Проблема выявления и коррекции дефицитов микро- и макроэлементов после бариатрических операций
Проблема выявления и коррекции дефицитов микро- и макроэлементов после бариатрических операций
Салухов В.В., Ковалевская Е.А., Сардинов Р.Т. Проблема выявления и коррекции дефицитов микро- и макроэлементов после бариатрических операций. Consilium Medicum. 2022;24(4):261–265.
DOI: 10.26442/20751753.2022.4.201691
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Salukhov VV, Kovalevskaya EA, Sardinov RT. The problem of identification and correction of micro- and macronutrients deficiency after bariatric surgery: A review. Consilium Medicum. 2022;24(4):261–265.
DOI: 10.26442/20751753.2022.4.201691
Проблема выявления и коррекции дефицитов микро- и макроэлементов после бариатрических операций
Салухов В.В., Ковалевская Е.А., Сардинов Р.Т. Проблема выявления и коррекции дефицитов микро- и макроэлементов после бариатрических операций. Consilium Medicum. 2022;24(4):261–265.
DOI: 10.26442/20751753.2022.4.201691
________________________________________________
Salukhov VV, Kovalevskaya EA, Sardinov RT. The problem of identification and correction of micro- and macronutrients deficiency after bariatric surgery: A review. Consilium Medicum. 2022;24(4):261–265.
DOI: 10.26442/20751753.2022.4.201691
Хирургическое лечение ожирения – один из эффективных способов снижения и долгосрочного удержания массы тела. В зависимости от типа операции у пациентов с различной частотой развивается синдром мальабсорбции. Вследствие этого у лиц, получивших данный вариант медицинской помощи, в разное время после бариатрической операции может выявляться дефицит микро- и макронутриентов. Долгосрочная безопасность этого метода лечения связана с коррекцией дефицита витаминов и микроэлементов как до, так и после бариатрического вмешательства. В данном обзоре освещены наиболее частые дефициты, которые обнаруживаются у пациентов с ожирением, а также методы их диагностики и лечения.
Ключевые слова: ожирение, бариатрические операции, микро- и макроэлементы
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Surgical treatment of obesity is one of the most effective ways to reduce and maintain body weight for a long time. Depending on the type of operation, patients with different frequency develop malabsorption syndrome. As a result, in individuals who have received this type of medical care, at different times after bariatric surgery, micro and macronutrient deficiencies may be detected. Therefore, the long-term safety of this treatment method is associated with the correction of vitamin and trace element deficiencies both before and after bariatric intervention. This review highlights the most common deficiencies that are found in obese patients, as well as methods for their diagnosis and treatment.
Keywords: obesity, bariatric surgery, micro- and macronutrients
1. Faria GR. A brief history of bariatric surgery. Porto Biomed J. 2017;2(3):90-2.
2. Дедов И.И., Мельниченко Г.А., Шестакова М.В., и др. Национальные клинические рекомендации по лечению морбидного ожирения у взрослых. 3-ий пересмотр (лечение морбидного ожирения у взрослых). Ожирение и метаболизм. 2018;15(1):53-70 [Dedov II, Mel'nichenko GA, Shestakova MV, et al. Russian national clinical recommendations for morbid obesity treatment in adults. 3rd revision (Morbid obesity treatment in adults). Obesity and metabolism. 2018;15(1):53-70 (in Russian)].
3. Angrisani L, Santonicola A, Iovino P, et al. Bariatric Surgery and Endoluminal Procedures: IFSO Worldwide Survey 2014. Obes Surg. 2017;27(9):2279-89.
4. Pucci A, Batterham RL. Mechanisms underlying the weight loss effects of RYGB and SG: similar, yet different. J Endocrinol Invest. 2019;42(2):117-28.
5. Khosravi-Largani M, Nojomi M, Aghili R, et al. Evaluation of all Types of Metabolic Bariatric Surgery and its Consequences: a Systematic Review and Meta-Analysis. Obes Surg. 2019;29(2):651-90.
