Vitamin status after bariatric surgery: a randomized study of gastric bypass and duodenal switch

Published on Jul 1, 2009in The American Journal of Clinical Nutrition7.047
· DOI :10.3945/AJCN.2009.27583
Erlend T. Aasheim25
Estimated H-index: 25
(University of Oslo),
Sofia Björkman7
Estimated H-index: 7
(University of Gothenburg)
+ 5 AuthorsThomas Bøhmer31
Estimated H-index: 31
(University of Oslo)
Background: Bariatric surgery is widely performed to induce weight loss. Objective: The objective was to examine changes in vitamin status after 2 bariatric surgical techniques. Design: A randomized controlled trial was conducted in 2 Scandinavian hospitals. The subjects were 60 superobese patients [body mass index (BMI; in kg/m 2 ): 50–60]. The surgical interventions were either laparoscopic Roux-en-Y gastric bypass or laparoscopic biliopancreatic diversion with duodenal switch. All patients received multivitamins, iron, calcium, and vitamin D supplements. Gastric bypass patients also received a vitamin B-12 substitute. The patients were examined before surgery and 6 wk, 6 mo, and 1 y after surgery. Results: Of 60 surgically treated patients, 59 completed the followup. After surgery, duodenal switch patients had lower mean vitamin A and 25-hydroxyvitamin D concentrations and a steeper decline in thiamine concentrations than did the gastric bypass patients. Other vitamins (riboflavin, vitamin B-6, vitamin C, and vitamin E adjusted for serum lipids) did not change differently in the surgical groups, and concentrations were either stable or increased. Furthermore, duodenal switch patients had lower hemoglobin and total cholesterol concentrations and a lower BMI (mean reduction: 41% compared with 30%) than did gastric bypass patients 1 y after surgery. Additional dietary supplement use was more frequent among duodenal switch patients (55%) than among gastric bypass patients (26%). Conclusions: Compared with gastric bypass, duodenal switch may be associated with a greater risk of vitamin A and D deficiencies in the first year after surgery and of thiamine deficiency in the initial months after surgery. Patients who undergo these 2 surgical interventions may require different monitoring and supplementation regimens in the first year after surgery. This trial was registered at as NCT00327912. Am J Clin Nutr 2009;90: 15–22.
📖 Papers frequently viewed together
7 Authors (Karen Schoelles)
#1Torgeir T. Søvik (University of Oslo)H-Index: 16
#2Erlend T. Aasheim (University of Oslo)H-Index: 25
Last. Tom MalaH-Index: 32
view all 7 authors...
Background Bariatric surgery was established at several Norwegian hospitals in 2004. This study evaluates the perioperative outcome and the learning curves for two surgeons while introducing laparoscopic Roux-en-Y gastric bypass (LRYGB).
#1Muriel CoupayeH-Index: 25
#2Karin PuchauxH-Index: 1
Last. Séverine LedouxH-Index: 25
view all 8 authors...
Background Gastric bypass (GBP) is more efficient than adjustable gastric banding (AGB) on weight loss and comorbidities, but potentially induces more nutritional deficits. However, no study has compared the prevalence of nutritional deficiencies after these two bariatric procedures.
#1M. FredH-Index: 1
#2Vojtech HainerH-Index: 21
Last. E. StanowskiH-Index: 1
view all 15 authors...
Summary In 2005, for the first time in European history, an extraordinary expert panel named BSCG (Bariatric Scientific Collaborative Group), was appointed through joint effort of the major European scientific societies which are active in the field of obesity management. Societies that constituted this panel were: IFSO – International Federation for the Surgery of Obesity, IFSO-EC – International Federation for the Surgery of Obesity – European Chapter, EASO – European Association for Study of ...
Objective: To review the clinical essentials of Wemicke encephalopathy (WE) after bariatric surgery. Background Data: An estimated 205,000 bariatric surgical procedures were performed in the United States in 2007. Such procedures may potentially lead to severe nutritional complications. Methods: Literature searches were performed in Medline, Embase, and abstract collections. Inclusion criteria were WE after bariatric surgery, diagnosed by the presence of two or more of the following signs: menta...
#1Jessica Fleischer (Columbia University)H-Index: 9
#2Emily M. Stein (Columbia University)H-Index: 37
Last. Shonni J. Silverberg (Columbia University)H-Index: 78
view all 8 authors...
