User:Izandm/Gastric Bypass Information

The long-term effects of gastric bypass on vitamin D metabolism.

Johnson JM, Maher JW, DeMaria EJ, Downs RW, Wolfe LG, Kellum JM.

Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, 23298, USA.

Abstract OBJECTIVE: Alterations of the endocrine system in patients following Roux-en-Y gastric bypass (GBP) are poorly described and have prompted us to perform a longitudinal study of the effects of GBP on serum calcium, 25-hydroxy-vitamin-D (vitamin D), and parathyroid hormone (PTH). METHODS: Prospectively collected data were compiled to determine how GBP affects serum calcium, vitamin D, and PTH. Student t test, Fisher exact test, or linear regression was used to determine significance. RESULTS: Calcium, vitamin D, and PTH levels were drawn on 243 patients following GBP. Forty-one patients had long-limb bypass (LL-GBP), Roux >100 cm, and 202 had short-limb bypass (SL-GBP), Roux < or =100 cm. The mean (+/-SD) postoperative follow-up time was significantly longer in the LL-GBP group (5.7 +/- 2.5 years) than the SL-GBP group (3.1 +/- 3.6 years, P < 0.0001). When corrected for albumin levels, mean calcium was 9.3 mg/dL (range, 8.5-10.8 mg/dL), and no difference existed between LL-GBP and SL-GBP patients. For patients with low vitamin D levels (<8.9 ng/mL), 88.9% had elevated PTH (>65 pg/mL) and 58.0% of patients with normal vitamin D levels (> or =8.9 ng/mL) had elevated PTH (P < 0.0001). In individuals with vitamin D levels <30 ng/mL, 55.1% (n = 103) had elevated PTH, and of those with vitamin D levels > or =30 ng/mL 28.5% (n = 16) had elevated PTH (P = 0.0007). Mean vitamin D levels were lower in patients who had undergone LL-GBP as opposed to those with SL-GBP, 16.8 +/- 10.8 ng/mL versus 22.7 +/- 11.1 ng/mL (P = 0.0022), and PTH was significantly higher in patients who had a LL-GBP (113.5 +/- 88.0 pg/mL versus 74.5 +/- 52.7 pg/mL, P = 0.0002). There was a linear decrease in vitamin D (P = 0.005) coupled with a linear increase in PTH (P < 0.0001) the longer patients were followed after GBP. Alkaline phosphatase levels were elevated in 40.3% of patients and correlated with PTH levels. CONCLUSION: Vitamin D deficiency and elevated PTH are common following GBP and progress over time. There is a significant incidence of secondary hyperparathyroidism in short-limb GBP patients, even those with vitamin D levels > or =30 ng/mL, suggesting selective Ca malabsorption. Thus, calcium malabsorption is inherent to gastric bypass. Careful calcium and vitamin D supplementation and long-term screening are necessary to prevent deficiencies and the sequelae of secondary hyperparathyroidism.

[PubMed - indexed for MEDLINE] Free PMC Article

Citation: Johnson JM, Maher JW, DeMaria EJ, Downs RW, Wolfe LG, Kellum JM. The long-term effects of gastric bypass on vitamin D metabolism. Ann Surg. 2006 May;243(5):701-4; discussion 704-5. ;.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1570540/pdf/20060500s00017p701.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1570540/ -- Am J Clin Nutr. 2008 May;87(5):1128-33.

Nutritional deficiencies after Roux-en-Y gastric bypass for morbid obesity often cannot be prevented by standard multivitamin supplementation

Gasteyger C, Suter M, Gaillard RC, Giusti V.

Division of Endocrinology, Diabetology, and Metabolism, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

Comment in:

Am J Clin Nutr. 2008 Oct;88(4):1176; author reply 1176-7.

