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A multidisciplinary approach to caring for bariatric patients.
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Purpose of review
The goal of this article is to review micronutrient deficiencies in patients with obesity. We will describe the absorption of micronutrients and highlight the risk factors that may exist pre- and post-surgery that contribute to the development of micronutrient deficiency states. Furthermore, we will discuss the process involved in...
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Lifelong daily multivitamin supplementation is highly recommended after sleeve gastrectomy (SG). Based on previous research, a specialized multivitamin supplement (MVS) for SG patients was developed and optimized (WLS Optimum 1.0 and 2.0). This study presents its mid-term effectives and compares micronutrient status of SG patients using thi...
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Metabolic surgery is an effective treatment method for glycemic control and weight loss in obese patients with type 2 diabetes mellitus (T2DM). This study aimed to present the mid-term metabolic effects and weight loss results of the patients with T2DM who underwent transit bipartition with sleeve gastrectomy (TB-SG).MethodsA total of 32...
Citations
... Consequently, there is a pressing need for a more comprehensive understanding of micronutrient deficiency prevalence and postoperative micronutrient supplementation patterns [44]. In this regard, thiamine deficiency is a concerning issue for post-bariatric patients because of its frequency (18% to 49% in certain studies) and the burden of its neurological sequelae [45,46]. ...
... Over 20 enzymes (from prokaryotes and eukaryotes) dependent on thiamine pyrophosphate are recognized. Noteworthy examples include glyoxylate carboligase [47], transketolase [48], phosphoenolpyruvate decarboxylase [49], 2-hydroxyacyl-CoA lyase [50], pyruvate dehydrogenase complex [45], 2-hydroxyphytanoyl-CoA lyase [51], branched-chain amino acid enzyme [52], phosphoketolase [53], benzoyl formate decarboxylase, acetohydroxyacid synthase [54], pyruvate decarboxylase [55], 2-oxoglutarate dehydrogenase complex [56], sulfopyruvate decarboxylase [57], pyruvate ferredoxin oxidoreductase [58], and phenylpyruvate decarboxylase [59]. ...
In this case series, the simultaneous occurrence of Wernicke’s encephalopathy (WE) and dry beriberi was reported in three patients who underwent vertical sleeve gastrectomy (VSG) between May 2021 and May 2023. All patients were obese women who underwent vertical sleeve gastrectomy (VSG) without immediate postoperative complications, but two weeks later, hyperemesis and subsequent encephalopathy with ocular movement abnormalities and weakness were observed over the following thirty days. Patients were referred to neurology, where due to the high suspicion of WE, thiamine replacement therapy was initiated; meanwhile, diagnostic neuroimaging and blood tests were conducted. Neurological and psychiatric evaluations and neuroconduction studies were performed to assess the clinical evolution and present sequelae. One year after diagnosis, all patients exhibited affective and behavioral sequelae, anterograde memory impairment, and executive functioning deficits. Two patients met the criteria for Korsakoff syndrome. Additionally, peripheral nervous system sequelae were observed, with all patients presenting with sensorimotor polyneuropathy. In conclusion, Wernicke’s encephalopathy requires a high diagnostic suspicion for timely intervention and prevention of irreversible sequelae, which can be devastating. Therefore, raising awareness among medical professionals regarding the significance of this disease is essential.
... Vitamin D and A deficiencies were less common among our patients (62% and 40%, respectively), in agreement with other reports [5,43,44]. While such deficiencies usually occur after malabsorptive procedures [11,34,45,46], our findings confirm that they also occur after sleeve gastrectomy. Clinicians should be vigilant that TD could be accompanied by several other deficiencies. ...
Background:
Thiamine deficiency (TD) among adolescents following metabolic and bariatric surgery (MBS) has not been assessed.
Objective:
We assessed TD among adolescents following MBS.
Setting:
University Hospital.
Methods:
A retrospective chart review was conducted for all adolescents and young adults (aged 10-25 years) who had MBS and subsequently presented with TD at our institution (n = 30). Diagnosis used clinical, laboratory, brain imaging, and neurophysiology criteria. Of 1575 patients, 7 subsequently had TD. Another 23 adolescents had MBS at private hospitals or overseas and presented at our institution with TD.