Context: Bariatric surgery is common and may be associated with deleterious effects on the skeleton. Objective: Our objective was to assess bone metabolism and bone mineral density (BMD) after Roux-en-Y gastric bypass. Design and Setting: We conducted a 1-yr prospective longitudinal study at a university hospital bariatric surgery practice and metabolic bone disease unit. Participants: Participants included 23 obese (mean body mass index 47 kg/m2) men and women, aged 20–64 yr. Main Outcome Measu...
#1Erlend T. Aasheim (University of Oslo)H-Index: 25
#2Torgeir T. SøvikH-Index: 16
Last. Espen F. Bakke (Oslo University Hospital)H-Index: 3
view all 3 authors...
Night blindness after duodenal switch Erlend T. Aasheim, M.D.*, Torgeir T. Sovik, M.D., Espen F. Bakke, M.D. Hormone Laboratory, Department of Endocrinology, Aker University Hospital and Faculty Division Aker University Hospital, University of Oslo, Oslo, Norway Department of Gastrointestinal Surgery, Aker University Hospital, Oslo, Norway Department of Ophthalmology, Ulleval University Hospital, Oslo, Norway Received April 24, 2008; revised May 2, 2008; accepted May 2, 2008 Surgery for Obesity ...
Background: Evidence suggests that the relation between plasma and red cell vitamin B-6 concentrations is perturbed as part of the systemic inflammatory response in critically ill patients. Objective: The aim was to examine the cross-sectional and longitudinal interrelations between pyridoxal (PL) and pyridoxal phosphate (PLP) concentrations in plasma and red and white cells in patients with critical illness. Design: PLP and PL concentrations were measured by HPLC in plasma and red and white cel...
#1Erlend T. Aasheim (University of Oslo)H-Index: 25
#2Dag HofsøH-Index: 21
Last. Rune SandbuH-Index: 17
view all 4 authors...
Severe thiamine (vitamin B-1) deficiency is a medical emergency that has long been recognized as a potential complication of bariatric surgery. The incidence of this rare complication is largely unknown. We describe a super-obese male patient with extreme lower limb weakness 3 months following a duodenal switch operation, occurring in association with persisting vomiting. Excessive malabsorption led to severe malnutrition, with lower limb edemas and clinical evidence of ascites and pleural effus...
Background: Despite the increasing use of Roux-en-Y gastric bypass (RYGBP) in the treatment of morbid obesity, data about postoperative nutritional deficiencies and their treatment remain scarce. Objective: The aim of this study was to evaluate the efficacy of a standard multivitamin preparation in the prevention and treatment of nutritional deficiencies in obese patients after RYGBP. Design: This was a retrospective study of 2 y of follow-up of obese patients after RYGBP surgery. Between the fi...
#1Shilen V. Lakhani (MedStar Washington Hospital Center)H-Index: 3
#2Hiral N. Shah (MedStar Washington Hospital Center)H-Index: 2
Last. Timothy R. Koch (Georgetown University)H-Index: 7
view all 6 authors...
Abstract It has been proposed that thiamine deficiency after gastric bypass surgery in obese patients results from prolonged nausea and emesis. We hypothesized that thiamine deficiency is induced by altered gut ecology. This report includes 2 retrospective studies of obese patients who underwent Roux-en-Y gastric bypass surgery at our institution from 1999 to 2005. In the first study, 80 patients (52 women and 28 men) had measurement of whole-blood thiamine diphosphate level and serum folate lev...
Cited By225
#1Sofia Raquel Gomes-Rocha (University of Porto)
#2André Costa-Pinho (University of Porto)H-Index: 2
Last. John Preto (University of Porto)H-Index: 10
view all 10 authors...
Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are safe procedures that may present sub-optimal results in superobesity (SO). A meta-analysis was performed aiming to summarize the available evidence on weight loss (primary outcome) and comorbidities resolution of LRYGB and LSG in patients with SO (BMI ≥ 50 kg/m2). From the 16 included studies, 7 integrated the meta-analysis. LRYGB showed a significantly higher weight loss at 6 to 12-months, but not after ...
#1Reshi Suthakaran (Austin Hospital)
#2Imeshi Indigahawela (Austin Hospital)
Last. Ahmad Aly (Austin Hospital)H-Index: 19
view all 5 authors...
INTRODUCTION Uncertain nutritional outcomes following common metabolic surgical techniques are concerning given the long-term potential for postoperative metabolic bone disease. This study aims to investigate the variations in serum calcium, vitamin D, and parathyroid hormone (PTH) levels following Roux-en-Y Gastric bypass (RYBP) and Sleeve Gastrectomy (SG). METHODS A retrospective analysis of 370 patients who underwent metabolic surgery at a single-centre group practice in Melbourne, Australia,...