6. Martinez KB, Pierre JF, Chang EB. The Gut Microbiota: The Gateway to Improved Metabolism. Gastroenterol Clin North Am. 2016;45(4):601-14.
7. Buchwald H, Estok R, Fahrbach K, et al. Trends in mortality in bariatric surgery: A systematic review and meta-analysis. Surgery. 2007;142(4):621-35.
8. Aron-Wisnewsky J, Verger EO, Bounaix C, et al. Nutritional and Protein Deficiencies in the Short Term following Both Gastric Bypass and Gastric Banding. PLOS One. 2016;11(2):e0149588.
9. Parrott J, Frank L, Rabena R, et al. American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient 2016 Update: Micronutrients. Surg Obes Relat Dis. 2017;13(5):727-41.
10. Al-Mutawa A, Anderson A, Alsabah S, Al-Mutawa M. Nutritional Status of Bariatric Surgery Candidates. Nutrients. 2018;10(1):67.
11. Ignat M, Vix M, Imad I, et al. Randomized trial of Roux-en-Y gastric bypass versus sleeve gastrectomy in achieving excess weight loss. Br J Surg. 2017;104(3):248-56.
12. Chakhtoura MT, Nakhoul N, Akl EA, et al. Guidelines on vitamin D replacement in bariatric surgery: Identification and systematic appraisal. Metabolism. 2016;65(4):586-97.
13. Chakhtoura MT, Nakhoul NN, Shawwa K, et al. Hypovitaminosis D in bariatric surgery: A systematic review of observational studies. Metabolism. 2016;65(4):574-85.
14. Luger M, Kruschitz R, Langer F, et al. Effects of Omega-Loop Gastric Bypass on Vitamin D and Bone Metabolism in Morbidly Obese Bariatric Patients. Obes Surg. 2015;25(6):1056-62.
15. Luger M, Kruschitz R, Kienbacher C, et al. Vitamin D3 Loading Is Superior to Conventional Supplementation After Weight Loss Surgery in Vitamin D-Deficient Morbidly Obese Patients: a Double-Blind Randomized Placebo-Controlled Trial. Obes Surg. 2017;27(5):1196-207.
16. Schijns W, Schuurman LT, Melse-Boonstra A, et al. Do specialized bariatric multivitamins lower deficiencies after RYGB? Surg Obes Relat Dis. 2018;14(7):1005-12.
17. Ben-Porat T, Elazary R, Sherf-Dagan S, et al. Bone Health following Bariatric Surgery: Implications for Management Strategies to Attenuate Bone Loss. Adv Nutr. 2018;9(2):114-27.
18. Arnaud MJ. Update on the assessment of magnesium status. Br J Nutr. 2008;99(Suppl. 3):S24-36.
19. Davison SP, Parikh PM, Jacobson JM, et al. A "buttressed mesh" technique for fascial closure in complex abdominal wall reconstruction. Ann Plast Surg. 2009;62(3):284-9.
DOI:10.1097/SAP.0b013e31817e9c6d
20. Nielsen JB, Pedersen AM, Gribsholt SB, et al. Prevalence, severity, and predictors of symptoms of dumping and hypoglycemia after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2016;12(8):1562-8.
21. Rudnicki SA. Prevention and Treatment of Peripheral Neuropathy after Bariatric Surgery. Curr Treat Options Neurol. 2010;12(1):29-36.
22. Remedios C, Bhasker AG, Dhulla N, et al. Bariatric Nutrition Guidelines for the Indian Population. Obes Surg. 2016;26(5):1057-68.
23. Sawaya RA, Jaffe J, Friedenberg L, Friedenberg FK. Vitamin, mineral, and drug absorption following bariatric surgery. Curr Drug Metab. 2012;13(9):1345-55.
24. Punchai S, Hanipah ZN, Meister KM, et al. Neurologic Manifestations of Vitamin B Deficiency after Bariatric Surgery. Obes Surg. 2017;27(8):2079-82.