Abstract 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 first and the sixth postoperative months, a standardized multivitamin preparation was prescribed for all patients. Specific requirements for additional substitutive treatments were systematically assessed by a biologic workup at 3, 6, 9, 12, 18, and 24 mo. RESULTS: A total of 137 morbidly obese patients (110 women and 27 men) were included. The mean (+/-SD) age at the time of surgery was 39.9 +/- 10.0 y, and the body mass index (in kg/m(2)) was 46.7 +/- 6.5. Three months after RYGBP, 34% of these patients required at least one specific supplement in addition to the multivitamin preparation. At 6 and 24 mo, this proportion increased to 59% and 98%, respectively. Two years after RYGBP, a mean amount of 2.9 +/- 1.4 specific supplements had been prescribed for each patient, including vitamin B-12, iron, calcium + vitamin D, and folic acid. At that time, the mean monthly cost of the substitutive treatment was $34.83. CONCLUSION: Nutritional deficiencies are very common after RYGBP and occur despite supplementation with the standard multivitamin preparation. Therefore, careful postoperative follow-up is indicated to detect and treat those deficiencies.

[PubMed - indexed for MEDLINE]Free Article

http://www.ajcn.org/cgi/reprint/87/5/1128.pdf

http://www.ajcn.org/cgi/content/full/87/5/1128 -- Obes Surg. 2002 Aug;12(4):551-8.

Comparison of nutritional deficiencies after Roux-en-Y gastric bypass and after biliopancreatic diversion with Roux-en-Y gastric bypass Skroubis G, Sakellaropoulos G, Pouggouras K, Mead N, Nikiforidis G, Kalfarentzos F.

Nutrition Support and Morbid Obesity Clinic, Department of Surgery, School of Medicine, University of Patras, Greece.

Abstract BACKGROUND: Patients undergoing either Roux-en-Y gastric bypass (RYGBP) or biliopancreatic diversion (BPD) with RYGBP are at risk of developing metabolic sequelae secondary to malabsorption. We compared the differences in nutritional complications between these two bariatric operations. METHODS: A retrospective analysis of a prospective database was done. From June 1994 to December 2001, 243 morbidly obese patients underwent various bariatric procedures at our institution. Of these patients, 79 (BMI 45.6 +/- SD = 4.9) who underwent RYGBP (gastric pouch 15 +/- 5 ml, biliopancreatic limb 60-80 cm, alimentary limb 80-100 cm and common limb the remainder of the small intestine), and 95 super obese (BMI 57.2 +/- 6.1) who underwent a BPD (gastric pouch 15 +/- 5 ml, biliopancreatic limb 150-200 cm, common limb 100 cm and alimentary limb the remainder of the small intestine), were selected and studied for the incidence of micronutrient deficiencies and level of serum albumin at yearly intervals postoperatively. A variety of nutritional parameters including Hb, Fe, ferritin, folic acid, vitamin B12 and serum albumin were measured preoperatively and compared postoperatively at 1, 3, 6, 12, 18 and 24 months, and yearly thereafter. RESULTS: Nutritional parameters were compared preoperatively and at similar periods postoperatively. No statistically significant (P < 0.05) difference in the occurrence of deficiency was observed between the groups for any of the nutritional parameters studied, except for ferritin, which showed a significant difference at the 2-year follow-up (37.7% low ferritin levels after RYGBP vs. 15.2% after BPD, P = 0.0294). All of these deficiencies were mild, without clinical symptomatology and were easily corrected with additional supplementation of the deficient micronutrient, with no need for hospitalization. Regarding serum albumin, there was only one patient with a level below 3 g/dl in the RYGBP group and two in the BPD group. These three patients were hospitalized and received total parenteral nutrition for 3 weeks, without further complications. CONCLUSION: There was no significant difference in the incidence of deficiency of the nutritional parameters studied, except for ferritin, following RYGBP vs. BPD with RYGBP. The most common deficiencies encountered were of iron and vitamin B12. The incidence of hypoalbuminemia was negligible in both groups, with mean values above 4 g/dl.

[PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/12194550

J Am Coll Surg. 2005 Jul;201(1):125-31.

Alterations in gastrointestinal physiology after Roux-en-Y gastric bypass

Ponsky TA, Brody F, Pucci E.

