Early changes in vitamin B12 uptake and biomarker status following Roux-en-Y gastric bypass and sleeve gastrectomy. Issue 2 (April 2019)

• Record Type: Journal Article
• Authors: Kornerup, L.S.; Hvas, C.L.; Abild, C.B.; Richelsen, B.; Nexo, E.
• Is Part Of: Clinical nutrition. Volume 38:Issue 2(2019)
• Page Start: 906
• Page End: 911
• Publication Date: 2019-04
• Subjects: Bariatric surgery -- Transcobalamins -- Homocysteine -- Methylmalonic acid -- Vitamin B12; B12 vitamin B12, cobalamin -- GI gastrointestinal -- holoTC holotranscobalamin -- Hcy homocysteine -- IF intrinsic factor -- MCV mean cell volume -- MeB12 methyl-B12 -- MMA methylmalonic acid -- RYGB Roux-en-Y gastric bypass -- SG sleeve gastrectomy; Critically ill -- Nutrition -- Periodicals; Diet therapy -- Periodicals; Parenteral feeding -- Periodicals; Enteral feeding -- Periodicals; Enteral Nutrition -- Periodicals; Parenteral Nutrition -- Periodicals; Metabolism -- Periodicals; Diétothérapie -- Périodiques; Alimentation parentérale -- Périodiques; Alimentation entérale -- Périodiques; Nutrition -- Périodiques; Diet therapy; Enteral feeding; Nutrition; Parenteral feeding; Electronic journals; Periodicals; Electronic journals; 615.854
• DOI: 10.1016/j.clnu.2018.02.007
• Languages: English
• ISSNs: 0261-5614

Abstract

Summary: Background & aims: Bariatric surgery increases the risk of micronutrient deficiencies, including vitamin B12 (B12) deficiency. We analysed early changes in biomarkers of B12 status following bariatric surgery. Methods: We prospectively included adult patients (n = 27) referred for either Roux-en-Y Gastric Bypass (RYGB) (n = 19) or Sleeve Gastrectomy (SG) (n = 8). Blood samples were drawn before surgery and 2 and 6 months following surgery for measurement of B12, holotranscobalamin (holoTC), and methylmalonic acid (MMA). The B12 absorption capacity was estimated from the increase in plasma holoTC two days after a standardised oral B12 challenge. Results: B12 status decreased following both RYBG and SG. While a decrease in plasma B12 was not evident until 6 months postoperatively, we observed a statistically significant decrease in plasma holoTC and increase in MMA already 2 months postoperatively. These changes were more pronounced at 6 months post surgery. Correspondingly, the B12 absorption capacity was decreased following surgery. Conclusions: HoloTC and MMA were superior to B12 to detect early changes in B12 status following bariatric surgery. Our data challenge the current concept that liver B12 stores secure long-term maintenance of B12 status. They indicate that B12 treatment in pharmacological doses may be warranted immediately after surgery.