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Aljuhani RA, Hassan FE, AlQurain ZJ, Khan TN, Turkistani DA, Alabbadi MA. Demographic and clinical predictors of bariatric surgery patients: A retrospective cohort study. J Minim Access Surg 2025:01413045-990000000-00138. [PMID: 40126427 DOI: 10.4103/jmas.jmas_377_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2024] [Accepted: 02/19/2025] [Indexed: 03/25/2025] Open
Abstract
INTRODUCTION The significant rise in bariatric procedures (BPs) reflects the global increase in obesity. In Saudi Arabia, obesity prevalence is notably high at 35.6%, surpassing the global average. This retrospective cohort study primarily aims to identify demographic and clinical predictors influencing BP uptake among individuals at a single healthcare centre in Jeddah, Saudi Arabia. Secondarily, it evaluates the effectiveness of BPs, particularly laparoscopic sleeve gastrectomy (LSG), in reducing body mass index (BMI) and obesity-related comorbidities. PATIENTS AND METHODS Data were extracted from the hospital's registry between October 2023 and June 2024. The study population included obese adults of varying ages, genders and comorbidities who underwent bariatric surgery. However, the single-centre design limited generalisability, long-term outcome data were unavailable and contextual factors, such as socioeconomic status and health literacy, were not captured. RESULTS A cohort of 208 patients was analysed, 64.9% females and 34.2% males, with a mean age of 36 ± 11.2 years. The pre-operative BMI was 44.10 ± 6.2 kg/m² (P = 0.462), which decreased to 35.1 ± 6.5 kg/m² (P = 0.577) postoperatively, reflecting a mean reduction of 9.03 ± 4.9 kg/m² (20.5%) (P = 0.255). LSG was the most performed BP at 93.3%. The most prevalent obesity-related comorbidities identified were hypertension, diabetes and GIT disease including gall bladder disorders (15.9%, 13.9% and 13.5%, respectively). CONCLUSIONS This study highlights the increasing prevalence of BP, particularly among young, predominantly female patients. LSG demonstrated substantial effectiveness, achieving a 20.5% reduction in BMI and improvement in obesity-related comorbidities. Future research could explore more patient demographics that could not be analysed in this study.
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Affiliation(s)
- Raghad Abdulmohsen Aljuhani
- General Medicine Practice Program, College of Medicine and Surgery, Batterjee Medical College, Jeddah, Saudi Arabia
| | - Fatma Elsayed Hassan
- Department of Medical Physiology, Faculty of Medicine, Kasr Alainy, Cairo University, Giza, Egypt
- Department of Physiology, General Medicine Practice Program, Batterjee Medical College, Jeddah, Saudi Arabia
| | - Zainab Jasim AlQurain
- General Medicine Practice Program, College of Medicine and Surgery, Batterjee Medical College, Jeddah, Saudi Arabia
| | - Tanveer Nidal Khan
- General Medicine Practice Program, College of Medicine and Surgery, Batterjee Medical College, Jeddah, Saudi Arabia
| | - Doaa A Turkistani
- General Medicine Practice Program, College of Medicine and Surgery, Batterjee Medical College, Jeddah, Saudi Arabia
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Simancas-Racines D, Frias-Toral E, Campuzano-Donoso M, Ramos-Sarmiento D, Zambrano-Villacres R, Reytor-González C, Schiavo L. Preoperative Nutrition in Bariatric Surgery: A Narrative Review on Enhancing Surgical Success and Patient Outcomes. Nutrients 2025; 17:566. [PMID: 39940424 PMCID: PMC11820445 DOI: 10.3390/nu17030566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2025] [Revised: 01/27/2025] [Accepted: 01/30/2025] [Indexed: 02/16/2025] Open
Abstract
Bariatric surgery has become the preferred treatment for individuals with morbid obesity. Nutrition is key in optimizing surgical outcomes by reducing risks and enhancing recovery. Preoperative strategies, such as reducing body fat, decreasing liver size, and improving metabolic profiles, have been shown to facilitate safer surgical procedures with fewer complications. This narrative review aims to provide an analysis of the fundamental role of preoperative nutritional management in improving bariatric surgery outcomes, emphasizing the importance of addressing specific nutritional challenges to enhance surgical safety, recovery, and overall health. Preoperative nutritional interventions focus on correcting comorbidities and nutritional deficiencies, particularly hypovitaminosis and micronutrient imbalances, through a multidisciplinary approach involving nutritionists and other healthcare professionals. These interventions not only prepare patients for the physiological demands of surgery but also initiate a period of adaptation to new dietary habits, aiming to improve long-term compliance and mitigate risks such as postoperative weight regain and dumping syndrome. Adopting dietary changes, such as very low-calorie or ketogenic diets 6-12 weeks before surgery, enhances adherence to postoperative restrictions and overall surgical success. Future research should focus on developing comprehensive guidelines for preoperative nutritional care to improve patient outcomes globally.
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Affiliation(s)
- Daniel Simancas-Racines
- Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito 170527, Ecuador; (D.S.-R.); (M.C.-D.); (D.R.-S.)
| | - Evelyn Frias-Toral
- Escuela de Medicina, Universidad Espíritu Santo, Samborondón 0901952, Ecuador
| | - Martín Campuzano-Donoso
- Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito 170527, Ecuador; (D.S.-R.); (M.C.-D.); (D.R.-S.)
| | - Daniel Ramos-Sarmiento
- Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito 170527, Ecuador; (D.S.-R.); (M.C.-D.); (D.R.-S.)
| | | | - Claudia Reytor-González
- Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito 170527, Ecuador; (D.S.-R.); (M.C.-D.); (D.R.-S.)
| | - Luigi Schiavo
- Department of Medicine, Surgery and Dentostry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy
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Salman MA, Conway N, Bateman L, Albon L, Mabrook M, Khalid A, Salman A. Examining the Beneficial Effect of Micronutrient Monitoring for Bariatric Surgical Patients: A Retrospective Observational Study. Bariatr Surg Pract Patient Care 2024; 19:165-170. [DOI: 10.1089/bari.2023.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2025] Open
Affiliation(s)
- Mohamed AbdAlla Salman
- Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
- University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - Natalie Conway
- University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - Lauren Bateman
- University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - Lorraine Albon
- University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - Mostafa Mabrook
- General Surgery Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Aizaz Khalid
- University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - Ahmed Salman
- Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
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Alqahtani A, Almayouf M, Butt A, Bawahab MA, Billa S, Maqsood B, Vergis A. Midterm Outcome of Early Pregnancy Versus Late Pregnancy After Laparoscopic Sleeve Gastrectomy. Obes Surg 2024; 34:1630-1638. [PMID: 38483741 DOI: 10.1007/s11695-024-07160-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/03/2024] [Accepted: 03/06/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Controversy regarding the timing of pregnancy and its implications is present in the literature. OBJECTIVE To evaluate the midterm outcome of weight loss in women who have undergone laparoscopic sleeve gastrectomy (LSG) followed by pregnancy at two different times. METHODS We retrospectively reviewed 53 women who matched the inclusion criteria and included them in the analysis. Demographics and anthropometric measurements were collected. Women who conceived within 12 months of LSG were labeled as early group (EG), and who conceived after 12 months were noted as late group (LG). RESULTS There were no differences between the groups regarding obesity-associated disease and number of pregnancies before. EG had higher weight (P = 0.0001) and body mass index (BMI) (P = 0.002) at LSG. The mean interval time for EG was 6.7 ± 3.2 months, and LG was 20 ± 5.2 months. Gestational weight gain (GWG) was lower in the EG (P = 0.001). There were no differences in the number of small for gestational age (SGA) births or gestational weight. In the first 2 years after LSG, LG had a higher percentage of total weight loss (%TWL) and percentage of body mass index loss (%EBMIL) (P < 0.0001). After 5 years of follow-up, %TWL (P = 0.4) and %EBMIL (P = 0.1) were not statistically significant between both groups. CONCLUSION Conception within 12 months from LSG might hinder the weight loss process in the short term but have no significant effect over 5 years of follow-up.
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Affiliation(s)
- Awadh Alqahtani
- College of Medicine, Department of Surgery, King Saud University, Riyadh, Saudi Arabia
- Dr. Sulaiman Alhabib Hospital, Riyadh, Saudi Arabia
| | - Mohammad Almayouf
- Dr. Sulaiman Alhabib Hospital, Riyadh, Saudi Arabia.
- College of Medicine, Department of Surgery, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia.
| | - Amina Butt
- Dr. Sulaiman Alhabib Hospital, Riyadh, Saudi Arabia
| | - Mohammed A Bawahab
- Department of General Surgery, Faculty of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Srikar Billa
- Dr. Sulaiman Alhabib Hospital, Riyadh, Saudi Arabia
| | | | - Ashley Vergis
- Department of Surgery, Section of General Surgery, University of Manitoba, 409 Tache Avenue, Winnipeg, Canada
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Engin A. Bariatric Surgery in Obesity: Metabolic Quality Analysis and Comparison of Surgical Options. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1460:697-726. [PMID: 39287870 DOI: 10.1007/978-3-031-63657-8_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
Obesity is a constantly growing health problem which reduces quality of life and life expectancy. Bariatric surgery (BS) for obesity is considered when all other conservative treatment modalities have failed. Comparison of the multidisciplinary programs with BS regarding to the weight loss showed that substantial and durable weight reduction have been achieved only with bariatric surgical treatments. Although laparoscopic sleeve gastrectomy is the most popular BS, it has high long-term failure rates, and it is claimed that one of every three patients will undergo another bariatric procedure within a 10-year period. Although BS provides weight loss and improvement of metabolic comorbidities, in long-term follow-up, weight gain is observed in half of the patients, while decrease in bone mass and nutritional deficiencies occur in up to 90%. Moreover, despite significant weight loss, several psychological aspects of patients are worsened in comparison to preoperative levels. Nearly one-fifth of postoperative patients with "Loss-of-eating control" meet food addiction criteria. Therefore, the benefits of weight loss following bariatric procedures alone are still debated in terms of the proinflammatory and metabolic profile of obesity.
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Affiliation(s)
- Atilla Engin
- Faculty of Medicine, Department of General Surgery, Gazi University, Besevler, Ankara, Turkey.
- Mustafa Kemal Mah. 2137. Sok. 8/14, 06520, Cankaya, Ankara, Turkey.
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Aaseth JO, Alexander J. Postoperative Osteoporosis in Subjects with Morbid Obesity Undergoing Bariatric Surgery with Gastric Bypass or Sleeve Gastrectomy. Nutrients 2023; 15:nu15061302. [PMID: 36986032 PMCID: PMC10057453 DOI: 10.3390/nu15061302] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/03/2023] [Accepted: 03/05/2023] [Indexed: 03/09/2023] Open
Abstract
Obesity has become a worldwide epidemic accompanied by adverse health effects. The limited efficiency of traditional weight reduction regimens has led to a substantial increase in the use of bariatric surgery. Today, sleeve gastrectomy (SG) and Roux-en-Y-gastric bypass (RYGB) are the most used procedures. The present narrative review focuses on the risk of developing postoperative osteoporosis and summarizes some of the most relevant micronutrient deficiencies associated with RYGB and SG. Preoperatively, the dietary habits of obese individuals might lead to precipitated deficiencies in vitamin D and other nutrients affecting bone mineral metabolism. Bariatric surgery with SG or RYGB can aggravate these deficiencies. The various surgical procedures appear to affect nutrient absorption differently. Being purely restrictive, SG may particularly affect the absorption of vitamin B12 and also vitamin D. In contrast, RYGB has a more profound impact on the absorption of fat-soluble vitamins and other nutrients, although both surgical methods induce only a mild protein deficiency. Despite adequate supplementation of calcium and vitamin D, osteoporosis may still occur after the surgery. This might be due to deficiencies in other micronutrients, e.g., vitamin K and zinc. Regular follow-ups with individual assessments and nutritional advice are indispensable to prevent osteoporosis and other adverse postoperative issues.
