Small intestinal bacterial overgrowth and thiamine deficiency after Roux-en-Y gastric bypass surgery in obese patients

Lakhani, Shilen V.; Shah, Hiral; Alexander, Kenneth S.; Finelli, Frederick C.; Kirkpatrick, John R.; Koch, Timothy R.

doi:10.1016/j.nutres.2008.03.002

Cited by 146 publications

(111 citation statements)

References 34 publications

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“…The longer and variable lengths of biliopancreatic limbs in our patients are similar to those measured recently by SavassiRocha et al (25), who suggested that differences are related to operative selection of a favorable vascular arcade for transection of the jejunum. There are several ways by which small increases in the length of the biliopancreatic limb might directly reduce digestion and absorption of fat: 1) increased delay in delivery of digestive secretions to the common channel, 2) accentuation of selective destruction of pancreatic lipase activity within the biliopancreatic limb (26), and 3) increased likelihood of bacterial overgrowth within the biliopancreatic limb with deconjugation of bile acids (27)(28)(29)(30). However, our results provide no evidence that longer biliopancreatic limbs were directly responsible for increasing severity of fat malabsorption.…”

Section: Discussionmentioning

confidence: 99%

The contribution of malabsorption to the reduction in net energy absorption after long-limb Roux-en-Y gastric bypass

Odstrcil

Martı́nez

Ana

et al. 2010

The American Journal of Clinical Nutrition

182

105

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Background: Roux-en-Y gastric bypass (RYGB) restricts food intake, and when the Roux limb is elongated to 150 cm, the procedure is believed to induce malabsorption. Objective: Our objective was to measure total reduction in intestinal absorption of combustible energy after RYGB and the extent to which this was due to restriction of food intake or malabsorption of ingested macronutrients. Design: Long-limb RYGB was performed in 9 severely obese patients. Dietary intake and intestinal absorption of fat, protein, carbohydrate, and combustible energy were measured before and at 2 intervals after bypass. By using coefficients of absorption to measure absorptive function, equations were developed to calculate the daily gram and kilocalorie quantities of ingested macronutrients that were not absorbed because of malabsorption or restricted food intake. Results: Coefficients of fat absorption were 92 6 1.3% before bypass, 72 6 5.5% 5 mo after bypass, and 68 6 8.7% 14 mo after bypass. There were no statistically significant effects of RYGB on protein or carbohydrate absorption coefficients, although protein coefficients decreased substantially in some patients. Five months after bypass, malabsorption reduced absorption of combustible energy by 124 6 57 kcal/d, whereas restriction of food intake reduced energy absorption by 2062 6 271 kcal/d. Fourteen months after bypass, malabsorption reduced energy absorption by 172 6 60 kcal/d compared with 1418 6 171 kcal/d caused by restricted food intake. Conclusion: On average, malabsorption accounted for '6% and 11% of the total reduction in combustible energy absorption at 5 and 14 mo, respectively, after this gastric bypass procedure. Am J Clin Nutr 2010;92:704-13.

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Section: Discussionmentioning

confidence: 99%

The contribution of malabsorption to the reduction in net energy absorption after long-limb Roux-en-Y gastric bypass

Odstrcil

Martı́nez

Ana

et al. 2010

The American Journal of Clinical Nutrition

182

105

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“…In our previous study, postoperative thiamine deficiency after RYGB was associated with small intestinal bacterial overgrowth (31). Consumption of micronutrients by small intestinal bacteria has been reported but is not fully understood.…”

Section: Small Intestinal Bacterial Overgrowthmentioning

confidence: 90%

Origins for Micronutrient Deficiencies

Lovette¹,

Shope²,

Koch³

2012

Advanced Bariatric and Metabolic Surgery

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“…The two micronutrients most likely to contribute to this disorder include deficiencies in B12 and folate. These patients are also at risk to develop thiamine (B1), iron (Fe), Selenium (Se), Zinc (Zn), and Copper (Cu) trace mineral deficiencies [107]. Secondary to reduced fat digestion, they are particularly prone to develop deficiencies in fat-soluble vitamins (A, D, E, and K).…”

Section: Bariatric Surgerymentioning

confidence: 99%

Hospital Based Nutrition Support: A Review of the Latest Evidence

Tignanelli¹,

Cherry-Bukowiec²

2017

J Clin Nutr Diet

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Meeting appropriate nutritional demands in the inpatient setting is a fundamental aspect of optimal patient care. Optimizing nutrition delivery and preventing malnutrition can have a significant positive effect on clinical outcomes and costs of care. Despite extensive research, many questions remain regarding the delivery of nutrients to hospitalized patients, especially in the critically ill. Recent advances have been made over the past decade, and landmark studies have yielded an end to many controversial topics, such as the broad utilization of immunonutrition. However, there are still many questions that remain unanswered, for example how do we objectively define malnutrition? Cutting edge research in the areas of morphomics and metabolomics are raising new questions which are poised to revolutionize how we will answer today's questions. In this review, we summarize the historical pedagogy underlying nutritional practice alongside contemporary evidence supporting current practice guidelines. Furthermore, we identify and explore key barriers preventing the rapid identification and treatment of malnutrition. We introduce two emerging technologies foremost in nutritional research that may eventually disrupt current barriers. And finally, we discuss key populations at specifically high risk for the development of malnutrition.

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Small intestinal bacterial overgrowth and thiamine deficiency after Roux-en-Y gastric bypass surgery in obese patients

Cited by 146 publications

References 34 publications

The contribution of malabsorption to the reduction in net energy absorption after long-limb Roux-en-Y gastric bypass

The contribution of malabsorption to the reduction in net energy absorption after long-limb Roux-en-Y gastric bypass

Origins for Micronutrient Deficiencies

Hospital Based Nutrition Support: A Review of the Latest Evidence

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