Impact of bariatric surgery on the absorption of nutrients in patients with obesity


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Abstract

The review considers disturbed metabolism of vitamins, minerals, and protein in patients following bariatric surgery. The positive effect of the surgery is proven; however, postresection syndromes that may further occur determine not only a patient follow-up, but also timely therapeutic interventions to prevent hypovitaminoses, anemia, and mineral metabolic disturbances. There are conflicting data on the incidence of these abnormalities. No guidelines for their treatment and prevention have been elaborated.

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Влияние бариатрических операций на всасывание пищевых веществ у больных ожирением. - Аннотация. В обзоре рассмотрены вопросы нарушений обмена витаминов, минеральных веществ и белка у больных, перенесших бариатрические операции. Положительный эффект хирургического вмешательства доказан, однако пострезекционные синдромы, возникающие в последующем, обусловливают не только наблюдение больного, но и своевременные терапевтические вмешательства с целью предотвращения гиповитаминозов, анемии и нарушений минерального обмена. Имеются противоречивые данные о частоте возникновения этих нарушений. Не разработаны рекомендации по их лечению и профилактике.
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References

  1. Pories W.J., MacDonald K.G. Jr, Morgan E.J. et al. Surgical treatment of obesity and its effect on diabetes: 10-y follow-up. Am J Clin Nutr 1992; 55 (2 suppl): 582-585.
  2. Foley E.F., Benotti P.N., Borlase B.C. et al. Impact of gastric restrictive surgery on hypertension in the morbidly obese. Am J Surg 1992; 163: 294-297.
  3. Gleysteen J.J. Results of surgery: long-term effects on hyperlipidemia. Am J Clin Nutr 1992; 55 (2 suppl): 591-593.
  4. Charuzi I., Lavie P., Peiser J., Peled R. Bariatric surgery in morbidly obese sleep-apnea patients: short- and long- term follow-up. Am J Clin Nutr 1992; 55 (2 suppl): 594-596.
  5. Sugerman H.J., Fairman R.P., Sood R.K. et al. Long-term effects of gastric surgery for treating respiratory insufficiency of obesity. Am J Clin Nutr 1992; 55 (2 suppl): 597-601.
  6. Sugerman H.J., DeMaria E.J. Gastric surgery for morbid obesity. In: Zinner M.J., Schwartz S.I., Ellis H. (eds.) Maingot's Abdominal Operations. 10th ed. Stamford, CT: Appleton & Lange 1997: 1057-1077.
  7. Cummings D.E., Overduin J., Foster-Schubert K.E. Gastric bypass for obesity: mechanisms of weight loss and diabetes resolution. J Clin Endocrinol Metab 2004; 89: 2608-2615.
  8. Cummings D.E., Overduin J., Foster-Schubert K.E., Carlson M.J. Role of the bypassed proximal intestine in the anti-diabetic effects of bariatric surgery. Surg Obes Relat Dis 2007; 3: 109-111.
  9. Hickey M.S., Pories W.J., MacDonald K.G. Jr et al. A new paradigm for type 2 diabetes mellitus: could it be a disease of foregut [with discussion]? Ann Surg 1998; 227: 637-644.
  10. Skroubis G., Anesidis S., Kehagias I. et al. Roux-en-Y gastric bypass versus a variant of biliopancreatic diversion in a non-superobese population: prospective comparison of the efficacy and the incidence of metabolic deficiencies. Obes Surg 2006; 16: 48.
  11. Capella J.F., Capella R.F. An assessment of vertical band- ed gastroplasty-Roux-en-Y gastric bypass for the treatment of morbid obesity. Am J Surg 2002; 183: 117-123.
  12. Regan J.P., Inabnet W.B., Gagner M., Pomp A. Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg 2003; 13: 861-864.
  13. van Mastrigt G.A., van Dielen F.M., Severens J.L. et al. One-year cost-effectiveness of surgical treatment of morbid obesity: vertical banded gastroplasty versus Lap-Band. Obes Surg 2006; 16: 75-84.
  14. Flancbaum L., Belsley S, Drake V. et al. Preoperative nutritional status of patients undergoing Roux-en-Y gastric bypass for morbidobesity. J Gastrointest Surg 2006; 10: 1033-1037.
  15. Rabkin R.A., Rabkin J.M., Metcalf B. et al. Nutritional markers following duodenal switch for morbid obesity. Obes Surg 2004; 14: 84-90.