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Affiliation(s)
- Jan O. Aaseth
- Department of Research, Innlandet Hospital Trust, P.O. Box 104, N-2381 Brumunddal, Norway
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, N-2418 Elverum, Norway
- Correspondence: ; Tel.: +47-9959-6960
| | - Jan Alexander
- Norwegian Institute of Public Health, P.O. Box 222, N-0213 Oslo, Norway
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Marincola G, Velluti V, Voloudakis N, Gallucci P, Ciccoritti L, Greco F, Sessa L, Salvi G, Iaconelli A, Aquilanti B, Guidone C, Capristo E, Mingrone G, Pennestrì F, Raffaelli M. Medium-Term Nutritional and Metabolic Outcome of Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S). Nutrients 2023; 15:nu15030742. [PMID: 36771446 PMCID: PMC9921544 DOI: 10.3390/nu15030742] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/23/2023] [Accepted: 01/28/2023] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy (SADI-S), like other hypoabsorptive procedures, could be burdened by long-term nutritional deficiencies such as malnutrition, anemia, hypocalcemia, and hyperparathyroidism. OBJECTIVES We aimed to report our experience in terms of mid-term (2 years) bariatric, nutritional, and metabolic results in patients who underwent SADI-S both as a primary or revisional procedure. METHODS One hundred twenty-one patients were scheduled for SADI-S as a primary or revisional procedure from July 2016 to February 2020 and completed at least 2 years of follow-up. Demographic features, bariatric, nutritional, and metabolic results were analyzed during a stepped follow-up at 3 months, 6 months, 1 year and 2 years. RESULTS Sixty-six patients (47 female and 19 male) were included. The median preoperative BMI was 53 (48-58) kg/m2. Comorbidities were reported in 48 (72.7%) patients. At 2 years, patients had a median BMI of 27 (27-31) kg/m2 (p < 0.001) with a median %EWL of 85.3% (72.1-96.1), a TWL of 75 (49-100) kg, and a %TWL of 50.9% (40.7-56.9). The complete remission rate was 87.5% for type 2 diabetes mellitus, 83.3% for obstructive sleep apnea syndrome and 64.5% for hypertension. The main nutritional deficiencies post SADI-S were vitamin D (31.82%) and folic acid deficiencies (9.09%). CONCLUSION SADI-S could be considered as an efficient and safe procedure with regard to nutritional status, at least in mid-term (2 years) results. It represents a promising bariatric procedure because of the excellent metabolic and bariatric outcomes with acceptable nutritional deficiency rates. Nevertheless, larger studies with longer follow-ups are necessary to draw definitive conclusions.
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Affiliation(s)
- Giuseppe Marincola
- U.O.C. Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell’Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Valeria Velluti
- U.O.S.D. Medicina Bariatrica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Nikolaos Voloudakis
- U.O.C. Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell’Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell’Obesità, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Pierpaolo Gallucci
- U.O.C. Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell’Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Luigi Ciccoritti
- U.O.C. Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell’Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Francesco Greco
- U.O.C. Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell’Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Luca Sessa
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell’Obesità, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
- Centro Malattie Endocrine e Obesità, Fondazione Gemelli Giglio Cefalù, 90015 Cefalù, Italy
| | - Giulia Salvi
- U.O.C. Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell’Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell’Obesità, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Amerigo Iaconelli
- U.O.S.D. Medicina Bariatrica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Barbara Aquilanti
- U.O.S.D. Medicina Bariatrica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Caterina Guidone
- U.O.C. Patologie dell’Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Esmeralda Capristo
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
- U.O.C. Patologie dell’Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Geltrude Mingrone
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
- U.O.C. Patologie dell’Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Francesco Pennestrì
- U.O.C. Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell’Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell’Obesità, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
- Correspondence: ; Tel.: +39-06-30154199; Fax: +39-06-30156086
| | - Marco Raffaelli
- U.O.C. Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell’Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell’Obesità, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
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Berardi G, Vitiello A, Abu-Abeid A, Schiavone V, Franzese A, Velotti N, Musella M. Micronutrients Deficiencies in Candidates of Bariatric Surgery: Results from a Single Institution over a 1-Year Period. Obes Surg 2023; 33:212-218. [PMID: 36331725 PMCID: PMC9834098 DOI: 10.1007/s11695-022-06355-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Micronutrient deficiencies represent a common condition after bariatric surgery (BS). The prevalence of these nutritional disorders before BS is still debated. The aim of our study was to retrospectively evaluate the prevalence of micronutrient deficiencies in candidates for BS. METHODS A prospectively maintained database of our institution was searched to find all patients who underwent surgery between January and December 2021. The following data were collected: age, gender, body mass index (BMI), obesity-associated diseases, and preoperative serum levels of vitamin B12, folate, and vitamin D. RESULTS A total of 174 patients were included in our study. Mean age and BMI were 39.2 ± 11.4 years and 44.3 ± 7.1 kg/m2, respectively. One hundred and thirty-nine patients (79.9%) had at least one preoperative micronutrient disorder, with vitamin D deficiency being the most common (116, 66.7%), followed by a deficit of folate (76, 43.7%) and vitamin B12 (10, 5.7%). Forty-seven (27%) individuals had insufficient levels of vitamin D. Comparison of deficiencies between sexes showed that vitamin B12 < 20 ng/ml was significantly more frequent in women (p = 0.03). DLP showed a mild significant effect on folate levels (p = 0.01), while the association of HNT and T2DM had a mild significant effect on vitamin B12 (p = 0.02). CONCLUSIONS Preoperative micronutrient deficiencies were frequently found in candidates for BS. Approximately 90% of patients had deficient or insufficient serum levels of vitamin D preoperatively. Almost half of the patients had a preoperative deficit of folate, and vitamin B12 deficiency was significantly more frequent in the female population. It is mandatory to screen all patients undergoing BS for vitamin deficiencies before surgery.
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Affiliation(s)
- Giovanna Berardi
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II"-via S.Pansini, 80131, Naples, Italy
| | - Antonio Vitiello
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II"-via S.Pansini, 80131, Naples, Italy.
| | - Adam Abu-Abeid
- Division of General Surgery, Affiliated to Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel
| | - Vincenzo Schiavone
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II"-via S.Pansini, 80131, Naples, Italy
| | - Antonio Franzese
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II"-via S.Pansini, 80131, Naples, Italy
| | - Nunzio Velotti
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II"-via S.Pansini, 80131, Naples, Italy
| | - Mario Musella
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II"-via S.Pansini, 80131, Naples, Italy
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Halloun R, Weiss R. Bariatric Surgery in Adolescents with Obesity: Long-Term Perspectives and Potential Alternatives. Horm Res Paediatr 2022; 95:193-203. [PMID: 34758466 DOI: 10.1159/000520810] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 11/05/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Severe obesity among adolescent shows a worrisome trend in regard to its increasing prevalence and poses a great challenge for treatment. Conservative measures have modest effects on weight loss, usually fail in achieving a sustainable weight loss and resolution of comorbidities. This has led to greater utilization of bariatric surgery (BS) that offers a fast reduction in body mass index with little perioperative complications. Despite the increasing utilization of BS, data are still insufficient, regarding their long-term outcome in adolescents. We review short- and long-term effects of BS and their implications on bone health and nutritional deficiencies in adolescents. In addition, we discuss possible pharmaceutical alternatives. SUMMARY BS results in a substantial weight loss of roughly 37% in the first-year post-operation and is superior to conservative measures in resolution of metabolic comorbidities. BS significantly improves health-related quality of life. Longer follow-up (F/U) shows weight regain in 50% of patients. Furthermore, reduced bone mass and nutritional deficiencies were reported in up to 90% of patients. Most recently, alternative to BS became more relevant with approval of GLP-1 analogues use in adolescents. GLP-1 analogues are potent enough to induce moderate clinically meaningful weight loss and improvement of metabolic component. KEY MESSAGES We conclude that obese adolescents without major obesity-related complications may benefit from pharmacological interventions with lifestyle modification. We advise considering BS as treatment approach in adolescents with severe obesity and major obesity-related complications with proper preoperative preparation and postoperative F/U in excellence centers.
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Affiliation(s)
- Rana Halloun
- Department of Pediatrics, Ruth Children's Hospital, Rambam Medical Center, Haifa, Israel
| | - Ram Weiss
- Department of Pediatrics, Ruth Children's Hospital, Rambam Medical Center, Haifa, Israel.,Bruce Rappaport School of Medicine, Technion Institute of Technology, Haifa, Israel
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Fanton D'Andon C, Correia P, Rigaill J, Kably B, Perinel-Ragey S, Launay M. Ceftazidime dosing in obese patients: is it time for more? Expert Opin Drug Metab Toxicol 2022; 18:277-284. [PMID: 35583387 DOI: 10.1080/17425255.2022.2080052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Ceftazidime is used for the treatment of many bacterial infections, including severe P. aeruginosa infections. Like other beta-lactams, inter-individual variability in ceftazidime pharmacokinetics has been described. Due to its related pathophysiological modifications, obesity might influence ceftazidime pharmacokinetics. AREAS COVERED The objective of this review is to assess the current state of knowledge about the impact of obesity on ceftazidime treatment. A literature search was conducted on PubMed-MEDLINE (2016-2021) to retrieve pharmacokinetic studies published in English, matching the terms 'ceftazidime' AND 'pharmacokinetics.' EXPERT OPINION The impact of obesity on pharmacokinetics is generally poorly known, mainly because obese patients are often excluded from clinical studies. However, the published literature clearly shows that obese patients have significantly lower ceftazidime concentrations. This could be explained by increased volume of distribution and clearance. This low exposure represents a major factor of therapeutic failure, potentially fatal for critically ill patients. While further studies would be useful to better assess the magnitude and understanding of this variability, the use of higher doses of ceftazidime is needed in obese patients. Moreover, therapeutic drug monitoring for dose adaptation is of major interest for these patients, as the efficacy of ceftazidime seems to be directly related to its plasma concentration.
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Affiliation(s)
- Cornélie Fanton D'Andon
- - Gaz du Sang, Hôpital NordLaboratoire de Pharmacologie - Toxicologie , CHU de Saint-Etienne, France
| | - Patricia Correia
- Service de Médecine Intensive et Réanimation G, CHU de Saint-Etienne, Saint Etienne, France
| | - Josselin Rigaill
- Department of Infectious Agents and Hygiene, University-Hospital of Saint-Etienne, Saint-Etienne, France
| | - Benjamin Kably
- Laboratoire de Pharmacologie, Hôpital Européen Georges Pompidou, Paris, France
| | - Sophie Perinel-Ragey
- Service de Médecine Intensive et Réanimation G, CHU de Saint-Etienne, Saint Etienne, France
| | - Manon Launay
- - Gaz du Sang, Hôpital NordLaboratoire de Pharmacologie - Toxicologie , CHU de Saint-Etienne, France
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11
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Yang C, Hammer FJ, Reissfelder C, Otto M, Vassilev G. Dental Erosion in Obese Patients before and after Bariatric Surgery: A Cross-Sectional Study. J Clin Med 2021; 10:4902. [PMID: 34768422 PMCID: PMC8584300 DOI: 10.3390/jcm10214902] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/17/2021] [Accepted: 10/21/2021] [Indexed: 11/24/2022] Open
Abstract
Obese patients are at risk of dental erosion due to micronutrient deficiency, consumption of soft drinks, gastric reflux disease and vomiting. The present study evaluates the presence of dental erosion in obese patients before and after bariatric surgery using the BEWE (basic erosive wear examination) scoring system. A total of 62 patients with severe obesity were included in the analysis, 31 in the control group (without bariatric surgery) and 31 in the surgery group (after bariatric surgery). BEWE scores did not vary between groups. Vitamin D deficiency was detected in 19 patients in the control group and three in the surgery group (p < 0.001). The serum calcium and vitamin D values were significantly higher in the surgery group (p = 0.003, p < 0.001 consecutively). All patients after bariatric surgery showed compliance with supplements, including vitamin D and calcium daily. Patients after bariatric surgery were less likely to drink soft drinks regularly (p = 0.026). Obese patients, before or after bariatric surgery, are at risk for erosive dental wear. However, with sufficient education prior to surgery and consistent intake of vitamin and mineral supplements, significant erosive dental wear after bariatric surgery could be avoided. Regular dental examination should be included in the check-up and follow-up program.