Results:
Based on MBS undertaken at our institution, TD prevalence was .45 cases per 100 MBS. The mean age of patients was 19.5 ± 3.23 years, 53.3% were male, 96.7% had sleeve gastrectomy, and time from MBS to admission averaged 4.97 ± 11.94 months. Mean weight loss from surgery to admission was 33.68 ± 10.90 kg. Risk factors included poor oral intake (90%), nausea and vomiting (80%), and noncompliance with multivitamins (71%). Signs and symptoms included generalized weakness, nystagmus, numbness, and paraparesis (83.3%-80%). Seven patients had Wernicke encephalopathy full triad; 16 displayed a mixed picture of Wernicke encephalopathy and dry beriberi; and there were no cases of wet beriberi. Half the patients achieved complete resolution of symptoms, whereas 47% and 40% had residual weakness or persistent sensory symptoms, respectively. There was no mortality. Most common concurrent nutritional deficiencies were of vitamins K, D, and A.
Conclusions:
Although TD is uncommon among adolescents after MBS, it is serious, requiring diligent suspicion and prompt treatment. Bariatric teams should emphasize compliance with multivitamin regimens and follow it up. This is the first in-depth study of post-MBS TD among adolescents.
... Still more importantly, vitamin B 12 deficiency has been associated with osteoporosis, which was reported in a systematic review by Macedo et al. [46]. Today, postoperative vitamin B 12 supplementation is routinely recommended following bariatric surgery [47]. Folic acid deficiency (vitamin B 9 ) is also reported after bariatric surgery [48,49]. ...
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.
... Albümin düzeyleri 3-3,5 g/dL aralığında hafif, 2,5-3 g/dL aralığında orta, <2,5 g/dL ise ciddi hipoalbüminemi olarak sınıflandırılmaktadır. Ciddi hipoalbüminemi durumunda çoklu organ bozukluğu gelişebilir ve hatta ölümle sonuçlanabilmektedir (25 (27). ASMBS tarafından bariatrik cerrahi sonrası oluşabilecek mikro besin ögesi eksikliklerini önleme ve eksiklik durumunda önerilen tedavi dozları Tablo 2' de verilmiştir (9). ...
Obezitenin tedavisinde bariatrik cerrahi, uzun dönem kalıcı ağırlık kaybında ve obeziteye bağlı oluşabilecek hastalıkların tedavisinde en etkili yöntemdir. Ancak özellikle malabsorbtif etkili bariatrik prosedürler sonrası malnütrisyon ve besin ögesi eksikliklerine bağlı sağlık sorunlarının oluşması, hastaların beslenme durumunun değerlendirilmesinin önemini vurgulamaktadır. Bu derleme bariatrik cerrahi sonrası malnütrisyonun değerlendirilmesi ve tedavisinde güncel yaklaşımları incelemek amacıyla yapılmıştır. Bariatrik cerrahi hastaları prosedüre göre değişmekle birlikte besin alımında ve sindirim yolundaki fizyolojik değişimlerden dolayı beslenme açısında risklidir. Restriktif etkili; günümüzde Avustralya dışında nadiren uygulanan Ayarlanabilir Gastrik Band ve Türkiye’ de ve dünyada en çok yapılan Sleeve Gastrektomi sonrası ciddi beslenmeye bağlı komplikasyon oluşma riski malabsorbtif prosedürlere göre daha düşüktür. Malabsorbtif etkili bazı prosedürlerin emilim bozucu etkisine göre sıralaması ise şu şekildedir; Duedenal Switch > Sleeve Gastrektomi ile Tek Anastomoz Duodenal İleal Bypass/SADI > Mini Gastrik Bypass> Roux-en-Y Gastrik Bypass/RYGB. Bariatrik cerrahi sonrası görülen en yaygın besin ögesi eksiklikleri; demir, B12 vitamini, kalsiyum, D vitamini, folat, bakır ve çinkodur ancak malabsorbtif etkili prosedürlerde en ciddi komplikasyonlardan biri protein malnütrisyonudur. Kısa sürede ağırlık kaybının fazla olması, hastaya uygulanması gereken aşamalı beslenme protokolü nedeniyle malnütrisyonu değerlendirmek oldukça zordur. Hastaların hem preoperatif hemde postoperatif dönemde beslenme durumunun değerlendirilmesi, beslenmeye bağlı gelişen sağlık sorunlarının önlenmesi ve tedavisi oldukça önemlidir. Ancak bariatrik cerrahi sonrası malnütrisyonun tedavisi ve değerlendirilmesiyle ilgili spesifik indekslere ve daha kapsamlı ileri çalışmalara gereksinim vardır.
