Skip to main content
Erschienen in: Current Diabetes Reports 2/2011

01.04.2011

Origins of and Recognition of Micronutrient Deficiencies After Gastric Bypass Surgery

verfasst von: Bikram S. Bal, Frederick C. Finelli, Timothy R. Koch

Erschienen in: Current Diabetes Reports | Ausgabe 2/2011

Einloggen, um Zugang zu erhalten

Abstract

Roux-en-Y gastric bypass surgery remains the major surgical option for individuals with medically complicated obesity. The importance of preoperative evaluation to permit identification of micronutrient deficiencies is being re-evaluated. The risk of complications related to pregnancy after gastric bypass supports careful follow-up. Micronutrient deficiencies are common in postoperative gastric bypass patients, despite the suggested use of routine vitamin and mineral supplements after surgery. Copper deficiency must be considered as an origin for visual disorders after gastric bypass. Vitamin D deficiency with metabolic bone disease remains common after gastric bypass and the results suggest that the present postoperative supplements of calcium and vitamin D are inadequate. Major nutritional complications of bariatric surgery are occurring more than 20 years after surgery. There is no evidence for intestinal adaptation as there remains decreased intestinal absorption of iron up to 18 months after gastric bypass surgery. This article supports ongoing examination of nutritional complications after gastric bypass surgery and supports the notion that the daily doses of micronutrient supplements, such as vitamin D, may need to be revised.
Literatur
1.
Zurück zum Zitat Flegal KM, Carroll MD, Ogden CL, Curtin LR.: Prevalence and trends in obesity among US adults, 1999–2008. JAMA 2010, 303(3): 235–41.PubMedCrossRef Flegal KM, Carroll MD, Ogden CL, Curtin LR.: Prevalence and trends in obesity among US adults, 1999–2008. JAMA 2010, 303(3): 235–41.PubMedCrossRef
2.
Zurück zum Zitat Buchwald H, Oien DM. Metabolic/bariatric surgery Worldwide 2008.: Obes Surg 2009, 19: 1605–1611.PubMedCrossRef Buchwald H, Oien DM. Metabolic/bariatric surgery Worldwide 2008.: Obes Surg 2009, 19: 1605–1611.PubMedCrossRef
3.
Zurück zum Zitat Makary MA, Clarke JM, Shore AD, et al.: Medication utilization and annual health care costs in patients with type 2 diabetes mellitus before and after bariatric surgery. Arch Surg 2010, 145(8): 726–31.PubMedCrossRef Makary MA, Clarke JM, Shore AD, et al.: Medication utilization and annual health care costs in patients with type 2 diabetes mellitus before and after bariatric surgery. Arch Surg 2010, 145(8): 726–31.PubMedCrossRef
4.
Zurück zum Zitat Sechi GP. Dietary supplements and the risk of Wernicke’s encephalopathy. Clin Pharmacol Ther 2010; 88: 164.PubMedCrossRef Sechi GP. Dietary supplements and the risk of Wernicke’s encephalopathy. Clin Pharmacol Ther 2010; 88: 164.PubMedCrossRef
5.
Zurück zum Zitat Schweiger C, Weiss R, Berry E, et al.: Nutritional deficiencies in bariatric surgery candidates. Obes Surg 2010, 20(2): 193–7.PubMedCrossRef Schweiger C, Weiss R, Berry E, et al.: Nutritional deficiencies in bariatric surgery candidates. Obes Surg 2010, 20(2): 193–7.PubMedCrossRef
6.
Zurück zum Zitat Gehrer S, Kern B, Peters T, et al.: Fewer nutrient deficiencies after laparoscopic sleeve gastrectomy (LSG) than after laparoscopic Roux-Y-gastric bypass (LTYGB)—a prospective study. Obes Surg 2010, 20(4): 447–53.PubMedCrossRef Gehrer S, Kern B, Peters T, et al.: Fewer nutrient deficiencies after laparoscopic sleeve gastrectomy (LSG) than after laparoscopic Roux-Y-gastric bypass (LTYGB)—a prospective study. Obes Surg 2010, 20(4): 447–53.PubMedCrossRef
7.