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Affiliation(s)
- Cui Yang
- Department of Surgery, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; (F.J.H.); (C.R.); (M.O.); (G.V.)
| | - Frederik Johannes Hammer
- Department of Surgery, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; (F.J.H.); (C.R.); (M.O.); (G.V.)
- Faculty of Dentistry, University of Heidelberg, 68167 Mannheim, Germany
| | - Christoph Reissfelder
- Department of Surgery, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; (F.J.H.); (C.R.); (M.O.); (G.V.)
| | - Mirko Otto
- Department of Surgery, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; (F.J.H.); (C.R.); (M.O.); (G.V.)
| | - Georgi Vassilev
- Department of Surgery, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; (F.J.H.); (C.R.); (M.O.); (G.V.)
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12
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Bhattacharya S, Kalra S, Kapoor N, Singla R, Dutta D, Aggarwal S, Khandelwal D, Surana V, Dhingra A, Kantroo V, Chittawar S, Deka N, Bindal V, Dutta P. Expert opinion on the preoperative medical optimization of adults with diabetes undergoing metabolic surgery. World J Diabetes 2021; 12:1587-1621. [PMID: 34754367 PMCID: PMC8554368 DOI: 10.4239/wjd.v12.i10.1587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/18/2021] [Accepted: 08/25/2021] [Indexed: 02/06/2023] Open
Abstract
Diabetes mellitus (DM) and obesity are interrelated in a complex manner, and their coexistence predisposes patients to a plethora of medical problems. Metabolic surgery has evolved as a promising therapeutic option for both conditions. It is recommended that patients, particularly those of Asian origin, maintain a lower body mass index threshold in the presence of uncontrolled DM. However, several comorbidities often accompany these chronic diseases and need to be addressed for successful surgical outcome. Laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are the most commonly used bariatric procedures worldwide. The bariatric benefits of RYGB and LSG are similar, but emerging evidence indicates that RYGB is more effective than LSG in improving glycemic control and induces higher rates of long-term DM remission. Several scoring systems have been formulated that are utilized to predict the chances of remission. A glycemic target of glycated hemoglobin < 7% is a reasonable goal before surgery. Cardiovascular, pulmonary, gastrointestinal, hepatic, renal, endocrine, nutritional, and psychological optimization of surgical candidates improves perioperative and long-term outcomes. Various guidelines for preoperative care of individuals with obesity have been formulated, but very few specifically focus on the concerns arising from the presence of concomitant DM. It is hoped that this statement will lead to the standardization of presurgical management of individuals with DM undergoing metabolic surgery.
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Affiliation(s)
| | - Sanjay Kalra
- Endocrinology, Bharti Hospital, Karnal 132001, Haryana, India
| | - Nitin Kapoor
- Endocrinology, Christian Medical College, Vellore 632004, Tamil Nadu, India
| | - Rajiv Singla
- Endocrinology, Kalpavriksh Super Speciality Center, New Delhi 110075, India
| | - Deep Dutta
- Endocrinology, CEDAR Superspecialty Clinic, New Delhi 110075, India
| | - Sameer Aggarwal
- Endocrinology, Apex Plus Superspeciality Hospital, Rohtak 124001, Haryana, India
| | | | - Vineet Surana
- Endocrinology, Manipal Hospitals, New Delhi 110075, India
| | - Atul Dhingra
- Endocrinology, Gangaram Bansal Super Speciality Hospital, Sri Ganganagar 335001, Rajasthan, India
| | - Viny Kantroo
- Respiratory Medicine & Critical Care, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi 110076, India
| | - Sachin Chittawar
- Endocrinology, Gandhi Medical College, Bhopal 462001, Madhya Pardesh, India
| | - Nilakshi Deka
- Endocrinology, Apollo Hospitals, Guwahati 781005, Assam, India
| | - Vivek Bindal
- Minimal Access, Metabolic and Bariatric surgery, Max Superspeciality Hospital, Patparganj, New Delhi 110092, India
| | - Puja Dutta
- Nutrition, Max Superspeciality Hospital, Patparganj, New Delhi 110092, India
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13
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Assessment of baseline rates of functional and absolute iron deficiency in bariatric surgery candidates: a retrospective study. Surg Obes Relat Dis 2021; 17:2009-2014. [PMID: 34620564 DOI: 10.1016/j.soard.2021.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 06/30/2021] [Accepted: 09/06/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Preoperative optimization of iron status is a priority in candidates for bariatric surgery. Inflammation is strongly associated with obesity, and as a consequence, functional iron deficiency (ID) is potentially an underreported issue in surgical candidates. OBJECTIVES In light of updated practice guidelines, to retrospectively review preoperative iron status in an Irish cohort of bariatric surgery candidates, taking account of the relative incidence rate of functional ID. SETTING A tertiary care obesity service with bariatric surgery referral in Ireland. METHODS Baseline nutritional biochemistry records were reviewed between February 2017 and February 2020 in a hospital, Dublin, Ireland. Absolute ID was defined as serum ferritin <30 μg/L; functional ID was defined as ferritin, 30 to 100 μg/L, in the presence of C-reactive protein >5 mg/L. Anemia was indexed with reference to hemoglobin and qualified by vitamin B12 and folate status to rule out anemia unrelated to primary ID. RESULTS The analysis included 120 patients, 68% female, 49.6 ± 9.3 years, and body mass index, 52.0 ± 9.6 kg/m2. The prevalence of absolute and functional ID was 11.7% and 30.8%, respectively (P = .0003). Anemia was associated with absolute ID and functional ID in 14.3% and 10.8% of patients (P = .29). Folate and vitamin B12 deficiency occurred in <5% of patients. CONCLUSION In patients seeking bariatric surgery for severe obesity, the prevalence of baseline functional ID is substantial and can be associated with anemia. These findings raise queries with regard to how best to optimize preoperative iron status in the context of ongoing inflammation.
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14
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Gasmi A, Bjørklund G, Mujawdiya PK, Semenova Y, Peana M, Dosa A, Piscopo S, Gasmi Benahmed A, Costea DO. Micronutrients deficiences in patients after bariatric surgery. Eur J Nutr 2021; 61:55-67. [PMID: 34302218 DOI: 10.1007/s00394-021-02619-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 06/09/2021] [Indexed: 12/14/2022]
Abstract
Bariatric surgery is an effective option for managing obesity and has gained general acceptance among patients in recent years. Generally, despite the high caloric intake, a bad nutritional habit of obese people results in the deficiency of several vitamins, minerals, and trace elements essential for body metabolism and normal physiological processes. Additionally, the current bariatric surgical approaches such as sleeve gastrectomy (SG), Roux-en-Y-gastric bypass (RYGB), laparoscopic adjustable gastric banding (LAGB), and jejunoileal bypass (JIB) can cause or exacerbate these deficiencies. Based on several reports, it appears that the various bariatric surgical procedures affect nutrient absorption differently. Being purely restrictive, LAGB and SG affect the absorption of iron, selenium, and vitamin B12, while RYGB, JIB, and biliopancreatic diversion have a more profound impact on the absorption of essential vitamins, minerals, and trace elements. Nutritional deficiencies in vitamins, minerals, and trace elements may follow bariatric surgery and are associated with clinical manifestations and diseases, including anemia, ataxia, hair loss, and Wernicke encephalopathy. The present review summarizes some of the major vitamin and micronutrient deficiencies associated with bariatric surgery, particularly those presented post-surgically. To avoid any adverse consequences of vitamin and trace element deficiency, proper monitoring and tests are recommended at any stage, from pre- to post-surgery (periodical check-up), followed by specific and individual nutritional supplementation treatments and a proper healthy diet.
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Affiliation(s)
- Amin Gasmi
- Société Francophone de Nutrithérapie et de Nutrigénétique Appliquée, Villeurbanne, France
| | - Geir Bjørklund
- Council for Nutritional and Environmental Medicine (CONEM), Toften 24, 8610, Mo i Rana, Norway.
| | | | - Yuliya Semenova
- Semey Medical University, Semey, Kazakhstan
- CONEM Kazakhstan Environmental Health and Safety Research Group, Semey Medical University, Semey, Kazakhstan
| | - Massimiliano Peana
- Department of Chemistry and Pharmacy, University of Sassari, Sassari, Italy
| | - Alexandru Dosa
- Faculty of Medicine, Ovidius University of Constanta, Constanta, Romania
| | - Salva Piscopo
- Société Francophone de Nutrithérapie et de Nutrigénétique Appliquée, Villeurbanne, France
- Department of Nutritional Research and Development, Nutri-Logics SA, Weiswampach, Luxembourg
| | - Asma Gasmi Benahmed
- Académie Internationale de Médecine Dentaire Intégrative, Paris, France
- Université Claude Bernard, Lyon 1, Villeurbanne, France
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15
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Sun L, Wang C, Sun W, Wang C. A Pilot Study of Nutritional Status Prior to Bariatric Surgery in South China. Front Nutr 2021; 8:697695. [PMID: 34322512 PMCID: PMC8310917 DOI: 10.3389/fnut.2021.697695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/14/2021] [Indexed: 12/29/2022] Open
Abstract
Objective: The was a pilot study to assess the biochemical and historical information about bariatric patients before undergoing the surgery in the aim of identifying nutritional deficiencies and their prevalence from 2015 to 2020. Methods: Clinical data of 247 patients (105 males and 142 females) were included. Vitamins, trace elements, electrolytes, albumin, globulin, hemoglobin, folate, ferritin, microalbuminuria (MAU), and parathyroid hormone (PTH) levels were determined to explore the nutritional status according to gender, age, high body mass index (BMI), and waist circumstance (WC). Results: The mean age, mean BMI, and mean WC of the candidates were 32.95 ± 10.46 years, 38.01 ± 7.11 kg/m2, and 117.04 ± 16.18 cm, respectively. The prevalence of preoperative nutritional deficiencies was 76.88% for 25 (OH) vitamin D, 19.84% for globulin, 11.74% for albumin, 11.02% for sodium, 8.33% for folic acid, 10.48% (male) and 6.34% (female) for chloride, 4.05% for calcium, 3.07% (male) and 0.70%(female) for ferritin, 11.90% for elevated PTH, and 44.96% for MAU. Males exhibited increased prevalence of globulin and MAU relative to females (P < 0.05). Older groups are more likely to exhibit albumin deficiency (P = 0.007), globulin deficiency (P = 0.003), and zinc deficiency (P = 0.015). In addition, 25 (OH) D deficiency and albumin deficiency were more common in patients with BMI ≥ 47.5 kg/m2 (P = 0.049 and 0.015, respectively). Wider WC (≥150 cm) exhibited higher rates of albumin deficiencies (P = 0.011). Conclusion: Electrolyte and nutritional deficiencies were common in patients prior to bariatric surgery in South China. Routine evaluation of electrolyte and nutritional levels should be carried out in this population.
