Abstract
Background
The aim of this study was to evaluate the changes of micronutrients in patients with morbid obesity after laparoscopic Roux-en-Y gastric bypass surgery (LRYGBP).
Methods
We retrospectively reviewed 121 patients diagnosed with morbid obesity who undertook LRYGBP and evaluated the serum iron (Fe), calcium (Ca), zinc (Zn), selenium (Se), vitamin A (VitA), 25-hydroxy vitamin D3 (VitD), vitamin B12 (VitB12), and parathormone (PTH) measured at 6, 12, and 24 months after LRYGBP.
Results
During a follow-up period of 69 months (June 1999 to February 2005), a cohort of 121 patients, 40 men and 81 women, underwent LRYGBP, a mean age of 46 years (range 22–67). The mean body mass index (BMI) before LRYGBP was 47.00 ± 7.15 kg/m2 (range 30.65–76.60 kg/m2). After 6 months of the surgery, the mean BMI was 33.79 ± 6.06 kg/m2 (range 21.70–52.76 kg/m2). The mean BMI decreased (P < 0.001) 6 months after the surgery. Within the following 2 years, the serum Fe, Ca, Zn, Se, VitA, VitD, and VitB12 had normalized. The serum Zn, Se, and VitA of some patients decreased but were nearly normal. In contrast, serum PTH remained continuously at a higher level than normal.
Conclusions
This study confirms that LRYGBP is a reliable and safe weight loss method for the patients suffering from morbid obesity. After surgery, serum Ca, Zn, and Se metabolisms and PTH levels are altered in these patients. Therefore, multi-vitamin and mineral supplementation are strongly recommended in all patients after LRYGBP.
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References
Gong K. Surgery for morbid obesity (review). Chinese J Minim Inv Surg. 2005;5:260–2.
Gong K, Gagner M, Bardaro S, et al. The procedure of mesh wrapping the gastric pouch in cadaver. Surg Endosc. 2007;21:2244–7.
Sugerman HJ, Kellum JM, Engle KM, et al. Gastric bypass for treating severe obesity. Am J Clin Nutr. 1992;55:560S–6S.
Benotti PN, Forse RA. The role of gastric surgery in the multidisciplinary management of severe obesity. Am J Surg. 1995;169:361–7.
Alvarez-Leite JI. Nutritional deficiencies secondary to bariatric surgery. Curr Opin Clin Nutr Metab Care. 2004;7:569–75.
Bloomberg RD, Fleishman A, Nalle JE, et al. Nutritional deficienies following bariatric surgery: what have we learned? Obes Surg. 2005;15:145–54.
Vargas-Ruiz A,·Hernández-Rivera G, Herrera MF. Prevalence of iron, folate, and vitamin B12 deficiency anemia after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2008;18:288–93.
Buchwald H, Williams SE. Bariatric surgery worldwide 2003. Obes Surg. 2004;14:1157–64.
Deitel M, Shikora SA. The development of the surgical treatment of morbid obesity. J Am Coll Nutr. 2002;12:365–71.
El-kadre LJ, Savassi Rocha PR, de Almeida Tinoco AC, et al. Calcium metabolism in pre- and postmenopausal morbidly obese women at baseline and after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2004;14:1062–6.
Fujioka K. Follow-up of nutritional and metabolic problems after bariatric surgery. Diabetes Care. 2005;28:481–4.
MacLean LD, Rhode BM, Shizgal, et al. Nutrition following gastric operations for morbid obesity. Ann Surg. 1983;198:347–55.
Amaral JF, Thompson WR, Caldweu, MD, et al. Prospective hematologic evaluation of gastric exclusion surgery for morbid obesity. Ann Surg. 1985;201(2):186–93.
Cooper PL, Brearley LK, Jamieson AC, et al. Nutritional consequences of modified vertical gastroplasty in obese subjects. Int J Obes Relat Metab Disord. 1999;23:382–8.
Avinoah E, Ovnot A, Choruzi I, et al. Nutritional status seven years after Roux-en-Y gastric bypass surgery. Surgery. 1992;111:137–42.
Institute of Medicine. Vitamin A. In: Dietary reference intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. Washington: National Academy Press; 2001. p. 82–161.
Villaca Chaves G, Pereira SE, Saboya CJ, et al. Nutritional status of vitamin A in morbid obesity before and after Roux-en-Y gastric bypass. Obes Surg. 2007;17:970–6.
Mott T. How effective is gastric bypass for weight loss? J Fam Pract. 2004;53:914–7.
Slater GH, Ren CF, Siegel N, et al. Serum fat-soluble vitamin deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery. J Gastrointest Surg. 2004;8:48–55.
Manzanares Castro W. Selenium in critically ill patients with systemic inflammatory response. Nutr Hosp. 2007;22:295–306.
Piekutowski K, Makarewicz R, Zachara BA. The antioxidative role of selenium in pathogensis of cancer of the female reproductive system. Neoplasma. 2007;54:374–8.
Prasad AS. Zinc: mechanisms of host defense. J Nutr. 2007;137:1345–9.
Prasad AS. Zinc in human health: effect of zinc on immune cells. Mol Med. 2008;14(5–6):353–7.
Mason E. Bone disease from duodenal exclusion. Obes Surg. 2000;10:585–6.
Rhode BM, Arsencau P, Cooper BA, et al. Vitamin B-12 deficiency after gastric surgery for obesity. Am J Clin Nutr. 1996;63:103–9.
Perkes E. Nutritional management of patients after bariatric surgery. Am J Med Sci. 2006;331:207–13.
Patel JA, Patel NA, Thomas RL, et al. Pregnancy outcomes after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2008;4:39–45.
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Gong, K., Gagner, M., Pomp, A. et al. Micronutrient Deficiencies After Laparoscopic Gastric Bypass: Recommendations. OBES SURG 18, 1062–1066 (2008). https://doi.org/10.1007/s11695-008-9577-9
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DOI: https://doi.org/10.1007/s11695-008-9577-9