Department of General Surgery, The George Washington University Medical Center, Washington, DC 20037, USA.

Comment in:

J Am Coll Surg. 2005 Nov;201(5):824-5; author reply 825.

[PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/15978453 - Obes Surg. 2010 Aug;20(8):1133-41.

Nutritional pyramid for post-gastric bypass patients

Moizé VL, Pi-Sunyer X, Mochari H, Vidal J.

Obesity Unit, Hospital Clinic i Universitari, Barcelona, Spain. vmoize@clinic.ub.es

Abstract BACKGROUND: Life-long nutrition education and diet evaluation are key to the long-term success of surgical treatment of obesity. Diet guidelines provided for bariatric surgery patients generally focus on a progression through dietary stages, from the immediate post-surgical period to 6 months after surgery. However, long-term dietary guidelines for those surgically treated for obesity are not readily available. Therefore, there is a need for dietary recommendations for meal planning and nutritional supplementation for bariatric surgery patients beyond the short-term, post-operative period. The purpose of this paper is to construct an educational tool to provide long-term nutritional and behavioral advice for the post-bariatric patient. METHODS: The manuscript summarizes the current knowledge on dietary strategies and behaviors associated with beneficial nutritional outcomes in the long term of post-bariatric surgery patients. RESULTS: Dietary and nutritional recommendations are presented in the form of a "bariatric food pyramid" designed to be easily disseminated to patients. CONCLUSIONS: The development of educational tools that are easy to understand and follow is essential for effective patient management during the surgery follow-up period. The pyramid can be used as a tool to help both therapists and patients to understand nutrition recommendations and thus promote a healthy long-term post-op dietary pattern based on high-quality protein, balanced with nutrient-dense complex carbohydrates and healthy sources of essential fatty acids.

[PubMed - in process]

http://www.springerlink.com/content/c485781j447v3vx4/

http://www.springerlink.com/content/c485781j447v3vx4/fulltext.pdf -- Surg Obes Relat Dis. 2008 Sep-Oct;4(5 Suppl):S73-108. Epub 2008 May 19.

ASMBS Allied Health Nutritional Guidelines for the Surgical Weight Loss Patient Allied Health Sciences Section Ad Hoc Nutrition Committee, Aills L, Blankenship J, Buffington C, Furtado M, Parrott J.

[PubMed - indexed for MEDLINE]

http://www.asmbs.org/Newsite07/resources/bgs_final.pdf -- Bariatric Surgery in Adults With Extreme (Not Morbid) Obesity Donald D. Hensrud, MD, MPH and M. Molly McMahon, MD

doi: 10.4065/​81.10_Suppl.S3

Mayo Clinic Proceedings October 2006 vol. 81 no. 10 Suppl S3-S4

http://www.mayoclinicproceedings.com/content/81/10_Suppl/S3.full#cited-by -- Nature. 2006 Dec 14;444(7121):854-9.

Gut hormones and the regulation of energy homeostasis Murphy KG, Bloom SR.

Department of Metabolic Medicine, Imperial College Faculty of Medicine, Hammersmith Campus, Du Cane Road, London W12 ONN, UK.

Abstract Food intake, energy expenditure and body adiposity are homeostatically regulated. Central and peripheral signals communicate information about the current state of energy balance to key brain regions, including the hypothalamus and brainstem. Hunger and satiety represent coordinated responses to these signals, which include neural and hormonal messages from the gut. In recent years our understanding of how neural and hormonal brain-gut signalling regulates energy homeostasis has advanced considerably. Gut hormones have various physiological functions that include specifically targeting the brain to regulate appetite. New research suggests that gut hormones can be used to specifically regulate energy homeostasis in humans, and offer a target for anti-obesity drugs.

[PubMed - indexed for MEDLINE]

http://cms1.daegu.ac.kr/_upload/PDSBoard_01/PDSBoardDocs_10/jwyun/534/Nature,2006,444,854-859(1).pdf --