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Affiliation(s)
- Linli Sun
- Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | | | - Wei Sun
- Department of Pharmacy, Third Xiangya Hospital, Central South University, Changsha, China
| | - Chunjiang Wang
- Department of Pharmacy, Third Xiangya Hospital, Central South University, Changsha, China
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16
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Pellegrini M, Rahimi F, Boschetti S, Devecchi A, De Francesco A, Mancino MV, Toppino M, Morino M, Fanni G, Ponzo V, Marzola E, Abbate Daga G, Broglio F, Ghigo E, Bo S. Pre-operative micronutrient deficiencies in patients with severe obesity candidates for bariatric surgery. J Endocrinol Invest 2021; 44:1413-1423. [PMID: 33026590 PMCID: PMC8195915 DOI: 10.1007/s40618-020-01439-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 09/28/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE In patients with obesity, micronutrient deficiencies have been reported both before and after bariatric surgery (BS). Obesity is a chronic pro-inflammatory status, and inflammation increases the risk of micronutrient malnutrition. Our objective was to assess in pre-BS patients the prevalence of micronutrient deficiencies and their correlation with blood values of C-reactive protein (CRP). METHODS Anthropometric data, instrumental examinations, and blood variables were centrally measured in the first 200 patients undergoing a pre-BS evaluation at the "Città della Salute e della Scienza" Hospital of Torino, starting from January 2018. RESULTS At least one micronutrient deficiency was present in 85.5% of pre-BS patients. Vitamin D deficiency was the most prevalent (74.5%), followed by folate (33.5%), iron (32%), calcium (13%), vitamin B12 (10%), and albumin (5.5%) deficiency. CRP values were high (> 5 mg/L) in 65% of the patients. These individuals showed increased rate of iron, folate, vitamin B12 deficiency, and a higher number of micronutrient deficiencies. In a multiple logistic regression model, increased CRP levels were significantly associated with deficiencies of vitamin B12 (OR = 5.84; 95% CI 1.25-27.2; p = 0.024), folate (OR = 4.02; 1.87-8.66; p < 0.001), and with the presence of ≥ 2 micronutrient deficiencies (OR = 2.31; 1.21-4.42; p = 0.01). CONCLUSIONS Micronutrient deficiencies are common in patients with severe obesity undergoing BS, especially when inflammation is present. In the presence of increased CRP values before surgery, it might be advisable to search for possible multiple micronutrient deficiencies.
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Affiliation(s)
- M Pellegrini
- Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126, Torino, Italy
| | - F Rahimi
- Unit of Clinical Nutrition, "Città della Salute e della Scienza" Hospital of Turin, Turin, Italy
| | - S Boschetti
- Unit of Clinical Nutrition, "Città della Salute e della Scienza" Hospital of Turin, Turin, Italy
| | - A Devecchi
- Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126, Torino, Italy
| | - A De Francesco
- Unit of Clinical Nutrition, "Città della Salute e della Scienza" Hospital of Turin, Turin, Italy
| | - M V Mancino
- Unit of Clinical Nutrition, "Città della Salute e della Scienza" Hospital of Turin, Turin, Italy
| | - M Toppino
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - M Morino
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - G Fanni
- Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126, Torino, Italy
| | - V Ponzo
- Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126, Torino, Italy
| | - E Marzola
- Department of Neuroscience, University of Turin, Turin, Italy
| | - G Abbate Daga
- Department of Neuroscience, University of Turin, Turin, Italy
| | - F Broglio
- Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126, Torino, Italy
- Diabetes and Metabolic Diseases Clinic, "Città della Salute e della Scienza" Hospital of Turin, Turin, Italy
| | - E Ghigo
- Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126, Torino, Italy
- Diabetes and Metabolic Diseases Clinic, "Città della Salute e della Scienza" Hospital of Turin, Turin, Italy
| | - S Bo
- Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126, Torino, Italy.
- Diabetes and Metabolic Diseases Clinic, "Città della Salute e della Scienza" Hospital of Turin, Turin, Italy.
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17
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Iron deficiency is highly prevalent among candidates for metabolic surgery and may affect perioperative outcomes. Surg Obes Relat Dis 2021; 17:1692-1699. [PMID: 34266778 DOI: 10.1016/j.soard.2021.05.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/19/2021] [Accepted: 05/30/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND The presence of chronic low-grade inflammation, commonly identified in patients with severe obesity, alters iron homeostasis and indicators of iron status, fostering the development of updated guidelines for the diagnosis of iron deficiency (ID). Current recommended diagnostic thresholds for ID in obesity derived from expert opinion include a ferritin level of <30 ng/mL and/or transferrin saturation (TSAT) < 20%. Earlier studies of ID among candidates for metabolic surgery using low levels of ferritin or iron as diagnostic thresholds demonstrated a prevalence of 5%-20%. OBJECTIVES Using the current recommended diagnostic thresholds for ID, this study measures the prevalence of ID in a large cohort of surgical candidates and its relationship to surgical outcomes. SETTING Geisinger Medical Center, Danville, Pennsylvania. METHODS The study cohort included 3,723 patients who underwent pre- operative nutritional assessment which included markers of iron nutrition over the period 2004-2018. RESULTS The cohort included 2,988 women (80.3%) and 735 men (19.7%); body mass index: 49.4 ± 9 kg/m2. The diagnosis of ID was based on ferritin level <30 ng/mL (true ID) and/or TSAT < 20% representing a combination of true ID and inflammation (serum ferritin ≥ 30 ng/mL and TSAT < 20%). A total of 399 patients (10.8%) were anemic. A serum ferritin level of < 30 ng/mL was found in 488 patients (13%; 481 women and 7 men). Of these, 122 patients (25.2%) were also anemic. An additional 1,204 had serum ferritin ≥ 30 ng/mL and TSAT < 20%. Overall, 1,692 patients (45.4%) in this cohort had laboratory evidence of ID by current criteria that adjusts for the very high prevalence of inflammation. Men with serum ferritin levels ≥30 ng/mL with TSAT < 20% had an increased surgical length of stay. CONCLUSION The prevalence of ID among surgical candidates (45.4%) is more than twice that identified as ID in earlier studies. ID was commonly identified in the absence of anemia. The most severe ID was found in those with a serum ferritin level <30 ng/mL and TSAT < 20%. ID in the presence of inflammation is often unrecognized and has implications regarding surgical outcomes after metabolic surgery.
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18
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Sherf-Dagan S, Sinai T, Goldenshluger A, Globus I, Kessler Y, Schweiger C, Ben-Porat T. Nutritional Assessment and Preparation for Adult Bariatric Surgery Candidates: Clinical Practice. Adv Nutr 2021; 12:1020-1031. [PMID: 33040143 PMCID: PMC8262552 DOI: 10.1093/advances/nmaa121] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/25/2020] [Accepted: 09/03/2020] [Indexed: 12/13/2022] Open
Abstract
Bariatric surgery (BS) has proven to be highly efficacious in the treatment of obesity and its comorbidities. However, careful patient selection is critical for its success. Thus, patients should undergo medical, behavioral, and nutritional assessment by a multidisciplinary team. From the nutritional point of view, BS candidates should undergo nutritional assessment, preparation, and education by a registered dietitian in the preoperative period. Currently, detailed specified and comprehensive information on these topics is lacking. The present narrative review aimed to summarize the available literature concerning both the preoperative nutritional assessment components and the preoperative nutritional preparation and education components of patients planning to undergo BS. Current literature indicates that proper management before BS should include a comprehensive nutritional assessment, in which it is advisable to perform a clinical interview to assess patients' medical background, weight management history, eating patterns and pathologies, oral health, physical activity habits, nutritional status, supplementation usage, BS knowledge, surgery expectations and anthropometric measurements. Nutritional preparation and educational strategies should include an individualized preoperative weight-loss nutrition program, improvement of glycemic control, micronutrients deficiencies correction, eating and lifestyle habits adaptation, physical activity initiation, and strengthening knowledge on obesity and BS. At this stage, more well-designed intervention and long-term cohort studies are needed in order to formulate uniform evidence-based nutritional guidelines for patients who plan to undergo BS, including populations at higher nutritional risk. Moreover, postoperative outcomes of presurgical nutritional intervention programs should be studied.
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Affiliation(s)
- Shiri Sherf-Dagan
- Department of Nutritional Sciences, School of Health Sciences, Ariel University, Ariel, Israel
- Department of Nutrition, Assuta Medical Center, Tel Aviv, Israel
| | - Tali Sinai
- Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
- School of Nutritional Sciences, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Ariela Goldenshluger
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, and Sylvan Adams Sports Institute, Tel-Aviv University, Tel Aviv, Israel
| | | | - Yafit Kessler
- Department of Nutritional Sciences, School of Health Sciences, Ariel University, Ariel, Israel
- Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel
| | - Chaya Schweiger
- Nutrition Service, Rabin Medical Center, Campus Beilinson, Petach Tiqva, Israel
| | - Tair Ben-Porat
- Department of Nutrition, Hadassah-Hebrew University Medical Center, Ein-Kerem Campus, Jerusalem, Israel
- Department of Human Metabolism and Nutrition, Braun School of Public Health, Hebrew University, Jerusalem, Israel
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19
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Al Mansoori A, Shakoor H, Ali HI, Feehan J, Al Dhaheri AS, Cheikh Ismail L, Bosevski M, Apostolopoulos V, Stojanovska L. The Effects of Bariatric Surgery on Vitamin B Status and Mental Health. Nutrients 2021; 13:1383. [PMID: 33923999 PMCID: PMC8073305 DOI: 10.3390/nu13041383] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/16/2021] [Accepted: 04/16/2021] [Indexed: 02/06/2023] Open
Abstract
Diet is a modifiable factor that ensures optimal growth, biochemical performance, improved mood and mental functioning. Lack of nutrients, notably vitamin B, has an impact on human health and wellbeing. The United Arab Emirates is facing a serious problem of micronutrient deficiencies because of the growing trend for bariatric surgery, including Roux-en-Y gastric bypass and sleeve gastrectomy. People undergoing bariatric surgery are at high risk of developing neurological, cognitive, and mental disabilities and cardiovascular disease due to deficiency in vitamin B. Vitamin B is involved in neurotransmitter synthesis, including γ-aminobutyric acid, serotonin, dopamine, and noradrenaline. Deficiency of vitamin B increases the risk of depression, anxiety, dementia and Alzheimer's disease. In addition, vitamin B deficiency can disrupt the methylation of homocysteine, leading to hyperhomocysteinemia. Elevated homocysteine levels are detrimental to human health. Vitamin B deficiency also suppresses immune function, increases the production of pro-inflammatory cytokines and upregulates NF-κB. Considering the important functions of vitamin B and the severe consequences associated with its deficiency following bariatric surgery, proper dietary intervention and administration of adequate supplements should be considered to prevent negative clinical outcomes.
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Affiliation(s)
- Amna Al Mansoori
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates; (A.A.M.); (H.S.); (H.I.A.); (A.S.A.D.)
| | - Hira Shakoor
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates; (A.A.M.); (H.S.); (H.I.A.); (A.S.A.D.)
| | - Habiba I. Ali
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates; (A.A.M.); (H.S.); (H.I.A.); (A.S.A.D.)
| | - Jack Feehan
- Institute for Health and Sport, Victoria University, Melbourne, VIC 8001, Australia; (J.F.); (V.A.)
- Department of Medicine-Western Health, The University of Melbourne, Melbourne, VIC 8001, Australia
| | - Ayesha S. Al Dhaheri
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates; (A.A.M.); (H.S.); (H.I.A.); (A.S.A.D.)
| | - Leila Cheikh Ismail
- Clinical Nutrition and Dietetics Department, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates;
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford OX1 2JD, UK
| | - Marijan Bosevski
- Faculty of Medicine Skopje, University Clinic of Cardiology, University of Ss. Cyril and Methodius, 1010 Skopje, North Macedonia;
| | - Vasso Apostolopoulos
- Institute for Health and Sport, Victoria University, Melbourne, VIC 8001, Australia; (J.F.); (V.A.)
| | - Lily Stojanovska
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates; (A.A.M.); (H.S.); (H.I.A.); (A.S.A.D.)