  16. Brolin R.E., LaMarca L.B., Henler H.A., Cody R.P. Malabsorptive gastric bypass in patients with super-obesity. J Gastrointest Surg 2002; 6: 195-203.
  17. Scopino N., Marinari G.M., Camerini G. et al. Energy and nitrogen absorption after biliopancreatic diversion. Obes Surg 2000; 10: 436-441.
  18. Totte E., Hendrickx L., van Hee R. Biliopancreatic diversion for treatment of morbid obesity: experience in 180 consecutive cases. Obes Surg 1999; 9: 161-165.
  19. Marinari G.M., Murelli F., Camerini G. et al. A 15 year evaluation of biliopancreatic diversion according to the bariatric analysis reporting outcome system (BAROS). Obes Surg 2004; 14: 325-328.
  20. Mahan L.K., Escott-Stump S. Medical nutrition therapy for anemia: Krause's food, nutrition, and diet therapy, 10th ed. Philadelphia: WB Saunders 2000; 469: 781-799.
  21. Berger J.R. The neurological complications of bariatric surgery. Arch Neurol 2004; 8: 1185-1189.
  22. Marcuard S.P., Sinar D.R.. Swanson M.S. et al. Absence of luminal intrinsic factor after gastric bypass surgery for morbid obesity. Dig Dis Sci 1989; 34: 1238-1242.
  23. Oxentenko A.S., Litiri S.C. Clinical pearls in gastroenterology. Mayo Clin Proc 2009; 84: 906-911.
  24. Breton O.J, Perez Naranjo S., Gimeno Laborda S. Effectiveness and complications of bariatric surgery in the treatment of morbid obesity. Nutr Hosp 2005; 20: 409-414.
  25. Alvarez-Leite J.I. Nutrient deficiencies secondary to bariatric surgery. Curr Opin Clin Nutr Metab Care 2004; 7: 569-575.
  26. MacLean L.D., Rhode B.M., Shizgal H.M. Nutrition following gastric operations for morbid obesity. Ann Surg 1983; 198: 347-355.
  27. Amaral J.F., Thompson W.R., Caldwell M.D. et al. Prospective hematologic evaluation of gastric exclusion surgery for morbid obesity. Ann Surg 1985; 201 (2): 186-193.
  28. Decker G.A. Swain I.M., Crowell M.D., Scolaolo I.S. Gastrointestinal and nutritional complications after barlarric surgery. Am J Gastroenterol 2007; 102: 2571-2580.
  29. Boylan L.M., Sugerman H.J., Driskell J.A. Vitamin E, vitamin B-6, vitamin B-12, and folate status of gastric bypass surgery patients. J Am Diet Assoc 1988; 88 (5): 579-585.
  30. Halverson J.D. Micronutrient deficiencies after gastric bypass for morbid obesiry. Am Surg 1986; 52: 594-598.
  31. Mallory G.N., Macgregor A.M. Folate status following gastric bypass surgery (the great folate mystery). Obes Surg 1991; 1: 69-72.
  32. Gasteyger C., Suter M., Calmes J.M. et al. Changes in body composition, metabolic profile, and nutritional status 24 months after gastric banding. Obes Surg 2006; 16: 243-250.
  33. Ke Z.J., DeGiorgio L.A., Volpe B.T., Gibson G.E. Reversal of thiamine deficiency- induced neurodegeneration. J Neuropathol Exp Neurol 2003; 62: 195-207.
  34. Printen K.J., Mason E.E. Gastric bypass for morbid obesity in patients more than fifty years of age. Surg Gynecol Obstet 1977; 144: 192-194.
  35. Ayub A., Faloon W.W., Heinig R.E. Encephalopathyfollowingjejunoileostomy. JAMA 1981; 246: 970-973.
  36. Oczkowski W.J., Kertesz A. Wernicke'sencephalopathy after gastroplasty for morbid obesity. Neurology 1985; 35: 99-101.
  37. Bozbora A., Coskun H., Ozarmagan S. et al. A rare complication of adjustable gastric banding: Wernicke's encephalopathy. Obes Surg 2000; 10: 274-275.
  38. Kramer L.D., Locke E. Wernicke'sencephalopathy: complication of gastric plication. J Clin Gastroenterol 1987; 9: 549-552.
  39. Sola E., Morillas C., Garzon S.A. Rapid onset of Wernicke's encephalopathy following gastric restrictive surgery. Obes Surg 2003; 13: 661-662.
