for TCN1 in the remnant gastric region (−0.132-fold) and CUBN in jejunum (+2.833-fold).Conclusions:RYGB affects multiple pathway-encoding genes that may be associated with postoperative B12 deficiency. Decreased TCN1 levels seem to be the main contributing factor. Increased CUBN levels suggest an adaptive genetic reprogramming of intestinal tissue aiming to compensate for impaired intestinal B12 delivery.

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“…Unfortunately, the optimal supplementation regimen to prevent such conditions has not been elucidated. Nonetheless, recent work by Moore et al highlights the significance of increased (>1000%) folate and B12 levels on body weight parameters and laboratory indices following 3 months of supplementation post-RYGB[21]. The long-term effects of this rapid rise in micronutrient levels are unclear and require further investigation in a prospective fashion.…”

Section: Discussionmentioning

confidence: 99%

Nutrient Deficiency 10 Years Following Roux-en-Y Gastric Bypass: Who’s Responsible?

Mehaffey

Mullen

et al. 2017

OBES SURG

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Objective(s) Monitoring and prevention of long-term nutrient deficiency after Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) remains ill defined due to limited surgical follow-up after bariatric surgery. This study compared nutrient supplementation as well as surgeon and primary care physician (PCP) follow-up between patients with short-term versus long-term follow-up. Methods All patients undergoing LRYGB at a single institution in 2004 (long-term group, n=281) and 2012–2013 (short-term group, n=149) were evaluated. Prospectively collected database, Electronic Medical Record (EMR) review and telephone survey were used to obtained follow-up for both cohorts. Multivariate logistic regression was used to assess factors independently predicting multivitamin use. Results Complete follow-up was achieved in 172 (61%) long-term and 107 (72%) short-term patients. We demonstrate a significant difference (p < 0.0001) in time since last surgeon follow-up (13.3±7.8 vs 86.9±39.9 months) for the long-term group with no difference in PCP follow-up, (3.1±4.3 vs 3.7±3.4). Nutrient supplementation was higher in the short-term group, including multivitamin (70.3% vs 58.9%, p<0.05), iron (84.2% vs 67.1%, p=0.02) and calcium (49.5% vs 32.9%, p=0.01). After adjusting for interval since surgery, %EBMI, and current comorbidities logistic regression (c=0.797) demonstrated shorter time since last surgeon visit was independently predictive of multivitamin use (p=0.001). Conclusions While it appears patients prefer to follow-up with their PCP this study reveals a large disparity in malnutrition screening and nutrient supplementation following LRYGB. Therefore, implementation of multidisciplinary, best-practice guidelines to recognize and prevent malnutrition is paramount in the management of this growing population of high-risk patients.

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Effectiveness of B Vitamin Supplementation Following Bariatric Surgery: Rapid Increases of Serum Vitamin B12

Cited by 25 publications

References 14 publications

Preventing Wernicke Encephalopathy After Bariatric Surgery

Preventing Wernicke Encephalopathy After Bariatric Surgery

Gastrointestinal Transcriptomic Response of Metabolic Vitamin B12 Pathways in Roux-en-Y Gastric Bypass

Nutrient Deficiency 10 Years Following Roux-en-Y Gastric Bypass: Who’s Responsible?

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