- Institute for Health and Sport, Victoria University, Melbourne, VIC 8001, Australia; (J.F.); (V.A.)
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Iron Deficiency - Not Only a Premenopausal Topic After Bariatric Surgery? Obes Surg 2021; 31:3242-3250. [PMID: 33821393 PMCID: PMC8175328 DOI: 10.1007/s11695-021-05380-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/24/2021] [Accepted: 03/24/2021] [Indexed: 11/11/2022]
Abstract
Purpose In our centre, specialized high dose multivitamin supplementation designed to meet the needs of patients after gastric bypass surgery is routinely recommended in the early postoperative period. The aim of the present study was to analyse whether iron supplementation prescribed in clinical practice is sufficient in both sexes and whether multivitamin supplementation standardized for women might potentially lead to iron overload in men. Materials/Methods This was a retrospective study covering the period up to 36 months after bariatric surgery. Three groups were compared (men, premenopausal and postmenopausal women). The iron status was evaluated employing serum ferritin concentrations. Results A total of 283 patients who had at least one follow-up visit between January 2015 and April 2018 at a specialized academic outpatient centre were included (71 men, 130 premenopausal women, 82 postmenopausal women). Thirty-six months after surgery, 33.3%, 68.4% and 54.5% of the men, pre- and postmenopausal women, respectively, were iron deficient. The preoperative prevalence of excess ferritin levels was 13.7% in premenopausal, 3.0% in postmenopausal women, 5.7% in men and declined in the following months. Conclusion Iron deficiency is very common after gastric bypass surgery, and even high dosages of multivitamin and mineral supplements might not be sufficient to prevent the development of iron deficiency. Men, pre- and postmenopausal women differ in their prevalence of iron deficiency which demands adapted iron dosage regimens based on the sex and the age. Iron overload is rare in all observed groups and highest in premenopausal women. Graphical abstract ![]()
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Benotti PN, Wood GC, Kaberi-Otarod J, Still CD, Gerhard GS, Bistrian BR. New concepts in the diagnosis and management approach to iron deficiency in candidates for metabolic surgery: should we change our practice? Surg Obes Relat Dis 2020; 16:2074-2081. [PMID: 33011074 PMCID: PMC7704546 DOI: 10.1016/j.soard.2020.08.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/29/2020] [Accepted: 08/12/2020] [Indexed: 12/15/2022]
Abstract
The near universal presence of chronic low-grade systemic inflammation among patients with severe obesity disrupts iron homeostasis and underlies the association between obesity and iron deficiency. Immune activation and inflammation result in a reduction in circulating iron and diminished iron bioavailability for erythropoiesis. Inflammation also alters blood levels of commonly measured markers of iron nutrition status, which makes the diagnosis of iron deficiency difficult and has led to new recommendations regarding laboratory markers for the diagnosis. Recent evidence using these newly recommended laboratory markers, which include levels of ferritin, C-reactive protein, and transferrin saturation, suggests that the actual prevalence of iron deficiency among candidates for metabolic surgery may be double or triple the prevalence identified by low levels of ferritin alone. Thus large numbers of surgical candidates have iron deficiency that has been heretofore largely unrecognized and inadequately treated. The assessment of iron status using the currently recommended markers in the presence of chronic inflammatory diseases and repletion of depleted stores for surgical candidates with deficiency during the preoperative period present an important opportunity for mitigating this condition in postoperative patients.
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Affiliation(s)
| | - G Craig Wood
- Geisinger Obesity Institute, Danville, Pennsylvania
| | | | | | - Glenn S Gerhard
- Department of Medical Genetics and Molecular Biology, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Bruce R Bistrian
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Qafiti FN, Lopez MA, Kichler K, Parreco J, Buicko JL. Hospital Readmissions for Hyperparathyroidism After Bariatric Surgery in the United States: A National Database Review. Cureus 2020; 12:e10585. [PMID: 33110721 PMCID: PMC7580962 DOI: 10.7759/cureus.10585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: The incidence and significance of hyperparathyroidism in patients after bariatric surgery have been established to some degree; however, the impact it has on the national healthcare system has not. We sought to assess the risk of readmission and related comorbidities in this patient population. Methods: The Healthcare Cost and Utilization Project Nationwide Readmission Database was queried for all patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Multivariate logistic regression analysis was conducted to identify factors associated with readmission for hyperparathyroidism. Results: A total of 915,792 patients between 2010 and 2015 were queried; 43.2% had undergone SG and 56.8% had RYGB. A total of 589 patients were readmitted for hyperparathyroidism; 80.8% were female and 68% had a Charlson comorbidity index ≥ 2. Factors associated with readmission were as follows: age 45-64 years (odds ratio [OR] 1.42, p=0.001), Medicare (OR 3.01, p<0.001) or Medicaid (OR 2.61, p<0.001) insurance status, lower median household income, renal failure (OR 17.14, p<0.001), hypertension (OR 2.89, p<0.001), and deficiency anemia (OR 2.62, p<0.01). Conclusions: Parathyroid axis monitoring may provide benefits to predictably high-risk patients. Appropriate surveillance may decrease the impact of bariatric hyperparathyroidism readmission on the U.S. healthcare system.
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Affiliation(s)
- Fred N Qafiti
- General Surgery, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Michael A Lopez
- General Surgery, University of Miami Miller School of Medicine, Lantana, USA
| | - Kandace Kichler
- Bariatric Surgery, University of Miami Miller School of Medicine, Lantana, USA
| | | | - Jessica L Buicko
- General Surgery, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA.,General Surgery, Bethesda Health Physician Group, Bethesda Hospital East, Boynton Beach, USA
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Hasan NA, Freije A, Abualsel A, Al-Saati H, Perna S. Effect of Bariatric Surgery on Weight Loss, Nutritional Deficiencies, Postoperative Complications and Adherence to Dietary and Lifestyle Recommendations: A retrospective cohort study from Bahrain. Sultan Qaboos Univ Med J 2020; 20:e344-e351. [PMID: 33110651 PMCID: PMC7574803 DOI: 10.18295/squmj.2020.20.03.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/05/2019] [Accepted: 03/12/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the effect of bariatric surgery on degree of weight loss, as well as the prevalence of nutritional deficiencies, postoperative complications and adherence to dietary and lifestyle recommendations in a cohort of patients from Bahrain. METHODS This retrospective cohort study took place between March and September 2018 at two hospitals in Bahrain. All adult patients who had undergone bariatric surgery between 2012-2017 were included. Sociodemographic and clinical information was collected from the patients' medical records and during phone interviews. RESULTS A total of 341 patients participated in the study. The mean age was 39.82 ± 9.95 years and 67.7% were female. There was a significant relationship between postoperative body mass index and both the type of surgery and time since surgery (P = 0.025 and 0.008, respectively). While type of surgery had no significant effect on percent of excess weight loss (EWL) or percent of total weight loss (TWL), time since surgery significantly affected both of these weight loss measures (P = 0.006 and 0.001, respectively). Biochemical tests revealed haemoglobin, mean corpuscular volume, 25-hydroxy vitamin D, ferritin and iron deficiencies. Commonly reported complications included hair loss (59.5%), flatulence/abdominal pain (39.3%), dry skin (34.3%) and gastroesophageal reflux disease (33.1%). The level of adherence to dietary and lifestyle recommendations was high to moderate. CONCLUSION Bariatric surgery was effective in accelerating EWL and TWL; however, it also resulted in complications such as nutritional deficiencies and gastrointestinal side-effects.
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Affiliation(s)
- Nawal A. Hasan
- Department of Biology, College of Science, University of Bahrain, Zallaq, Bahrain
| | - Afnan Freije
- Department of Biology, College of Science, University of Bahrain, Zallaq, Bahrain
| | | | - Hani Al-Saati
- Department of Surgery, Salmania Medical Complex, Manama, Bahrain
| | - Simone Perna
- Department of Biology, College of Science, University of Bahrain, Zallaq, Bahrain
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Nutritional Status of Obese Taiwanese Before Bariatric-Metabolic Surgery and Their Serum 25-Hydroxyvitamin D Concentrations for Maximal Suppression of Parathyroid Hormone. Obes Surg 2020; 30:3940-3946. [PMID: 32638247 DOI: 10.1007/s11695-020-04759-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/31/2020] [Accepted: 05/31/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND This is the first report from Taiwan using laboratory tests to assess nutritional status of patients with obesity before bariatric-metabolic surgery. Moreover, the 25(OH)D threshold for maximal suppression of parathyroid hormone (PTH) was evaluated to offer a reference value for preoperative nutritional care. METHODS Inclusion criteria were Taiwanese, 18-65 years old, and with BMI ≥ 27.5 kg/m2 awaiting bariatric-metabolic surgery. Anthropometric data and blood samples were collected before surgery. Serum concentrations of protein; vitamins B1, B12, folate, A, D, and E; calcium; iron; zinc; copper; selenium; PTH; and erythrocyte glutathione reductase activity coefficient (vitamin B2 status) were measured. RESULTS For 52 participants with a mean BMI 37.6 ± 6.4 kg/m2, vitamin D deficiency (25(OH)D < 20 ng/mL) and insufficiency (20 < 25(OH)D < 30 ng/mL) were at 73 and 22% prevalence, respectively. Secondary hyperparathyroidism (PTH ≧ 65 pg/mL) was 24% and hypocalcemia was 50% (ionized Ca < 4.5 mg/dL). Deficiency of other nutrients was sporadic (< 10%) or nil. When participants were stratified according to 25(OH)D concentrations (< 10, 10-15, 15-20, and ≥ 20 ng/mL), PTH increased at 25(OH)D < 10 ng/mL (β = 48.34, p = 0.001) after adjusting for age, gender, and BMI. CONCLUSION For patients with obesity before bariatric-metabolic surgery, vitamin D/calcium deficiency was the only nutritional issue that needs to be addressed in Taiwan. However, a lower cutoff point of 25(OH)D, i.e., 10 ng/mL, for vitamin D deficiency may be considered for patients before surgery. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03915158.
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Lee PC, Ganguly S, Dixon JB, Tan HC, Lim CH, Tham KW. Nutritional Deficiencies in Severe Obesity: a Multiethnic Asian Cohort. Obes Surg 2019; 29:166-171. [PMID: 30191504 DOI: 10.1007/s11695-018-3494-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Micronutrient deficiencies are highly prevalent in patients seeking metabolic-bariatric surgery (MBS), although literature remains scant in Asia. In this study, we assess the prevalence of nutritional deficiencies in patients with clinically severe obesity in Singapore and examine factors associated with the deficiencies. METHODS This is a prospective, observational study of 577 consecutive patients scheduled to undergo MBS. Nutritional profile including renal panel, calcium, phosphate, intact parathyroid hormone (iPTH), 25-hydroxyvitamin D (25(OH)D), vitamin B12, folate, ferritin, iron studies, hemoglobin, albumin, and alkaline phosphatase were analyzed. RESULTS Mean age was 40.6 ± 10.3 years, 61.2% female, and mean BMI 42.4 ± 8.4 kg/m2. 92.9% had suboptimal vitamin D levels; of which 25.6% had vitamin D insufficiency (25(OH)D < 30 mcg/L), 57.5% had vitamin D deficiency (25(OH)D < 20 mcg/L), and 9.8% had severe vitamin D deficiency (25(OH)D < 10 mcg/L). Younger age, female gender, and higher BMI were independent factors associated with lower 25(OH)D. There was an inverse relationship between iPTH and 25(OH)D, with an inflection point at 25(OH)D of approximately 20 mcg/L. Folate deficiency was present in 31% and vitamin B12 deficiency in 9.5% of the cohort. Serum ferritin levels were low in 29.3%. 25(OH)D, ferritin, serum iron, and albumin were also significantly higher in Chinese compared to Malay and Indian patients. CONCLUSION Vitamin D deficiency was the most common micronutrient deficiency observed in this multi-ethnic Asian cohort presenting for MBS. Ethnic differences in nutritional status were observed.