25. Smelt HJM, van Loon S, Pouwels S, et al. Do Specialized Bariatric Multivitamins Lower Deficiencies After Sleeve Gastrectomy? Obes Surg. 2020;30(2):427-38.
26. Wolffenbuttel BHR, Wouters HJCM, Heiner-Fokkema MR, van der Klauw MM. The Many Faces of Cobalamin (Vitamin B12) Deficiency. Mayo Clin Proc Innov Qual Outcomes. 2019;3(2):200-14.
27. Asim Syed IA, Abbas Naqvi SH. Proton pump inhibitors use; beware of side-effects. J Pak Med Assoc. 2016;66(10):1314-8.
28. Hannibal L, Lysne V, Bjørke-Monsen A-L, et al. Biomarkers and Algorithms for the Diagnosis of Vitamin B12 Deficiency. Front Mol Biosci. 2016;3:27.
29. Brito A, Verdugo R, Hertrampf E, et al. Vitamin B-12 treatment of asymptomatic, deficient, elderly Chileans improves conductivity in myelinated peripheral nerves, but high serum folate impairs vitamin B-12 status response assessed by the combined indicator of vitamin B-12 status. Am J Clin Nutr. 2016;103(1):250-7.
30. Komorniak N, Szczuko M, Kowalewski B, Stachowska E. Nutritional Deficiencies, Bariatric Surgery, and Serum Homocysteine Level: Review of Current Literature. Obes Surg. 2019;29(11):3735-42.
31. Miles LM, Mills K, Clarke R, Dangour AD. Is there an association of vitamin B-12 status with neurological function in older people? A systematic review. Br J Nutr. 2015;114(4):503-8.
32. Torsvik IK, Ueland PM, Markestad T, et al. Motor development related to duration of exclusive breastfeeding, B vitamin status and B12 supplementation in infants with a birth weight between 2000-3000 g, results from a randomized intervention trial. BMC Pediatrics. 2015;15(1):218.
33. Said HM. Intestinal absorption of water-soluble vitamins in health and disease. Biochem J. 2011;437(3):357-72.
34. Arias PM, Domeniconi EA, García M, et al. Micronutrient Deficiencies After Roux-en-Y Gastric Bypass: Long-Term Results. Obes Surg. 2020;30(1):169-73.
35. Lespessailles E, Toumi H. Vitamin D alteration associated with obesity and bariatric surgery. Exp Biol Med (Maywood). 2017;242(10):1086-94.
36. Wei J-H, Lee W-J, Chong K, et al. High Incidence of Secondary Hyperparathyroidism in Bariatric Patients: Comparing Different Procedures. Obes Surg. 2018;28(3):798-804.
37. Via MA, Mechanick JI. Nutritional and Micronutrient Care of Bariatric Surgery Patients: Current Evidence Update. Curr Obes Rep. 2017;6(3):286-96.
38. Peterson LA, Zeng X, Caufield-Noll CP, et al. Vitamin D status and supplementation before and after bariatric surgery: a comprehensive literature review. Surg Obes Relat Dis. 2016;12(3):693-702.
39. Lanzarini E, Nogués X, Goday A, et al. High-Dose Vitamin D Supplementation is Necessary After Bariatric Surgery: A Prospective 2-Year Follow-up Study. Obes Surg. 2015;25(9):1633-8.
40. White MG, Ward MA, Applewhite MK, et al. Rates of secondary hyperparathyroidism after bypass operation for super-morbid obesity: An overlooked phenomenon. Surgery.
2017;161(3):720-6.
41. Busetto L, Dicker D, Azran C, et al. Obesity Management Task Force of the European Association for the Study of Obesity Released “Practical Recommendations for the Post-Bariatric Surgery Medical Management”. Obes Surg. 2018;28(7):2117-21.
42. Enani G, Bilgic E, Lebedeva E, et al. The incidence of iron deficiency anemia post-Roux-en-Y gastric bypass and sleeve gastrectomy: a systematic review. Surg Endosc. 2020;34(7):3002-10.