#1Anna Ek (KI: Karolinska Institutet)H-Index: 11
#2María Yasmín Vásquez-Barquero (Uppsala University)
Last. Paulina Nowicka (KI: Karolinska Institutet)H-Index: 22
view all 6 authors...
Background: Parental depression is an emerging factor associated with the development and treatment of childhood obesity.Aim: To examine the role of parental depression on child weight status, pare ...
#1Jane Ha (KU: Korea University)H-Index: 2
#2Yeongkeun Kwon (KU: Korea University)H-Index: 10
Last. Sungsoo Park (KU: Korea University)H-Index: 24
view all 8 authors...
The micronutrient status and optimal monitoring schedule after bariatric surgery have not been sufficiently assessed. This systematic review and meta-analysis investigated the longitudinal changes in micronutrient status after bariatric surgery. PubMed, EMBASE, and Cochrane Library were searched for articles that measured preoperative and postoperative serum micronutrient levels in patients undergoing Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Among guideline-adherent studies, t...
#1Amna Al MansooriH-Index: 1
#2Hira ShakoorH-Index: 3
Last. Lily Stojanovska (VU: Victoria University, Australia)H-Index: 27
view all 9 authors...
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 ...
#1Shiri Sherf-Dagan (RMIT: RMIT University)H-Index: 10
#2Assaf Buch (HUJI: Hebrew University of Jerusalem)H-Index: 9
Last. Tali Sinai (HUJI: Hebrew University of Jerusalem)H-Index: 2
view all 5 authors...
Abstract Vitamin E, a fat-soluble vitamin with antioxidant properties, is thought to modulate enzymes involved in signal transduction, affect gene expression, and have immunomodulatory capabilities. Severe vitamin E deficiency is associated with neuronal disorders, impaired immune response, hemolytic anemia, and oxidative-based disorders. Patients who undergo bariatric surgery (BS), especially malabsorptive procedures, are at greater risk of developing fat-soluble vitamin deficiencies. Current d...
#1Amin Andalib (McGill University)H-Index: 13
#2Philippe Bouchard (McGill University)H-Index: 4
Last. Olivier Court (McGill University)H-Index: 7
view all 6 authors...
Abstract Background Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is a modification of the classic duodenal switch (DS). These modifications are intended to address concerns about DS, including malnutrition, longer operative times, and technical challenges, while preserving the benefits. Objectives To evaluate safety and outcomes of SADI-S as it compares to classic DS procedure. Setting Bariatric Surgery Center of Excellence, University Hospital, Montreal, Canada. Meth...
#1Ma Jose Castro Alija (University of Valladolid)
#2José María Jiménez Pérez (University of Valladolid)H-Index: 4
view all 3 authors...
Abstract After bariatric surgery procedures, whether by restrictive, malabsorptive, or mixed techniques, vitamin and mineral absorption is compromised as the gastrointestinal tract is altered. The nutritional recommendations for bariatric surgery may vary depending on the intervention. Guidelines for bariatric surgery regarding postoperative vitamin supplementation have recently been endorsed by the International Federation for the Surgery of Obesity and Metabolic Disorders, the American Associa...
#1Hidenori HarutaH-Index: 18
#2Kazunori KasamaH-Index: 20
Last. Alan Kawarai Lefor (Jichi Medical University)H-Index: 23
view all 4 authors...
This chapter describes why and how to revise a sleeve gastrectomy (SG) to a duodeno-jejunal bypass (DJB). We discuss the significance of adding DJB, especially the effect on diabetes. It also discusses the reasons for revising a SG to a DJB and the appropriate surgical procedure. We also explain surgical methods and therapeutic effects of Biliopancreatic diversion/Duodenal switch (BPD/DS), SG/DJB and loop DJB with SG.
Bariatric surgery is an effective treatment for patients with morbid obesity. However, as safe and common as bariatric procedures have become, multiple complications can still result. These complications vary depending on the type of procedure performed (malabsorptive or restrictive) and are often nutritional derangements from the altered malabsorptive surface of the gastrointestinal tract and decreased capacity of the stomach. Deficiencies in vitamin D after malabsorptive procedures such as the...
This website uses cookies.
We use cookies to improve your online experience. By continuing to use our website we assume you agree to the placement of these cookies.
To learn more, you can find in our Privacy Policy.