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Affiliation(s)
- Phong Ching Lee
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore.
| | - Sonali Ganguly
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - John B Dixon
- Clinical Obesity Research, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Hong Chang Tan
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - Chin Hong Lim
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore, Singapore
| | - Kwang Wei Tham
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
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Ben-Porat T, Weiss R, Sherf-Dagan S, Nabulsi N, Maayani A, Khalaileh A, Abed S, Brodie R, Harari R, Mintz Y, Pikarsky AJ, Elazary R. Nutritional Deficiencies in Patients with Severe Obesity before Bariatric Surgery: What Should Be the Focus During the Preoperative Assessment? J Acad Nutr Diet 2019; 120:874-884. [PMID: 31892499 DOI: 10.1016/j.jand.2019.10.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 10/21/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Nutritional deficiencies are a well-recognized long-term complication following bariatric surgery. The presence of preoperative deficiencies has been shown to be predictive of postoperative deficiencies. OBJECTIVE The aim of the study was to investigate the prevalence of micronutrient deficiency in a large sample of patients with severe obesity preoperatively, and to determine whether such deficiencies may be related to patient's sex, body mass index, or ethnic subgroup. DESIGN A cross-sectional study of data collected at the time of the preoperative evaluation. PARTICIPANTS/SETTING Data were collected during the preoperative evaluation of 872 bariatric surgery candidates in a university hospital in Israel between 2011 and 2018. The patients were 72.9% women, with a mean age of 37.9±12.1 years and mean body mass index of 42.4±4.7 MAIN OUTCOME MEASURES: Nutritional deficiencies according to blood assays. Data on anthropometrics, comorbidities, and demographic characteristics was also collected. STATISTICAL ANALYSES Baseline differences between patient subgroups were analyzed using independent-samples t test, analysis of variance, or χ2 test. RESULTS Deficiencies of vitamin D, iron, folate, vitamin B-12, elevated parathyroid hormone and low transferrin saturation were present in 75.2%, 42.6%, 28.5%, 8.5%, 35.5%, and 70% of patients, respectively. Nutritional deficiencies were significantly more common among women compared with men for iron (45.9% vs 33.5%; P=0.002), low transferrin saturation (77.7% vs 44.6%; P<0.001), vitamin D (77.5% vs 69.2%; P=0.019) and elevated parathyroid hormone level (39.5% vs 22.9%; P=0.002). Iron, transferrin saturation, and vitamin D deficiencies were more prevalent in Arab patients compared with Jewish patients: 59.6% vs 36%; P<0.001, 80.2% vs 62.8%; P=0.003, and 85.1% vs 71.6%; P<0.001, respectively. Vitamin D and iron deficiency were more common among higher body mass index subgroups (P=0.004 and P=0.040, respectively). CONCLUSIONS The results indicate a high prevalence of nutritional deficiencies, mainly of iron and vitamin D in bariatric surgery candidates. Patients at higher risk for nutritional deficiencies include those with higher body mass index, women, and Arabs.
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Smelt HJM, van Loon S, Pouwels S, Boer AK, Smulders JF, Aarts EO. Do Specialized Bariatric Multivitamins Lower Deficiencies After Sleeve Gastrectomy? Obes Surg 2019; 30:427-438. [DOI: 10.1007/s11695-019-04191-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Asghari G, Khalaj A, Ghadimi M, Mahdavi M, Farhadnejad H, Valizadeh M, Azizi F, Barzin M, Hosseinpanah F. Prevalence of Micronutrient Deficiencies Prior to Bariatric Surgery: Tehran Obesity Treatment Study (TOTS). Obes Surg 2019. [PMID: 29520704 DOI: 10.1007/s11695-018-3187-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Micronutrient deficiencies are major concerns after bariatric surgery, although these conditions often go undiagnosed pre-surgery. OBJECTIVE To assess pre-surgery micronutrient status of an Iranian population of morbidly obese candidates of bariatric surgery in a cross-sectional study. METHODS A cross-sectional analysis of 2008 candidates for bariatric surgery, aged 15-65 years, with either body mass index (BMI) ≥ 40 kg/m2 or 30 < BMI < 35 kg/m2 with a medical comorbidity was conducted. In order to determine the micronutrient status of participants, blood samples were collected to assess serum concentrations of vitamins (B12 and D), minerals (copper, calcium, phosphate, and zinc), and iron profiles (total iron binding capacity, iron concentration, ferritin, and iron saturation), according to standard protocol. RESULTS The mean age and BMI of patients (79.3% female) were 37.8 years and 44.8 kg/m2, respectively. Deficiencies were found for 25(OH) D (53.6%), vitamin B12 (34.4%), serum iron (10.2%), and low levels of hemoglobin (16.6%). The prevalence of other deficiencies were all below 10%. Body mass index had a negative correlation with iron, calcium, vitamin B12, and 25(OH) D and was positively correlated with copper. CONCLUSION Micronutrient deficiencies, including vitamin D, vitamin B12, and iron, are commonly found among morbidly obese subjects who are potential candidates of bariatric surgery.
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Affiliation(s)
- Golaleh Asghari
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Khalaj
- Tehran Obesity Treatment Center, Department of Surgery, Faculty of Medicine, Shahed University, Tehran, Iran
| | - Maryam Ghadimi
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Mahdavi
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Farhadnejad
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Valizadeh
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Barzin
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Lange J, Königsrainer A. Malnutrition as a Complication of Bariatric Surgery - A Clear and Present Danger? Visc Med 2019; 35:305-311. [PMID: 31768394 DOI: 10.1159/000503040] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 08/29/2019] [Indexed: 12/21/2022] Open
Abstract
Obesity is a chronic life-threatening disease, and bariatric surgery is the most effective treatment in those patients. The two main operations are laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (RYGB). LSG carries a smaller risk for nutritional deficiencies, while gastric bypass procedures are associated with increased nutritional deficiencies because the procedure is more complex and changes the gastrointestinal anatomy. Recent studies comparing LSG and RYGB have proven that these types of operation may lead to a similar weight reduction effect but cause different micronutrient deficiencies. Types of malnutrition after bariatric surgery include protein-energy malnutrition and deficiencies of micronutrients, such as iron, folate, vitamin A, and vitamin B<sub>12</sub>. Bariatric patients who do not adhere to the recommended diets are at a greater risk of developing relevant malnutrition. Therefore, life-long postoperative clinical and laboratory monitoring is necessary to diagnose deficiencies of vitamins, trace elements, and minerals and to correct them with supplements. Unfortunately, no standardized aftercare regimes exist for these patients, and the costs for nutritional supplements are paid by the patients themselves.
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Affiliation(s)
- Jessica Lange
- Department of General, Visceral and Transplantation Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Alfred Königsrainer
- Department of General, Visceral and Transplantation Surgery, University Hospital Tübingen, Tübingen, Germany
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Abstract
Bariatric surgeries are considered the only effective way of weight loss therapy in morbidly obese patients, i.e. body mass index ≥ 35. However, micronutrient deficiencies and malnutrition are common after most bariatric procedures and thus, pre- and postoperative nutritional assessment and corrections are advised. The present review is presented in an effort to describe in some detail about prevalence, and mechanisms of macro- and micronutrient deficiencies in obese and post-bariatric surgery individuals. We also aimed to summarize the data on screening and supplementation of macro- and micronutrients before and after bariatric surgeries.
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Affiliation(s)
- Sonmoon Mohapatra
- Department of Gastroenterology and Hepatology, Saint Peter's University Hospital - Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ, United States
| | - Keerthana Gangadharan
- Department of Internal Medicine, Saint Peter's University Hospital - Rutgers Robert Wood, Johnson School of Medicine, New Brunswick, NJ, United States
| | - Capecomorin S Pitchumoni
- Department of Gastroenterology, Hepatology and Clinical Nutrition, Saint Peter's University Hospital - Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ, United States.
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Mangan A, Le Roux CW, Miller NG, Docherty NG. Iron and Vitamin D/Calcium Deficiency after Gastric Bypass: Mechanisms Involved and Strategies to Improve Oral Supplement Disposition. Curr Drug Metab 2019; 20:244-252. [DOI: 10.2174/1389200219666181026160242] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 10/01/2018] [Accepted: 11/20/2018] [Indexed: 12/17/2022]
Abstract
Background:Nutritional deficiencies are common following Roux-en-Y Gastric Bypass (RYGB). Aetiology is diverse; including non-compliance, altered diet, unresolved preoperative deficiency and differential degrees of post-operative malabsorption occurring as function of length of bypassed intestine. Iron and calcium/vitamin D deficiency occur in up to 50% of patients following RYGB. Currently, treatment strategies recommend the prescription of oral supplements for those who become deficient. Meanwhile, debate exists regarding the absorption capacity of these post-operatively and their efficacy in treating deficiency.Objective:To examine the disposition of oral iron and calcium/vitamin D supplementation following RYGB. Methods: A literature review was carried out using PubMed and Embase. Data from the key interventional studies investigating iron and calcium/vitamin D oral supplement absorption and efficacy following RYGB was summarized.Results:Absorption of both iron and vitamin D/calcium is adversely affected following RYGB. Distribution and metabolism may be altered by the predominance of paracellular absorption pathways which promote unregulated influx into the circulatory system. Overall, studies indicate that current supplementation strategies are efficacious to a degree in treating deficiency following RYGB, generally restoration of optimal status is not achieved.Conclusion:Oral supplement disposition is altered following RYGB. As a result, patients are required to take regimens of oral supplementation indefinitely. The dosage which confers optimum health benefit while avoiding potential toxicity and tolerability issues remains unknown. Novel preparations with improved disposition could help limit the extent of post-RYGB nutritional deficiencies.
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Affiliation(s)
- Aisling Mangan
- Diabetes Complications Research Center, Conway Institute, University College Dublin, Dublin, Ireland
| | - Carel W. Le Roux
- Diabetes Complications Research Center, Conway Institute, University College Dublin, Dublin, Ireland
| | | | - Neil G. Docherty
- Diabetes Complications Research Center, Conway Institute, University College Dublin, Dublin, Ireland
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Benotti PN, Wood GC, Still CD, Gerhard GS, Rolston DD, Bistrian BR. Metabolic surgery and iron homeostasis. Obes Rev 2019; 20:612-620. [PMID: 30589498 DOI: 10.1111/obr.12811] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 10/29/2018] [Accepted: 10/29/2018] [Indexed: 12/13/2022]
Abstract
Iron deficiency and anaemia after metabolic surgery, potentially modifiable nutritional complications, are becoming an increasing cause for concern as prevalence increases with time and there is limited evidence supporting the effectiveness of the current guidelines for prophylactic oral iron supplementation and treatment for deficiency. Abnormalities in iron nutrition predisposing to deficiency are common in severely obese patients, and the low-grade systemic inflammation, also common to these patients, reduces the effectiveness of oral iron supplementation. The surgical procedures result in alterations of foregut anatomy and physiology, which limit iron absorptive capacity and daily food intake. These alterations and the limited effects of oral iron supplementation explain the high prevalence of postoperative iron deficiency and anaemia. This review outlines current mechanisms concerning the pathogenesis of disordered iron nutrition in patients with severe obesity, current gaps in knowledge, and opportunities for quality improvement.
