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Different Supplementation Regimes to Treat Perioperative Vitamin B12 Deficiencies in Bariatric Surgery: a Systematic Review

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Abstract

Vitamin B12 dosage in multivitamin supplementation in the current literature is quite variable. There is no consensus about the optimal treatment of vitamin B12 deficiency. A systematic literature search on different supplementation regimes to treat perioperative vitamin B12 deficiencies in bariatric surgery was performed. The methodological quality of ten included studies was rated using the Newcastle Ottawa scale and ranged from moderate to good. The agreement between the reviewers was assessed with a Cohen’s kappa (0.69). The current literature suggests that 350 μg oral vitamin B12 is the appropriate dose to correct low vitamin B12 levels in many patients. Further research must focus on a better diagnosis of a vitamin B12 deficiency, the optimal dose vitamin B12 supplementation, and clinical relevance next to biochemical data.

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References

  1. Schilling RD, Gohdes PN, Hardie GH. Vitamin B12 deficiency after gastric bypass for obesity. Ann Intern Med. 1984;101:501–2.

    Article  CAS  PubMed  Google Scholar 

  2. Kushner R. Managing the obese patient after bariatric surgery: a case report of severe malnutrition and review of the literature. JPEN J Parenter Enteral Nutr. 2000;24:126–32.

    Article  CAS  PubMed  Google Scholar 

  3. Brolin RE, LaMarca LB, Henler HA, et al. Malabsorptive gastric bypass in patients with super-obesity. J Gastrointest Surg. 2002;6:195–203.

    Article  PubMed  Google Scholar 

  4. Rhode BM, Arseneau P, Cooper BA, et al. Vitamin B12 deficiency after gastric surgery for obesity. Am J Clin Nutr. 1996;63:103–9.

    CAS  PubMed  Google Scholar 

  5. MacLean LD, Rhode BM, Shizgal HM. Nutrition following gastric operations for morbid obesity. Ann Surg. 1983;198:347–55.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Brolin RE, Gorman JH, Gorman RC, et al. Are vitamin B12 and folate deficiency clinically important after roux-en-y gastric bypass? J Gastrointest Surg. 1998;2(5):436–42.

    Article  CAS  PubMed  Google Scholar 

  7. Sumner AE. Elevated methylmalonic acid and total homocysteine levels show high prevalence of vitamin B12 deficiency after gastric surgery. Ann Intern Med. 1996;124:469–76.

    Article  CAS  PubMed  Google Scholar 

  8. Smelt HJM, Smulders JF, Said M, et al. Improving bariatric patient aftercare outcome by improved detection of a functional vitamin B12 deficiency. Obes Surg. 2015; doi:10.1007/s11695-015-1952-8.

    Google Scholar 

  9. Donadelli SP, Junqueira-Franco MVM, de Mattos Donadelli CA, et al. Daily vitamin supplementation and hypovitaminosis after obesity surgery. Nutr. 2012;28(4):391–6.

    Article  CAS  Google Scholar 

  10. Wells G.A., Shea B., O’Conell D., et al. The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomized studies in meta-analysis.

  11. Aasheim ET, Johnson LK, Hofso D, et al. Vitamin status after gastric bypass and lifestyle intervention: a comparative prospective study. Surg Obes Relat Dis. 2012;8(2):169–75.

    Article  PubMed  Google Scholar 

  12. Rhode BM, Tamin H, Gilfix BM, et al. Treatment of vitamin B12 deficiency after gastric surgery for severe obesity. Obes Surg. 1995;5(2):154–8.

    Article  CAS  PubMed  Google Scholar 

  13. Capoccia D, Coccia F, Paradiso F, et al. Laparoscopic gastric sleeve and micronutrients supplementation: our experience. J of Obes. 2012; doi:10.1155/2012/672162.

    Google Scholar 

  14. Homan J, Schijns W, Aarts EO, et al. An optimized multivitamin supplement lowers the number of vitamin and mineral deficiencies three years after roux-en-y gastric bypass: a cohort study. Surg Obes Rel Dis. 2015; doi:10.1016/j.soard.2015.12.010.

    Google Scholar 

  15. Moore CE, Sherman V. Effectiveness of B vitamin supplementation following bariatric surgery: rapid increases of serum vitamin B12. Obes Surg. 2015;25:694–9.

    Article  PubMed  Google Scholar 

  16. Altman D. Practical statistics for medical research. Chapman and Hal. London. 1991.

  17. Gasteyger C, Suter M, Gaillard RC, et al. Nutritional deficiencies after roux-en-y gastric bypass for morbid obesity often cannot be prevented by standard multivitamin supplementation. Am J Clin Nutr. 2008;87:1128–33.

    CAS  PubMed  Google Scholar 

  18. de Jesus Ramos NMCP, Magno FCCM, Cohen L, et al. Weight loss and nutritional anemia in patients submitted to roux-en-y gastric bypass on use of vitamin and mineral supplementation. Arq Bras Cir Dig. 2015;28(1):44–7.

    Article  Google Scholar 

  19. Carmel R, Brar S, Agrawal A, et al. Failure of assay to identify low cobalamin concentrations. Clin Chem. 2000;46(12):2017–25.

    CAS  PubMed  Google Scholar 

  20. Carmel R, Agrawal YP. Failures of cobalamin assays in pernicious anemia. N Engl J Med. 2012;367:385–91.

    Article  CAS  PubMed  Google Scholar 

  21. Solomon LR. Disorders of cobalamin metabolism: emerging concepts in pathophysiology, diagnosis and treatment. Blood Rev. 2007;3:113–30.

    Article  Google Scholar 

  22. Hvas AM, Nexo E. Holotranscobalamin: a first choice assay for diagnosing early vitamin B12 deficiency? J Int Med. 2005;257:289–98.

    Article  CAS  Google Scholar 

  23. Dogan K., Aarts, E.O., Koehestanie, P. et al. Optimization of vitamin supplementation after roux-en-y gastric bypass surgery can lower postoperative deficiencies: a randomized controlled trial. Medicine. 2014;93(25). doi:10.1097/MD.0000000000000169.

  24. Aills L, Blankenship J, Buffington C, et al. ASMBS allied health nutritional guidelines for surgical weight loss patient. Surg Obes Relat Dis. 2008;4:73–108.

    Article  Google Scholar 

  25. Mechanick J.I., Youdim A., Jones D.B., et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update. Surg Obes Relat Dis. 2013;9(2):159–91.

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Authors and Affiliations

  1. Department of Nutrition, Catharina Hospital, Eindhoven, The Netherlands

    H. J. M. Smelt

  2. Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands

    S. Pouwels & J. F. Smulders

  3. Obesity Center, Catharina Hospital, Eindhoven, The Netherlands

    H. J. M. Smelt, S. Pouwels & J. F. Smulders

Authors
  1. H. J. M. Smelt
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  2. S. Pouwels
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  3. J. F. Smulders
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Correspondence to H. J. M. Smelt.

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Conflict of Interest

Author 3 reports educational grants from Medtronic and FitForMe. Author 1 and author 2 have nothing to disclose.

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For this type of study, formal consent is not required.

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Author Contributions

Study design and data collection: HS, SP

Drafting and revision of the manuscript: HS, SP, JS

Final approval: HS, SP, JS

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Smelt, H., Pouwels, S. & Smulders, J. Different Supplementation Regimes to Treat Perioperative Vitamin B12 Deficiencies in Bariatric Surgery: a Systematic Review. OBES SURG 27, 254–262 (2017). https://doi.org/10.1007/s11695-016-2449-9

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