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Comment repérer et traiter les carences en vitamines, minéraux et oligoéléments

How to recognize and treat deficiencies in vitamins, minerals and trace elements

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Obésité

Résumé

La chirurgie bariatrique entraîne des risques de complications métaboliques et nutritionnelles. Les carences observées sont liées le plus souvent à la malabsorption créée par le montage chirurgical, mais la diminution des apports et le déséquilibre alimentaire généré par la restriction est également en cause. La prévalence élevée de la carence en fer (environ un tiers des patients après gastroplastie et plus de 50 % après court-circuit gastrique [CCG]) justifie une surveillance biologique régulière. Une supplémentation en cas de carence avérée est conseillée après chirurgie restrictive, et chez l’homme après CCG. Une supplémentation systématique doit être discutée chez les femmes en âge de procréer ayant subi un CCG (200 mg de fer élement par jour). La carence en vitamine B12 est classique après CCG, mais n’est pas rare après chirurgie restrictive (4–10 %). Une supplémentation est indispensable après CCG. La voie orale est possible (1 000 μg/semaine à 500 μg/j). Le déficit en acide folique concerne environ 40 % des sujets après CCG. Une dose de 400 μg à 1 mg/j est nécessaire pour corriger cette carence. Elle doit être prévenue systématiquement en cas de désir de grossesse. Une élévation de la parathormone, traduisant la carence en vitamine D et la diminution de l’absorption du calcium avec ses conséquences osseuses, est fréquente après CCG. Une supplémentation calcique et en vitamine D doit être proposée dans ce cas (1 000–1 500 mg/j de calcium [citrate] associée à 400–1 000 UI de cholécalciférol). La carence en thiamine (Vit B1), responsable d’une encéphalopathie de Gayet-Wernicke, est généralement provoquée par la perfusion de glucose chez un patient carencé (vomissements). La carence en zinc et en sélénium touche 25 à 30 % des patients. La supplémentation en fer, vitamine B12, folate, calcium et vitamine D et un suivi rigoureux du statut nutritionnel est nécessaire après chirurgie bariatrique, et notamment après CCG. Le patient devra être informé de cette nécessité. L’évaluation de la compliance du patient est un des éléments à prendre en compte dans l’analyse de l’indication.

Abstract

Bariatric surgery leads to the risk of metabolic and nutritional complications. The nutritional deficiencies observed are most often associated with malabsorption caused by the surgical technique, but the reduction in food intake and nutritional imbalance generated by food restriction are also at play. The high prevalence of iron deficiency (about one third of gastroplasty patients and more than 50% of gastric bypass patients) calls for regular monitoring of blood levels. Dietary supplements in cases of nutritional deficiency are recommended following restrictive surgery and gastric bypass procedures (GBP). Women of childbearing age who have undergone GBP must discuss regular dietary supplementation (200 mg of iron a day) with their healthcare providers. Vitamin B12 deficiency is highly prevalent after GBP, but also occurs at a significant rate after restrictive surgery (4–10%). Dietary supplements after GBP are crucial, and oral administration is possible (1,000 μg a week at 500 μg a day). Folic acid deficiency occurs in about 40% of patients after GBP. A dose of 400 μg at 1 mg a day is necessary to correct this deficiency. This must always be administered when pregnancy has been planned. Increased parathyroid hormone levels stemming from vitamin D deficiency and reduced calcium absorption, with its consequences on bone, occur frequently after GBP. Calcium and vitamin D supplements must be administered in this case (1,000–1,500 mg a day of calcium (citrate), combined with 400–1,000 UI of cholecalciferol). Symptoms of thiamine (vitamin B1) deficiency, responsible for Wernicke’s encephalopathy, are usually triggered by glucose administration in deficient patients (vomiting). Zinc and selenium deficiencies affect 25–30% of patients. Dietary supplements of iron, vitamin B12, folic acid, calcium and vitamin D, as well as comprehensive monitoring of nutritional status, are necessary after bariatric surgery, especially following gastric bypass procedures. Patients should be informed of this necessity. The assessment of patient compliance is a factor to take into account when evaluating indications.

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Authors and Affiliations

  1. Unité transversale de nutrition, CHU de Nancy, F-54000, Nancy, France

    D. Quilliot

  2. Service de diabétologie, maladies métaboliques et nutrition, hôpital Jeanne-d’Arc, F-54201, Toul cedex, France

    D. Quilliot & O. Ziegler

  3. Service de chirurgie digestive et générale, hôpital de Brabois, CHU de Nancy, F-54000, Nancy, France

    L. Brunaud

  4. Service de chirurgie générale et urgences, hôpital central, CHU de Nancy, F-54000, Nancy, France

    N. Reibel

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  1. D. Quilliot
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  2. L. Brunaud
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  3. N. Reibel
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  4. O. Ziegler
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Correspondence to D. Quilliot.

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Quilliot, D., Brunaud, L., Reibel, N. et al. Comment repérer et traiter les carences en vitamines, minéraux et oligoéléments. Obes 2, 312–317 (2007). https://doi.org/10.1007/s11690-007-0087-z

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