Zurück zum Zitat Shea MK, Booth SL, Gundberg CM, et al.: Adulthood obesity is positively associated with adipose tissue concentrations of vitamin K and inversely associated with circulating indicators of vitamin K status in men and women. J Nutr 2010, 140(5): 1029–34.PubMedCrossRef Shea MK, Booth SL, Gundberg CM, et al.: Adulthood obesity is positively associated with adipose tissue concentrations of vitamin K and inversely associated with circulating indicators of vitamin K status in men and women. J Nutr 2010, 140(5): 1029–34.PubMedCrossRef
8.
Zurück zum Zitat Pereira S, Saboya C, Chaves G, et al.: Class III obesity and its relationship with the nutritional status of vitamin A in pre- and postoperative gastric bypass. Obes Surg 2009, 19(6): 738–44.PubMedCrossRef Pereira S, Saboya C, Chaves G, et al.: Class III obesity and its relationship with the nutritional status of vitamin A in pre- and postoperative gastric bypass. Obes Surg 2009, 19(6): 738–44.PubMedCrossRef
9.
Zurück zum Zitat • Eerdekens A, Debeer A, Van Hoey G, et al.: Maternal bariatric surgery: adverse outcomes in neonates. Eur J Pediatr 2010, 169(2): 191–6. This report describes five babies with intracranial hemorrhage whose mothers had undergone bariatric surgery. The report suggests the potential for vitamin K deficiency.PubMedCrossRef • Eerdekens A, Debeer A, Van Hoey G, et al.: Maternal bariatric surgery: adverse outcomes in neonates. Eur J Pediatr 2010, 169(2): 191–6. This report describes five babies with intracranial hemorrhage whose mothers had undergone bariatric surgery. The report suggests the potential for vitamin K deficiency.PubMedCrossRef
10.
Zurück zum Zitat Dalcanale L, Oliveira CP, Faintuch J, et al.: Long-term nutritional outcome after gastric bypass. Obes Surg 2010, 20(2): 181–7.PubMedCrossRef Dalcanale L, Oliveira CP, Faintuch J, et al.: Long-term nutritional outcome after gastric bypass. Obes Surg 2010, 20(2): 181–7.PubMedCrossRef
11.
Zurück zum Zitat Toh SY, Zarshenas N, Jorgensen J.: Prevalence of nutrient deficiencies in bariatric patients. Nutrition 2009, 25(11–12): 1150–6.PubMedCrossRef Toh SY, Zarshenas N, Jorgensen J.: Prevalence of nutrient deficiencies in bariatric patients. Nutrition 2009, 25(11–12): 1150–6.PubMedCrossRef
12.
Zurück zum Zitat Lakhani SV, Shah HN, Alexander K, Finelli FC, Kirkpatrick JR, Koch TR.: Small intestinal bacterial overgrowth and thiamine deficiency after Roux-en-Y gastric bypass surgery in obese patients. Nutrition Res 2008, 28(5): 293–298.CrossRef Lakhani SV, Shah HN, Alexander K, Finelli FC, Kirkpatrick JR, Koch TR.: Small intestinal bacterial overgrowth and thiamine deficiency after Roux-en-Y gastric bypass surgery in obese patients. Nutrition Res 2008, 28(5): 293–298.CrossRef
13.
Zurück zum Zitat Rounis E, Laing CM, Davenport A.: Acute neurological presentation due to copper deficiency in a hemodialysis patient following gastric bypass surgery. Clin Nephrol 2010, 74(5): 389–92.PubMed Rounis E, Laing CM, Davenport A.: Acute neurological presentation due to copper deficiency in a hemodialysis patient following gastric bypass surgery. Clin Nephrol 2010, 74(5): 389–92.PubMed
14.
Zurück zum Zitat Spyropoulos C, Kehagias I, Panagiotopoulos S, et al.: Revisional bariatric surgery: 13-year experience from a tertiary institution. Arch Surg 2010, 145(2): 173–7.PubMedCrossRef Spyropoulos C, Kehagias I, Panagiotopoulos S, et al.: Revisional bariatric surgery: 13-year experience from a tertiary institution. Arch Surg 2010, 145(2): 173–7.PubMedCrossRef
15.
Zurück zum Zitat • Naismith RT, Shepherd JB, Weihl CC, et al.: Acute and bilateral blindness due to optic neuropathy associated with copper deficiency. Arch Neurol 2009, 66(8): 1025–7. A patient 22 years after gastric bypass surgery developed bilateral blindness due to optic neuropathy. Copper deficiency was identified.PubMedCrossRef • Naismith RT, Shepherd JB, Weihl CC, et al.: Acute and bilateral blindness due to optic neuropathy associated with copper deficiency. Arch Neurol 2009, 66(8): 1025–7. A patient 22 years after gastric bypass surgery developed bilateral blindness due to optic neuropathy. Copper deficiency was identified.PubMedCrossRef