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Affiliation(s)
- Peter N Benotti
- Geisinger Obesity Institute, Geisinger Medical Center, Danville, Pennsylvania
| | - G Craig Wood
- Geisinger Obesity Institute, Geisinger Medical Center, Danville, Pennsylvania
| | - Christopher D Still
- Geisinger Obesity Institute, Geisinger Medical Center, Danville, Pennsylvania
| | - Glenn S Gerhard
- Department of Medical Genetics and Molecular Biochemistry, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - David D Rolston
- Geisinger Obesity Institute, Geisinger Medical Center, Danville, Pennsylvania
| | - Bruce R Bistrian
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Daviddi G, Ricci MA, De Vuono S, Gentili A, Boni M, Lupattelli G. Folate and Vitamin B12 in Morbid Obesity: The Influence of Folate on Anti-Atherogenic Lipid Profile. INT J VITAM NUTR RES 2019; 90:295-301. [PMID: 30829139 DOI: 10.1024/0300-9831/a000538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Previous studies showed a high prevalence of micronutrient deficiencies in obese subjects, with low folate and vitamin B12 serum levels and intakes. Correlations between vitamins and lipids have been investigated both in animal and human studies. The aim of our study is to evaluate the influence of dietetic and serum levels of folate and vitamin B12 on lipid pattern in morbidly obese subjects. We also analysed the relationship between serum concentrations and dietary intake of these micronutrients, and compared the intakes to the Recommended Levels of Nutrients and Energy Intakes (LARN). In 122 morbidly obese patients, mean BMI 45 ± 7 kg/m2, we evaluated anthropometric parameters, hepatic, glyco/lipid profile, total folate and vitamin B12, blood pressure, and finally nutritional intakes in a subgroup of 68 patients using a food frequency questionnaire about the frequency of food consumption and daily water intake. These values were determined in obese patients before and one year after sleeve gastrectomy. Both before and after surgery, levels of vitamins and minerals remained in normal range compared to LARN. According to univariate analysis, at baseline folate showed a significantly positive correlation with high-density lipoprotein cholesterol (p = 0.028, ρ = 0.204), apolipoprotein A-I (p = 0.006, ρ = 0.268) and vitamin B12 (p = 0.040, ρ = 0.192), and a significantly negative correlation with triglycerides (p = 0.049, ρ = -0.184). Folate and vitamin B12 levels do not correlate with their nutritional intakes, which remain within recommended range after surgery. In conclusion the correlation between folate and anti-atherogenic lipid profile is confirmed also in a large group of morbid obese patients.
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Affiliation(s)
- Giulia Daviddi
- Internal Medicine, Department of Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Italy
| | - Maria Anastasia Ricci
- Internal Medicine, Department of Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Italy
| | - Stefano De Vuono
- Internal Medicine, Department of Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Italy
| | - Alessandra Gentili
- Internal Medicine, Department of Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Italy
| | - Marcello Boni
- Surgery Department, San Giovanni Battista Hospital, Foligno, Perugia, Italy
| | - Graziana Lupattelli
- Internal Medicine, Department of Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Italy
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Prevalence of Micronutrient Deficiency in Patients with Morbid Obesity Before Bariatric Surgery. Obes Surg 2018; 28:643-648. [PMID: 28849358 DOI: 10.1007/s11695-017-2902-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Postoperative micronutrient deficiency is a known side effect of bariatric surgery. In this study, we examined the prevalence of micronutrient deficiency in patients with morbid obesity (MO) preoperatively. METHODS A total of 1732 patients with MO wishing to undergo bariatric surgery (age: 40 ± 12 years, mean BMI: 44 ± 9 kg/m2, means ± SD, 77.3% female) were analyzed in this cross-sectional examination. Iron state, vitamin B12, folic acid, 25hydroxy(OH)-vitamin D, PTH, vitamin A, and vitamin E levels were determined. Subsequently, patients underwent nutritional counseling and were substituted accordingly. RESULTS A total of 63.2% (n = 1094) of the patients had a deficit in folic acid (< 5.3 ng/ml), 97.5% (n = 1689) in 25OHvitamin D (< 75 nmol/l), and 30.2% (n = 523) had a PTH elevation (> 56.9 pg/ml). A total of 5.1% (n = 88) of the patients presented with a deficit in vitamin B12 (< 188 pg/ml) and 6.2% (n = 107) in vitamin A (< 1.05 μmol/l). A total of 9.6% (n = 166) exhibited iron deficiency (ferritin < 15 μg/l). None of the patients had a deficit in vitamin E. There were no gender differences except for ferritin deficiency (women 11.8% vs. men 1.5%, p < 0.001). Patients in the highest BMI tertile had significantly more often a deficit in vitamin D (p = 0.033) and folic acid (p < 0.001). Patients in the lowest age tertile had significantly more often a deficit in folic acid (p < 0.001). CONCLUSIONS Our data show a high prevalence of micronutrient deficiency in patients with morbid obesity preoperatively and emphasize the importance of exact preoperative evaluation and adequate substitution as well as postoperative surveillance.
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Severe anemia after Roux-en-Y gastric bypass: a cause for concern. Surg Obes Relat Dis 2018; 14:902-909. [DOI: 10.1016/j.soard.2018.03.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 02/28/2018] [Accepted: 03/26/2018] [Indexed: 12/21/2022]
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37
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38
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Randell EW, Twells LK, Gregory DM, Lester KK, Daneshtalab N, Dillon C, Pace D, Smith C, Boone D. Pre-operative and post-operative changes in CRP and other biomarkers sensitive to inflammatory status in patients with severe obesity undergoing laparoscopic sleeve gastrectomy. Clin Biochem 2018; 52:13-19. [DOI: 10.1016/j.clinbiochem.2017.10.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 10/15/2017] [Indexed: 01/09/2023]
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Gimenes JC, Nicoletti CF, de Souza Pinhel MA, de Oliveira BAP, Salgado Júnior W, Marchini JS, Nonino CB. Pregnancy After Roux en Y Gastric Bypass: Nutritional and Biochemical Aspects. Obes Surg 2018; 27:1815-1821. [PMID: 28102495 DOI: 10.1007/s11695-017-2558-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Although pregnancy after bariatric surgery is related to risk reduction, nutritional complications may occur. This study aimed to evaluate nutritional and biochemical indicators of women who became pregnant after Roux en Y gastric bypass (RYGB). MATERIALS AND METHODS We carried out a retrospective study with women who became pregnant after RYGB. We evaluated anthropometric, biochemical, and dietary intake indicators in the preoperative period and before, during, and after pregnancy by analysis of medical records. Shapiro-Wilk test and ANOVA for repeated measures were performed (p < 0.05). RESULTS The study included 25 patients (35.7 ± 3.8 years), who became pregnant 31.3 ± 21.7 months after RYGB. Weight loss until the beginning of pregnancy was 32.4%, and the gestational weight gain was 3.8 ± 12 kg. There was a higher frequency of patients with hypertension in the preoperative time when compared to that during the pregnancy period. Total cholesterol (180.9 ± 24.8 versus 148.5 ± 30.4 mg/dL), LDL-cholesterol (103.5 ± 19.2 versus 85.8 ± 23.1 mg/dL), HDL-cholesterol (56.4 ± 8 versus 46.9 ± 8.7 mg/dL), and latent iron-binding capacity (337.6 ± 95.8 versus 277.8 ± 65 μg/dL) were higher during the pregnancy compared to that before the pregnancy, while hemoglobin values (11.2 ± 1 versus 12.3 ± 1.2 g/dL) and sodium (138.8 ± 2.9 versus 141 ± 3 mmol/L) were lower. No differences of food intake were found among times. There is no difference on gestational weight gain between women who became pregnant before or after the first year. CONCLUSION During pregnancy, there was an expected weight gain and maintenance of the lipid profile within the normal range; however, there was a reduction of hemoglobin levels. These findings show the need for individualized follow-up with adequate nutritional intervention in the event of deficiencies.
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Affiliation(s)
- Jessica Cristina Gimenes
- Department of Internal Medicine, Faculty of Medicine of Ribeirao Preto-FMRP, Laboratory of Nutrigenomic Studies, University of São Paulo-USP, Av Bandeirantes, 3900, Monte Alegre, Ribeirao Preto, SP, 14049-900, Brazil
| | - Carolina Ferreira Nicoletti
- Department of Internal Medicine, Faculty of Medicine of Ribeirao Preto-FMRP, Laboratory of Nutrigenomic Studies, University of São Paulo-USP, Av Bandeirantes, 3900, Monte Alegre, Ribeirao Preto, SP, 14049-900, Brazil
| | - Marcela Augusta de Souza Pinhel
- Department of Internal Medicine, Faculty of Medicine of Ribeirao Preto-FMRP, Laboratory of Nutrigenomic Studies, University of São Paulo-USP, Av Bandeirantes, 3900, Monte Alegre, Ribeirao Preto, SP, 14049-900, Brazil
| | - Bruno Affonso Parenti de Oliveira
- Department of Internal Medicine, Faculty of Medicine of Ribeirao Preto-FMRP, Laboratory of Nutrigenomic Studies, University of São Paulo-USP, Av Bandeirantes, 3900, Monte Alegre, Ribeirao Preto, SP, 14049-900, Brazil
| | - Wilson Salgado Júnior
- Department of Surgery and Anatomy, Faculty of Medicine of Ribeirao Preto-FMRP, University of Sao Paulo-USP, Ribeirao Preto, SP, Brazil
| | - Júlio Sérgio Marchini
- Department of Internal Medicine, Faculty of Medicine of Ribeirao Preto-FMRP, Laboratory of Nutrigenomic Studies, University of São Paulo-USP, Av Bandeirantes, 3900, Monte Alegre, Ribeirao Preto, SP, 14049-900, Brazil
| | - Carla Barbosa Nonino
- Department of Internal Medicine, Faculty of Medicine of Ribeirao Preto-FMRP, Laboratory of Nutrigenomic Studies, University of São Paulo-USP, Av Bandeirantes, 3900, Monte Alegre, Ribeirao Preto, SP, 14049-900, Brazil.
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Thomas-Valdés S, Tostes MDGV, Anunciação PC, da Silva BP, Sant'Ana HMP. Association between vitamin deficiency and metabolic disorders related to obesity. Crit Rev Food Sci Nutr 2018; 57:3332-3343. [PMID: 26745150 DOI: 10.1080/10408398.2015.1117413] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Inappropriate food behavior contributes to obesity and leads to vitamin deficiency. This review discusses the nutritional status of water- and fat-soluble vitamins in obese subjects. We verified that most vitamins are deficient in obese individuals, especially the fat-soluble vitamins, folic acid, vitamin B12 and vitamin C. However, some vitamins have been less evaluated in cases of obesity. The adipose tissue is considered a metabolic and endocrine organ, which in excess leads to changes in body homeostasis, as well as vitamin deficiency which can aggravate the pathological state. Therefore, the evaluation of vitamin status is of fundamental importance in obese individuals.