43. Mücke V, Mücke MM, Raine T, Bettenworth D. Diagnosis and treatment of anemia in patients with inflammatory bowel disease. Ann Gastroenterol. 2017;30(1):15-22.
44. Boyce SG, Goriparthi R, Clark J, et al. Can Composite Nutritional Supplement Based on the Current Guidelines Prevent Vitamin and Mineral Deficiency After Weight Loss Surgery? Obes Surg. 2016;26(5):966-71.
45. Cappellini DM, Motta I. Anemia in Clinical Practice-Definition and Classification: Does Hemoglobin Change With Aging? Semin Hematol. 2015;52(4):261-9.
46. Homan M, Kovač J, Orel R, et al. Relevant Weight Reduction and Reversed Metabolic Co-morbidities Can Be Achieved by Duodenojejunal Bypass Liner in Adolescents with Morbid Obesity. Obes Surg. 2020;30(3):1001-10.
47. Mostafa MMA, Hasanin AM, Alhamade F, et al. Accuracy and trending of non-invasive oscillometric blood pressure monitoring at the wrist in obese patients. Anaesth Crit Care Pain Med. 2020;39(2):221-7.
________________________________________________
1. Faria GR. A brief history of bariatric surgery. Porto Biomed J. 2017;2(3):90-2.
2. Дедов И.И., Мельниченко Г.А., Шестакова М.В., и др. Национальные клинические рекомендации по лечению морбидного ожирения у взрослых. 3-ий пересмотр (лечение морбидного ожирения у взрослых). Ожирение и метаболизм. 2018;15(1):53-70 [Dedov II, Mel'nichenko GA, Shestakova MV, et al. Russian national clinical recommendations for morbid obesity treatment in adults. 3rd revision (Morbid obesity treatment in adults). Obesity and metabolism. 2018;15(1):53-70 (in Russian)].
3. Angrisani L, Santonicola A, Iovino P, et al. Bariatric Surgery and Endoluminal Procedures: IFSO Worldwide Survey 2014. Obes Surg. 2017;27(9):2279-89.
4. Pucci A, Batterham RL. Mechanisms underlying the weight loss effects of RYGB and SG: similar, yet different. J Endocrinol Invest. 2019;42(2):117-28.
5. Khosravi-Largani M, Nojomi M, Aghili R, et al. Evaluation of all Types of Metabolic Bariatric Surgery and its Consequences: a Systematic Review and Meta-Analysis. Obes Surg. 2019;29(2):651-90.
6. Martinez KB, Pierre JF, Chang EB. The Gut Microbiota: The Gateway to Improved Metabolism. Gastroenterol Clin North Am. 2016;45(4):601-14.
7. Buchwald H, Estok R, Fahrbach K, et al. Trends in mortality in bariatric surgery: A systematic review and meta-analysis. Surgery. 2007;142(4):621-35.
8. Aron-Wisnewsky J, Verger EO, Bounaix C, et al. Nutritional and Protein Deficiencies in the Short Term following Both Gastric Bypass and Gastric Banding. PLOS One. 2016;11(2):e0149588.
9. Parrott J, Frank L, Rabena R, et al. American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient 2016 Update: Micronutrients. Surg Obes Relat Dis. 2017;13(5):727-41.
10. Al-Mutawa A, Anderson A, Alsabah S, Al-Mutawa M. Nutritional Status of Bariatric Surgery Candidates. Nutrients. 2018;10(1):67.
11. Ignat M, Vix M, Imad I, et al. Randomized trial of Roux-en-Y gastric bypass versus sleeve gastrectomy in achieving excess weight loss. Br J Surg. 2017;104(3):248-56.
12. Chakhtoura MT, Nakhoul N, Akl EA, et al. Guidelines on vitamin D replacement in bariatric surgery: Identification and systematic appraisal. Metabolism. 2016;65(4):586-97.
13. Chakhtoura MT, Nakhoul NN, Shawwa K, et al. Hypovitaminosis D in bariatric surgery: A systematic review of observational studies. Metabolism. 2016;65(4):574-85.