16.
Zurück zum Zitat Jayakumar S, Micallef-Eynaud PD, Lyon TD, et al.: Acquired copper deficiency following prolonged jejunostomy feeds. Ann Clin Biochem 2005, 42(3), 227–231.PubMedCrossRef Jayakumar S, Micallef-Eynaud PD, Lyon TD, et al.: Acquired copper deficiency following prolonged jejunostomy feeds. Ann Clin Biochem 2005, 42(3), 227–231.PubMedCrossRef
17.
Zurück zum Zitat Genead MA, Fishman GA, Lindeman M.: Fundus white spots and acquired night blindness due to vitamin A deficiency. Doc Ophthalmol 2009, 119(3): 229–33.PubMedCrossRef Genead MA, Fishman GA, Lindeman M.: Fundus white spots and acquired night blindness due to vitamin A deficiency. Doc Ophthalmol 2009, 119(3): 229–33.PubMedCrossRef
18.
Zurück zum Zitat • Al-Shoha A, Qui S, Palnitkar S, et al.: Osteomalacia with bone marrow fibrosis due to severe vitamin D deficiency after a gastrointestinal bypass operation for severe obesity. Endocr Pract 2009, 15(6): 528–33. This article discusses patients with bone biopsy-proven osteomalacia with marrow fibrosis; symptoms were present for 2 to 5 years after gastric bypass surgery. Significant improvement occurred after treatment with ergocalciferol (100,000 IU daily) and calcium carbonate (1 to 2.5 g daily).PubMedCrossRef • Al-Shoha A, Qui S, Palnitkar S, et al.: Osteomalacia with bone marrow fibrosis due to severe vitamin D deficiency after a gastrointestinal bypass operation for severe obesity. Endocr Pract 2009, 15(6): 528–33. This article discusses patients with bone biopsy-proven osteomalacia with marrow fibrosis; symptoms were present for 2 to 5 years after gastric bypass surgery. Significant improvement occurred after treatment with ergocalciferol (100,000 IU daily) and calcium carbonate (1 to 2.5 g daily).PubMedCrossRef
19.
Zurück zum Zitat Valderas JP, Velasco S, Solari S, et al.: Increase of bone resorption and the parathyroid hormone in postmenopausal women in the long-term after Roux-en-Y gastric bypass. Obes Surg 2009, 19(8): 1132–8.PubMedCrossRef Valderas JP, Velasco S, Solari S, et al.: Increase of bone resorption and the parathyroid hormone in postmenopausal women in the long-term after Roux-en-Y gastric bypass. Obes Surg 2009, 19(8): 1132–8.PubMedCrossRef
20.
Zurück zum Zitat Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Spitz AF, Apovian CM, Livingston EH, Brolin R, Sarwer DB, Anderson WA, Dixon J, Guven S.: American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Obesity 2009;17 Suppl 1:S1–70.PubMed Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Spitz AF, Apovian CM, Livingston EH, Brolin R, Sarwer DB, Anderson WA, Dixon J, Guven S.: American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Obesity 2009;17 Suppl 1:S1–70.PubMed
21.
Zurück zum Zitat • Signori C, Zalesin KC, Franklin B, et al.: Effect of gastric bypass on vitamin D and secondary hyperparathyroidism. Obes Surg 2010, 20(7): 949–52. Eighty-six percent of gastric bypass patients had preoperative vitamin D deficiency, whereas at the 1-year postoperative follow-up, 70% of patients still had evidence for inadequate blood levels of vitamin D.PubMedCrossRef • Signori C, Zalesin KC, Franklin B, et al.: Effect of gastric bypass on vitamin D and secondary hyperparathyroidism. Obes Surg 2010, 20(7): 949–52. Eighty-six percent of gastric bypass patients had preoperative vitamin D deficiency, whereas at the 1-year postoperative follow-up, 70% of patients still had evidence for inadequate blood levels of vitamin D.PubMedCrossRef
22.
Zurück zum Zitat Sung CC, Lee HS, Diang LK, et al.: Refractory diffuse bony pain 20 years after jejunoileal bypass. South Med J 2010, 103(6): 570–3.PubMed Sung CC, Lee HS, Diang LK, et al.: Refractory diffuse bony pain 20 years after jejunoileal bypass. South Med J 2010, 103(6): 570–3.PubMed
23.