  40. Gollobin C., Marcus W.Y. Bariatric beriberi. Obes Surg 2002; 12: 309-311.
  41. Chaves L.C, Faintuch J., Kahwage S., Alencar Fde A. A cluster of polyneuropathy and Wernicke-Korsakoff syndrome in a bariatric unit. Obes Surg 2002; 12: 328-334.
  42. Koike H., Misu K., Hattori N. Postgastrectomy polyneuropathy with thiamine deficiency. J Neurol Neurosurg Psychiatry 2001; 71: 357-362.
  43. Carrodeguas L., Kaidar-Person O., Szomstein S., Antozzi P. Preoperative thiamin deficiency in obese population undergoing laparoscopic bariatric surgery. Surg Obes Relat Dis 2005; 1: 517-522.
  44. Seehra H., MacDermott N., Lascelles R.G., Taylor T.V. Wernicke's encephalopathy after vertical banded gastroplasty for morbid obesity. BMJ 1996; 312 :434.
  45. Wadstrom C., Backman L. Polyneuropathy following gastric banding for obesity. Case report. Acta Chir Scand 1989; 55: 131-134.
  46. Salas-Salvado J., Garcia-Lourda P., Cuatrecasas G. et al. Wernicke's syndrome after bariatric surgery. Clin Nutr 2000;12: 371-373.
  47. Primavera A., Brusa G., Novello P. et al. Wernicke-Korsakoff encephalopathy following biliopancreatic diversion. Obes Surg 1998; 3: 175-177.
  48. Aasheim E.T., Bjorkman S., Sovik L.T. Vitamin status after bariatric surgew: a randomized study of gastric bypass and duodenal switch. Am J Clin Nutr 2009; 90: 15-22.
  49. Lakhani S.V., Shah H.N., Alexander K. et al. Small intestinal bacterial overgrowth and thiamin deficiency after Roux-en-Y gastric bypass surgent in obese patients. Nutr Res 2008; 8: 293-298.
  50. Chang C.G., Adams-Huet B., Provost D.A. Acute postgastric reduction surgery (APGARS) neuropathy. Obes Surg 2004; 14: 182-189.
  51. John S., Hoegeri C. Nutritional deficiencies after gastric bypass surgery. J Am Osteopath Assoc 2009; 109 (11): 601-604.
  52. Khandalavala B.N., Hibma P.P., Fang X. Prevalence and persistence of vitamin D deficiency in biliopancreatic diversion patients: a retrospective study. Obes Surg 2010; 20 (7): 881-884.
  53. Bhan A., Rao A.D., Rao D.S. Osteomalacia as a result of vitamin D deficiency. Endocrinol Metab Clin North Am 2010; 39 (2): 321-331.
  54. Slater G.H., Ren C.J., Seigel N. et al. Serum fat-soluble vitamin deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery. J Gastrointest Surg 2004; 8: 48-55.
  55. Fish E., Beverstein G., Olson D. et al. Vitamin D status of the morbidly obese bariatric surgery patient. J Surg Res 2010; 2: 198-202.
  56. Stein E.M., Strain G., Sinha N. et al. Vitamin D insufficiency prior to bariatric surgery: risk factors and a pilot treatment study. Clin Endocrinol (Oxf) 2009; 71 (2): 176-183.
  57. Vasconcelos R.S., Viégas M., Marques T.F. et al. Factors associated with secondary hyperparathyroidism in premenopausal women undergoing Roux-en-Y gastric bypass for the treatment of obesity. Arq Bras Endocrinol Metabol 2010; 54 (2): 233-238.
  58. Kumar R., Lieske J.C., Collazo-Clavell M.L. et al. Fat malabsorption and increased intestinal oxalate absorption are common after Roux-en-Y gastric bypass surgery. Surgery 2011; 5: 654-661.
  59. Keidar A., Appelbaum L., Schweiger C. et al. Dilated upper sleeve can be associated with severe postoperative gastroesophageal dysmotility and reflux. Obes Surg 2010; 20 (2): 140-147.
  60. Dolan K., Hatzifotis M., Newbury L. et al. A clinical and nutritional comparison of biliopancreatic diversion with and without duodenal switch. Ann Surg 2004; 240: 51-56.
  61. Ledoux S., Msika S., Moussa F. et al. Comparison of nutritional consequences of conventional therapy of obesity, adjustable gastric banding, and gastric bypass. Obes Surg 2006; 16: 1041-1049.
  62. Madan A.K., Orth W.S., Tichansky D.S., Ternovits C.A. Vitamin and trace mineral levels after laparoscopic gastric bypass. Obes Surg 2006; 16: 603-606.