14. Luger M, Kruschitz R, Langer F, et al. Effects of Omega-Loop Gastric Bypass on Vitamin D and Bone Metabolism in Morbidly Obese Bariatric Patients. Obes Surg. 2015;25(6):1056-62.
15. Luger M, Kruschitz R, Kienbacher C, et al. Vitamin D3 Loading Is Superior to Conventional Supplementation After Weight Loss Surgery in Vitamin D-Deficient Morbidly Obese Patients: a Double-Blind Randomized Placebo-Controlled Trial. Obes Surg. 2017;27(5):1196-207.
16. Schijns W, Schuurman LT, Melse-Boonstra A, et al. Do specialized bariatric multivitamins lower deficiencies after RYGB? Surg Obes Relat Dis. 2018;14(7):1005-12.
17. Ben-Porat T, Elazary R, Sherf-Dagan S, et al. Bone Health following Bariatric Surgery: Implications for Management Strategies to Attenuate Bone Loss. Adv Nutr. 2018;9(2):114-27.
18. Arnaud MJ. Update on the assessment of magnesium status. Br J Nutr. 2008;99(Suppl. 3):S24-36.
19. Davison SP, Parikh PM, Jacobson JM, et al. A "buttressed mesh" technique for fascial closure in complex abdominal wall reconstruction. Ann Plast Surg. 2009;62(3):284-9.
DOI:10.1097/SAP.0b013e31817e9c6d
20. Nielsen JB, Pedersen AM, Gribsholt SB, et al. Prevalence, severity, and predictors of symptoms of dumping and hypoglycemia after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2016;12(8):1562-8.
21. Rudnicki SA. Prevention and Treatment of Peripheral Neuropathy after Bariatric Surgery. Curr Treat Options Neurol. 2010;12(1):29-36.
22. Remedios C, Bhasker AG, Dhulla N, et al. Bariatric Nutrition Guidelines for the Indian Population. Obes Surg. 2016;26(5):1057-68.
23. Sawaya RA, Jaffe J, Friedenberg L, Friedenberg FK. Vitamin, mineral, and drug absorption following bariatric surgery. Curr Drug Metab. 2012;13(9):1345-55.
24. Punchai S, Hanipah ZN, Meister KM, et al. Neurologic Manifestations of Vitamin B Deficiency after Bariatric Surgery. Obes Surg. 2017;27(8):2079-82.
25. Smelt HJM, van Loon S, Pouwels S, et al. Do Specialized Bariatric Multivitamins Lower Deficiencies After Sleeve Gastrectomy? Obes Surg. 2020;30(2):427-38.
26. Wolffenbuttel BHR, Wouters HJCM, Heiner-Fokkema MR, van der Klauw MM. The Many Faces of Cobalamin (Vitamin B12) Deficiency. Mayo Clin Proc Innov Qual Outcomes. 2019;3(2):200-14.
27. Asim Syed IA, Abbas Naqvi SH. Proton pump inhibitors use; beware of side-effects. J Pak Med Assoc. 2016;66(10):1314-8.
28. Hannibal L, Lysne V, Bjørke-Monsen A-L, et al. Biomarkers and Algorithms for the Diagnosis of Vitamin B12 Deficiency. Front Mol Biosci. 2016;3:27.
29. Brito A, Verdugo R, Hertrampf E, et al. Vitamin B-12 treatment of asymptomatic, deficient, elderly Chileans improves conductivity in myelinated peripheral nerves, but high serum folate impairs vitamin B-12 status response assessed by the combined indicator of vitamin B-12 status. Am J Clin Nutr. 2016;103(1):250-7.
30. Komorniak N, Szczuko M, Kowalewski B, Stachowska E. Nutritional Deficiencies, Bariatric Surgery, and Serum Homocysteine Level: Review of Current Literature. Obes Surg. 2019;29(11):3735-42.
31. Miles LM, Mills K, Clarke R, Dangour AD. Is there an association of vitamin B-12 status with neurological function in older people? A systematic review. Br J Nutr. 2015;114(4):503-8.