Zurück zum Zitat Ruz M, Carrasco F, Rojas P, et al.: Iron absorption and iron status are reduced after Roux-en-Y gastric bypass. Am J Clin Nutr 2009, 90(3): 527–32.PubMedCrossRef Ruz M, Carrasco F, Rojas P, et al.: Iron absorption and iron status are reduced after Roux-en-Y gastric bypass. Am J Clin Nutr 2009, 90(3): 527–32.PubMedCrossRef
24.
Zurück zum Zitat Avgerinos DV, Llaguna OH, Seigerman M, et al.: Incidence and risk factors for the development of anemia following gastric bypass surgery. World J Gastroenterol 2010, 16(15): 1867–70.PubMedCrossRef Avgerinos DV, Llaguna OH, Seigerman M, et al.: Incidence and risk factors for the development of anemia following gastric bypass surgery. World J Gastroenterol 2010, 16(15): 1867–70.PubMedCrossRef
25.
Zurück zum Zitat Bal B, Koch TR, Finelli FC, Sarr MG.: Management of medical and surgical disorders after divided Roux-en-Y gastric bypass surgery. Nat Rev Gastroenterol Hepatol 2010, 7(6): 320–334.PubMed Bal B, Koch TR, Finelli FC, Sarr MG.: Management of medical and surgical disorders after divided Roux-en-Y gastric bypass surgery. Nat Rev Gastroenterol Hepatol 2010, 7(6): 320–334.PubMed
26.
Zurück zum Zitat Iannelli A, Addeo P, Novellas S, et al.: Wernicke’s encephalopathy after laparoscopic Roux-en-Y gastric bypass: a misdiagnosed complication. Obes Surg 2010, 20(11): 1594–6.PubMedCrossRef Iannelli A, Addeo P, Novellas S, et al.: Wernicke’s encephalopathy after laparoscopic Roux-en-Y gastric bypass: a misdiagnosed complication. Obes Surg 2010, 20(11): 1594–6.PubMedCrossRef
27.
Zurück zum Zitat Sebastian JL, V JM, Tang LW, et al.: Thiamine deficiency in a gastric bypass patient leading to acute neurologic compromise after plastic surgery. Surg Obes Relat Dis 2010, 6(1): 105–6.PubMedCrossRef Sebastian JL, V JM, Tang LW, et al.: Thiamine deficiency in a gastric bypass patient leading to acute neurologic compromise after plastic surgery. Surg Obes Relat Dis 2010, 6(1): 105–6.PubMedCrossRef
28.
Zurück zum Zitat • Francini-Pesenti F, Brocadello F, et al.: Wernicke’s syndrome during parenteral feeding: not an unusual complication. Nutrition 2009, 25(2): 142–6. The authors discuss the potential effects of parenteral feedings on the development of thiamine deficiency. This question of consumption may be very important in patients after gastric bypass surgery in whom parenteral nutrition is being considered for potential protein-calorie malnutrition.PubMedCrossRef • Francini-Pesenti F, Brocadello F, et al.: Wernicke’s syndrome during parenteral feeding: not an unusual complication. Nutrition 2009, 25(2): 142–6. The authors discuss the potential effects of parenteral feedings on the development of thiamine deficiency. This question of consumption may be very important in patients after gastric bypass surgery in whom parenteral nutrition is being considered for potential protein-calorie malnutrition.PubMedCrossRef
29.
Zurück zum Zitat • Paparrigopoulos T, Tzavelas E, Karaiskos D, et al.: Complete recovery from undertreated Wernicke-Korsakoff syndrome following aggressive thiamine treatment. In Vivo 2010, 24(2): 231–3. This is a report of improved recovery from Wernicke’s syndrome by using high-dose oral thiamine (600 mg/day) and intramuscular thiamine (300 mg/day) for 2 months.PubMed • Paparrigopoulos T, Tzavelas E, Karaiskos D, et al.: Complete recovery from undertreated Wernicke-Korsakoff syndrome following aggressive thiamine treatment. In Vivo 2010, 24(2): 231–3. This is a report of improved recovery from Wernicke’s syndrome by using high-dose oral thiamine (600 mg/day) and intramuscular thiamine (300 mg/day) for 2 months.PubMed
Metadaten
Titel
Origins of and Recognition of Micronutrient Deficiencies After Gastric Bypass Surgery
verfasst von
Bikram S. Bal
Frederick C. Finelli
Timothy R. Koch
Publikationsdatum
01.04.2011
Verlag
Current Science Inc.
Erschienen in
Current Diabetes Reports / Ausgabe 2/2011
Print ISSN: 1534-4827
Elektronische ISSN: 1539-0829
DOI
https://doi.org/10.1007/s11892-010-0169-4