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Affiliation(s)
- Samanta Thomas-Valdés
- a Escuela de Nutrición y Dietética, Facultad de Ciencias de la Salud , Universidad de Talca , Talca , Chile
| | - Maria das Graças V Tostes
- b Center of Agrarian Sciences , Universidade Federal do Espírito Santo , Alegre , Espírito Santo , Brazil
| | - Pamella C Anunciação
- c Department of Nutrition and Health , Universidade Federal de Viçosa , Viçosa , Minas Gerais , Brazil
| | - Bárbara P da Silva
- c Department of Nutrition and Health , Universidade Federal de Viçosa , Viçosa , Minas Gerais , Brazil
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Nutritional Status of Bariatric Surgery Candidates. Nutrients 2018; 10:nu10010067. [PMID: 29324643 PMCID: PMC5793295 DOI: 10.3390/nu10010067] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 01/04/2018] [Accepted: 01/08/2018] [Indexed: 12/18/2022] Open
Abstract
Obesity is a global epidemic affecting populations globally. Bariatric surgery is an effective treatment for morbid obesity, and has increased dramatically. Bariatric surgery candidates frequently have pre-existing nutritional deficiencies that might exacerbate post-surgery. To provide better health care management pre- and post-bariatric surgery, it is imperative to establish the nutritional status of prospective patients before surgery. The aim of this study was to assess and provide baseline data on the nutritional status of bariatric candidates. A retrospective study was conducted on obese patients who underwent bariatric surgery from 2008 to 2015. The medical records of 1538 patients were reviewed for this study. Pre-operatively, the most commonly observed vitamin deficiencies were Vitamin D (76%) and Vitamin B12 (16%). Anemia and iron status parameters were low in a considerable number of patients before surgery, as follows: hemoglobin 20%, mean corpuscular volume (MCV) 48%, ferritin 28%, serum iron 51%, and transferrin saturation 60%. Albumin and transferrin were found to be low in 10% and 9% of the patients, respectively, prior to surgery. In addition to deficiencies, a great number of patients had hypervitaminosis pre-operatively. Excess levels of Vitamin B6 (24%) was the most remarkable. The findings in this study advocate a close monitoring and tailored supplementation pre- and post-bariatric surgery.
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Abstract
BACKGROUND Two main causes for nutrient deficiencies following bariatric surgery (BS) are pre-operative deficiencies and favoring foods with high-energy density and poor micronutrient content. The aims of this study were to evaluate nutritional status and gender differences and the prevalence of nutritional deficiencies among candidates for laparoscopic sleeve gastrectomy (LSG) surgery. METHODS A cross-sectional analysis of pre-surgery data collected as part of a randomized clinical trial on 100 morbidly obese patients with non-alcoholic fatty liver disease (NAFLD) admitted to LSG surgery at Assuta Medical Center between February 2014 and January 2015. Anthropometrics, food intake, and fasting blood tests were evaluated during the baseline visit. RESULTS One-hundred patients completed the pre-operative measurements (60 % female) with a mean age of 41.9 ± 9.8 years and a mean BMI of 42.3 ± 4.7 kg/m(2). Pre-operatively, deficiencies for iron, ferritin, folic acid, vitamin B1, vitamin B12, vitamin D, and hemoglobin were 6, 1, 1, 6, 0, 22, and 6 %, respectively. Pre-surgery, mean energy, protein, fat, and carbohydrate intake were 2710.7 ± 1275.7 kcal/day, 114.2 ± 48.5, 110.6 ± 54.5, and 321.6 ± 176.1 gr/day, respectively. The intakes for iron, calcium, folic acid, vitamin B12, and vitamin B1 were below the Dietary Reference Intake (DRI) recommendations for 46, 48, 58, 14, and 34 % of the study population, respectively. CONCLUSION We found a low prevalence of nutritional deficiencies pre-operatively except for vitamin D. Most micronutrient intake did not reach the DRI recommendations, despite high-caloric and macronutrient intake indicating a poor dietary quality.
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Bergeat D, Lechaux D, Ghaina A, Thibault R, Bouygues V. Postoperative Outcomes of Laparoscopic Bariatric Surgery in Older Obese Patients: a Matched Case-Control Study. Obes Surg 2017; 27:1414-1422. [PMID: 28035521 DOI: 10.1007/s11695-016-2517-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Laparoscopic bariatric surgery (LBS) in older obese patients remains debated regarding postoperative outcomes. OBJECTIVES The aim of this case-control study is to evaluate global results of LBS in patients ≥60 years (yr) with a matched case control study. METHODS All patients ≥60 years who benefited from LBS in our center between January 2009 and January 2014 were included in this retrospective study. They were matched (1:2) to patients <40 and 40-59 years on BMI, surgical procedure and year, and history of previous LBS. Postoperative complications in the first 90 days following LBS, micronutrient and mineral deficiencies, and Bariatric Analysis and Reporting Outcome System (BAROS) were analyzed. RESULTS Fifty-five patients ≥60 year (40 sleeve gastrectomy, 14 one anastomosis gastric bypass, 1 gastric bypass revision) were matched to patients <40 year and patients 40-59 year (n = 55 each). Patients ≥60 year presented more obesity-related comorbidities at baseline. Except for bleeding complications (P = 0.01), no difference in major complication rate was observed (P = 0.43). At 24 months, %EWL was lower in older patients compared to others (76.3, 82.2 and 89.7, respectively, P = 0.009). Iron and vitamin B12 deficiencies were less prevalent in patients ≥60 year After a mean follow-up of 27 months, BAROS score (filled in by 82% of patients) was lower in patients ≥60 years (P = 0.01). CONCLUSION Despite less weight loss, postoperative complications rate, and lower BAROS results, LBS keeps an acceptable benefit-risk balance in selected older patients and should not be rejected on the sole argument of age. Additional studies are needed to assess the long-term benefits of LBS in older patients.
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Affiliation(s)
- Damien Bergeat
- Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Rennes, France.
- Université de Rennes 1, Rennes, France.
- UMR NuMeCan (Nutrition, Métabolismes, Cancer), INRA, ALICE, St Gilles, France.
| | - David Lechaux
- Service de Chirurgie Digestive, Hôpital Yves-le-Foll, Saint Brieuc, France
| | - Adil Ghaina
- Service de Chirurgie Digestive, Hôpital Yves-le-Foll, Saint Brieuc, France
| | - Ronan Thibault
- Université de Rennes 1, Rennes, France
- UMR NuMeCan (Nutrition, Métabolismes, Cancer), INRA, ALICE, St Gilles, France
- Unité de Nutrition, Service d'Endocrinologie-Diabétologie-Nutrition, INSERM U991, CHU Rennes, Université Rennes 1, F-35000, Rennes, France
| | - Vianney Bouygues
- Service de Chirurgie Digestive, Hôpital Yves-le-Foll, Saint Brieuc, France
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Assessment of Folate Status in Obese Patients: Should We Measure Folate in Serum or in Red Blood Cells? Obes Surg 2017; 26:3069-3075. [PMID: 27718179 DOI: 10.1007/s11695-016-2402-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Recent studies revealed that obesity is associated with decreased serum but at the same time increased red blood cell (RBC) folate concentrations compared with lean subjects, thus casting doubt upon the agreement between serum and RBC folate measurements for assessing folate status. This work aimed to determine whether these two metrics lead to the same classification of folate status in obese patients. METHODS RBC and serum folate concentrations were measured with a chemiluminescent immunoassay in 263 adults with body mass index ≥30 kg/m2 and without previous bariatric surgery. Among them, 68.1 % were eligible for bariatric surgery. Each serum and RBC folate result was classified as deficient or not according to thresholds recommended by the kit manufacturer (model A) or by the World Health Organization (model B). The agreement between serum and RBC folate results was evaluated using the proportion of overall agreement and the prevalence-adjusted bias-adjusted kappa (PABAK) statistics. RESULTS The overall percentage agreements between serum and RBC measurements were 91.6 % (95 % CI 87.6-94.7 %) and 92.4 % (95 % CI 88.5-95.3 %) with PABAK coefficients of 0.87 (95 % CI 0.82-0.93) and 0.88 (95 % CI 0.83-0.94) in the models A and B, respectively, corresponding to almost perfect agreement. The same was true in the subgroup of patients eligible for bariatric surgery. Gender, age, and BMI did not influence the quality of agreement between the two parameters. CONCLUSIONS The present study showed that folate measurements in serum and in RBC display similar performances to assess folate status in obese patients.
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Predictors of Success in Bariatric Surgery: the Role of BMI and Pre-operative Comorbidities. Obes Surg 2017; 28:1335-1341. [DOI: 10.1007/s11695-017-3011-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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46
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Preoperative and Postoperative Assessments of Biochemical Parameters in Patients with Severe Obesity Undergoing Laparoscopic Sleeve Gastrectomy. Obes Surg 2017; 28:2261-2271. [PMID: 29116560 DOI: 10.1007/s11695-017-3007-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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47
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Problems in bariatric patient care - challenges for dieticians. Wideochir Inne Tech Maloinwazyjne 2017; 12:207-215. [PMID: 29062439 PMCID: PMC5649507 DOI: 10.5114/wiitm.2017.70193] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/08/2017] [Indexed: 02/08/2023] Open
Abstract
Obesity management options include a low-calorie diet, behavioral therapy, regular physical activity and pharmacological therapy. However, treatment failure is frequently encountered, most of these methods are ineffective, and a positive outcome is rarely maintained in the long term. In morbidly obese patients, bariatric surgery is considered the most effective treatment for obesity as well as the accompanying diseases. Bariatric surgery promotes much greater weight loss than conservative treatment, regardless of the applied surgical technique. Bariatric surgery patients should receive professional perioperative (preoperative, intraoperative and postoperative) care from a multidisciplinary team of specialists, including a bariatric surgeon, a general practitioner, a dietitian and a health psychologist. Patients require postoperative nutritional counseling to be able to stabilize their weight and maintain long-term weight loss after surgery. Patients are guided by bariatric dietitians through the process of adopting new eating habits and behavior, learning how to make healthy food choices.
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Ben-Porat T. Comment on: Long-term nutritional impact of sleeve gastrectomy. Surg Obes Relat Dis 2017; 13:1673-1675. [PMID: 28888795 DOI: 10.1016/j.soard.2017.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 08/08/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Tair Ben-Porat
- Department of Diet and Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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49
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Velazquez A, Apovian CM, Istfan NW. The Complexities of Iron Deficiency in Patients After Bariatric Surgery. Am J Med 2017; 130:e293-e294. [PMID: 28238687 DOI: 10.1016/j.amjmed.2017.01.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 01/20/2017] [Accepted: 01/23/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Amanda Velazquez
- Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston Medical Center, Boston University School of Medicine, Mass
| | - Caroline M Apovian
- Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston Medical Center, Boston University School of Medicine, Mass.
| | - Nawfal W Istfan
- Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston Medical Center, Boston University School of Medicine, Mass
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50
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Frame-Peterson LA, Megill RD, Carobrese S, Schweitzer M. Nutrient Deficiencies Are Common Prior to Bariatric Surgery. Nutr Clin Pract 2017. [PMID: 28636832 DOI: 10.1177/0884533617712701] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Obesity, defined as a body mass index >30 kg/m2, is a growing worldwide epidemic currently effecting 1 in 10 adults, with rates as high as 40% in the United States. The only proven long-term treatment of severe obesity on a population level is surgical modification of the gastrointestinal anatomy to induce weight loss, termed bariatric surgery. With adequate physician guidance and appropriate candidate criteria, bariatric surgery is an option for effective long-term treatment of obesity and its related comorbidities. Complications of bariatric surgery can be seen in patients who are not compliant to the recommended lifestyle and dietary changes required following bariatric surgery, including nausea, vomiting, dumping syndrome, acid reflux, and nutrition deficiencies. Despite caloric density, the diet of patients prior to bariatric surgery is often of poor nutrition quality and does not meet recommended dietary guidelines for micronutrient intake, making this an at-risk population for micronutrient malnutrition. Currently, improvements are needed in standardization of nutrition assessment as well as micronutrient cutoffs for deficiency and insufficiency. In the meantime, utilizing our current tools to conduct nutrition assessment at baseline and implement supplementation where necessary may improve the nutrition status of patients undergoing bariatric surgery, both before and after surgery, which may improve their surgical outcomes.
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Affiliation(s)
| | - Robin D Megill
- 2 Georgetown University School of Medicine, Washington, DC, USA
| | - Suzanne Carobrese
- 1 The Johns Hopkins Center for Bariatric Surgery, Baltimore, Maryland, USA
| | - Michael Schweitzer
- 1 The Johns Hopkins Center for Bariatric Surgery, Baltimore, Maryland, USA
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