32. Torsvik IK, Ueland PM, Markestad T, et al. Motor development related to duration of exclusive breastfeeding, B vitamin status and B12 supplementation in infants with a birth weight between 2000-3000 g, results from a randomized intervention trial. BMC Pediatrics. 2015;15(1):218.
33. Said HM. Intestinal absorption of water-soluble vitamins in health and disease. Biochem J. 2011;437(3):357-72.
34. Arias PM, Domeniconi EA, García M, et al. Micronutrient Deficiencies After Roux-en-Y Gastric Bypass: Long-Term Results. Obes Surg. 2020;30(1):169-73.
35. Lespessailles E, Toumi H. Vitamin D alteration associated with obesity and bariatric surgery. Exp Biol Med (Maywood). 2017;242(10):1086-94.
36. Wei J-H, Lee W-J, Chong K, et al. High Incidence of Secondary Hyperparathyroidism in Bariatric Patients: Comparing Different Procedures. Obes Surg. 2018;28(3):798-804.
37. Via MA, Mechanick JI. Nutritional and Micronutrient Care of Bariatric Surgery Patients: Current Evidence Update. Curr Obes Rep. 2017;6(3):286-96.
38. Peterson LA, Zeng X, Caufield-Noll CP, et al. Vitamin D status and supplementation before and after bariatric surgery: a comprehensive literature review. Surg Obes Relat Dis. 2016;12(3):693-702.
39. Lanzarini E, Nogués X, Goday A, et al. High-Dose Vitamin D Supplementation is Necessary After Bariatric Surgery: A Prospective 2-Year Follow-up Study. Obes Surg. 2015;25(9):1633-8.
40. White MG, Ward MA, Applewhite MK, et al. Rates of secondary hyperparathyroidism after bypass operation for super-morbid obesity: An overlooked phenomenon. Surgery.
2017;161(3):720-6.
41. Busetto L, Dicker D, Azran C, et al. Obesity Management Task Force of the European Association for the Study of Obesity Released “Practical Recommendations for the Post-Bariatric Surgery Medical Management”. Obes Surg. 2018;28(7):2117-21.
42. Enani G, Bilgic E, Lebedeva E, et al. The incidence of iron deficiency anemia post-Roux-en-Y gastric bypass and sleeve gastrectomy: a systematic review. Surg Endosc. 2020;34(7):3002-10.
43. Mücke V, Mücke MM, Raine T, Bettenworth D. Diagnosis and treatment of anemia in patients with inflammatory bowel disease. Ann Gastroenterol. 2017;30(1):15-22.
44. Boyce SG, Goriparthi R, Clark J, et al. Can Composite Nutritional Supplement Based on the Current Guidelines Prevent Vitamin and Mineral Deficiency After Weight Loss Surgery? Obes Surg. 2016;26(5):966-71.
45. Cappellini DM, Motta I. Anemia in Clinical Practice-Definition and Classification: Does Hemoglobin Change With Aging? Semin Hematol. 2015;52(4):261-9.
46. Homan M, Kovač J, Orel R, et al. Relevant Weight Reduction and Reversed Metabolic Co-morbidities Can Be Achieved by Duodenojejunal Bypass Liner in Adolescents with Morbid Obesity. Obes Surg. 2020;30(3):1001-10.
47. Mostafa MMA, Hasanin AM, Alhamade F, et al. Accuracy and trending of non-invasive oscillometric blood pressure monitoring at the wrist in obese patients. Anaesth Crit Care Pain Med. 2020;39(2):221-7.
Авторы
В.В. Салухов*, Е.А. Ковалевская, Р.Т. Сардинов
ФГБВОУ ВО «Военно-медицинская академия им. С.М. Кирова» Минобороны России, Санкт-Петербург, Россия
*vlasaluk@yandex.ru
________________________________________________
Vladimir V. Salukhov*, Elena A. Kovalevskaya, Ruslan T. Sardinov
Kirov Military Medical Academy, Saint Petersburg, Russia
*vlasaluk@yandex.ru