Weitere Artikel der Ausgabe 2/2011

Current Diabetes Reports 2/2011 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Positiver FIT: Die Ursache liegt nicht immer im Dickdarm

27.05.2024 Blut im Stuhl Nachrichten

Immunchemischer Stuhltest positiv, Koloskopie negativ – in solchen Fällen kann die Blutungsquelle auch weiter proximal sitzen. Ein Forschungsteam hat nachgesehen, wie häufig und in welchen Lokalisationen das der Fall ist.

GLP-1-Agonisten können Fortschreiten diabetischer Retinopathie begünstigen

24.05.2024 Diabetische Retinopathie Nachrichten

Möglicherweise hängt es von der Art der Diabetesmedikamente ab, wie hoch das Risiko der Betroffenen ist, dass sich sehkraftgefährdende Komplikationen verschlimmern.

Mehr Lebenszeit mit Abemaciclib bei fortgeschrittenem Brustkrebs?

24.05.2024 Mammakarzinom Nachrichten

In der MONARCHE-3-Studie lebten Frauen mit fortgeschrittenem Hormonrezeptor-positivem, HER2-negativem Brustkrebs länger, wenn sie zusätzlich zu einem nicht steroidalen Aromatasehemmer mit Abemaciclib behandelt wurden; allerdings verfehlte der numerische Zugewinn die statistische Signifikanz.

ADT zur Radiatio nach Prostatektomie: Wenn, dann wohl länger

24.05.2024 Prostatakarzinom Nachrichten

Welchen Nutzen es trägt, wenn die Strahlentherapie nach radikaler Prostatektomie um eine Androgendeprivation ergänzt wird, hat die RADICALS-HD-Studie untersucht. Nun liegen die Ergebnisse vor. Sie sprechen für länger dauernden Hormonentzug.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.