  63. Marceau P., Hould F.S., Simard S. et al. Biliopancreatic diversion with duodenal switch. World J Surg 1998; 22: 947-954.
  64. Clernents R.H., Katasani V.G., Palepu R. et al. Incidence of vitamin deficiency after laparoscopic Roux-en-Y gastric bypass in a university hospital setting. Am Surg 2006; 72: 1196-1204.
  65. Pereira S.E., Sabova C.J., Chaves G.V., Ramalho A. Class Ill obesity and its relationship with the nutritional status of vitamin A in pre- and post- operative gastric bypass. Obes Surg 2009; 19: 738-744.
  66. Kerstyn C., Zalesin K.C., Miller W.M. et al. Vitamin A Deficiency after Gastric Bypass Surgery: An Underreported Postoperative Complication. J Obes 2011, 2011. Pii: 760695. Epub 2010 Sep 14.
  67. Hatizifotis M., Dolan K., Newbury L. et al. Symptomatic vitamin A deficiency following biliopancreatic diversion. Obes Surg 2003; 13: 655-657.
  68. Diniz M de F., Diniz M.T., Sanches S.R. et al. Elevated serum parathormone after Roux-en-Y gastric bypass. Obes Surg 2004; 14: 1222-1226.
  69. Eerdekens A., Debeer A., Van Hoey G. et al. Maternal bariatric surgery: Adverse outcomes in neonates. Eur J Pediatr 2010; 169 (2):191-196.
  70. Cone L.A., Waterbor B.R., Sofonia M.V. Purpura fulminans due to Streptococcus pneumoniae sepsis following gastric bypass. Obes Surg 2004; 14: 690-694.
  71. Van Mieghem T., Van Schoubroeck D., Depiere M. et al. Fetal cerebral hemorrhage caused by vitamin K deficiency after complicated bariatric surgery. Obstet Gynecol 2008; 112 (2 pt 2): 434-436.
  72. Trostler N., Mann A., Zilberbush N. et al. Nutrient intake following vertical banded gastroplasty or gastric bypass. Obes Surg 1995; 5: 403-410.
  73. Skroubis G., Sakellarapoulos G., Pouggouras K. Comparison of nutritional deficiencies after Roux-en-Y gastric bypass and biliopan-creatic diversion with Roux-en-Y gastric bypass. Obes Surg 2002; 12: 551-558.
  74. Brolin R.E., Gorman R.C., Milgrim L.M., Kenler H.A. Multivitamin prophylaxis in prevention of post-gastric bypass vitamin and mineral deficiencies. Int J Obes 1991; 15 :661-667.
  75. Sallé A., Demarsy D., Poirier A.L. et al. Zinc deficiency: a frequent and underestimated complication after bariatric surgery. Obes Surg 2010; 20 (12): 1660-1670.
  76. Lovette A.S., Shope T.R., Koch T.R. Origins for Micronutrient Deficiencies. Доступно на: http://www.intechopen.com/books/advanced-bariatric-and-metabolic-surgery/origins-for-micronutrient-deficiencies
  77. Neve H.J., Bhatti W.A., Soulsby C. et al. Reversal of hair loss following vertical gastroplasty when treated with zinc sulphate. Obes Surg 1996; 6: 63-65.
  78. Burge J. Changes in patients' taste acuity after Roux-en-Y gastric bypass for clinically severe obesity. J Am Diet Assoc 1995; 95: 666-670.
  79. Davies D.J., Baxter J.M., Baxter J.N. Nutritional deficiencies after bariatric surgery. Obes Surg 2007; 17: 1150-1158.
  80. Zimnicka A.M., Ivy K., Kaplan J.H. Acquisition of dietary copper: a role for anion transporters in intestinal apical copper uptake. Am J Physiol Cell Physiol 2011; 300 (3): 58.
  81. Kumar N., McEvoy K.M., Ahiskog J.E. Myelopathy due to copper deficiency following gastrointestinal surgery. Arch Neurol 2003; 60: 1782-1785.
  82. Todd L.M., Godber I.M., Gunn I.R. Iatrogenic copper deficiency causing anaemia and neutropenia. Ann Clin Biochem 2004; 41: 414-416.
  83. Naismith R.T., Shepherd J.B., Weihl C.C. et al. Acute and bilateral blindness due to optic neuropathy associated with copper deficiency. Arch Neurol 2009; 66 (8): 1025-1027.

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