Vitamin B12 deficiency in patients undergoing bariatric surgery: Preventive strategies and key recommendations

Shounak Majumder, Jose Soriano, Allan Louie Cruz, Constantin A. Dasanu

Research output: Contribution to journalReview article

30 Citations (Scopus)

Abstract

Background Advances in bariatric surgery have brought about a paradigm shift in the management of obesity, with benefits extending beyond weight loss. However, nutritional deficiencies are an inherent problem in the postoperative period and often require lifelong supplementation. Vitamin B12, also referred to as cobalamin, is one of the most common micronutrient deficiencies affecting this population. This review explores the pathophysiology of cobalamin deficiency in patients undergoing bariatric surgery and provides an overview of the effectiveness of various available vitamin B12 formulations. Methods To identify the relevant literature, a systematic review of MEDLINE was conducted from the earliest dates through September 2012 for English-language articles describing the prevention and management of vitamin B12 deficiency in patients undergoing bariatric surgery. Results Intramuscular vitamin B12 continues to be the gold standard of therapy for vitamin B12 deficiency, especially in symptomatic patients. In select patients with asymptomatic vitamin B12 deficiency after Roux-en-Y gastric bypass (RYGB), high-dose oral cyanocobalamin should be given a consideration, especially when there are concerns with the adherence to intramuscular therapy or if compliance comes into question. Unlike patients post-RYGB, those undergoing restrictive procedures such as gastric banding and sleeve gastrectomy may be maintained postoperatively on a lower-dose daily vitamin B12 supplementation. Efficacy data of nasal and sublingual routes for maintenance therapy is currently awaited. Conclusion Patients undergoing bariatric surgery must be continuously educated on proper nutrition, the risk of developing significant vitamin B12 deficiency, and the role of supplements in avoiding catastrophic consequences.

Original languageEnglish (US)
Pages (from-to)1013-1019
Number of pages7
JournalSurgery for Obesity and Related Diseases
Volume9
Issue number6
DOIs
StatePublished - Nov 1 2013
Externally publishedYes

Fingerprint

Vitamin B 12 Deficiency
Bariatric Surgery
Vitamin B 12
Gastric Bypass
Micronutrients
Gastrectomy
Nose
Postoperative Period
MEDLINE
Malnutrition
Compliance
Weight Loss
Stomach
Language
Therapeutics
Obesity

Keywords

  • Bariatric surgery
  • Cobalamin
  • Gastric banding
  • Gastric bypass
  • RYGB
  • Vitamin B

ASJC Scopus subject areas

  • Surgery

Cite this

Vitamin B12 deficiency in patients undergoing bariatric surgery : Preventive strategies and key recommendations. / Majumder, Shounak; Soriano, Jose; Louie Cruz, Allan; Dasanu, Constantin A.

In: Surgery for Obesity and Related Diseases, Vol. 9, No. 6, 01.11.2013, p. 1013-1019.

Research output: Contribution to journalReview article

@article{b1d14389d7d94117a48e3fc0022ad7da,
title = "Vitamin B12 deficiency in patients undergoing bariatric surgery: Preventive strategies and key recommendations",
abstract = "Background Advances in bariatric surgery have brought about a paradigm shift in the management of obesity, with benefits extending beyond weight loss. However, nutritional deficiencies are an inherent problem in the postoperative period and often require lifelong supplementation. Vitamin B12, also referred to as cobalamin, is one of the most common micronutrient deficiencies affecting this population. This review explores the pathophysiology of cobalamin deficiency in patients undergoing bariatric surgery and provides an overview of the effectiveness of various available vitamin B12 formulations. Methods To identify the relevant literature, a systematic review of MEDLINE was conducted from the earliest dates through September 2012 for English-language articles describing the prevention and management of vitamin B12 deficiency in patients undergoing bariatric surgery. Results Intramuscular vitamin B12 continues to be the gold standard of therapy for vitamin B12 deficiency, especially in symptomatic patients. In select patients with asymptomatic vitamin B12 deficiency after Roux-en-Y gastric bypass (RYGB), high-dose oral cyanocobalamin should be given a consideration, especially when there are concerns with the adherence to intramuscular therapy or if compliance comes into question. Unlike patients post-RYGB, those undergoing restrictive procedures such as gastric banding and sleeve gastrectomy may be maintained postoperatively on a lower-dose daily vitamin B12 supplementation. Efficacy data of nasal and sublingual routes for maintenance therapy is currently awaited. Conclusion Patients undergoing bariatric surgery must be continuously educated on proper nutrition, the risk of developing significant vitamin B12 deficiency, and the role of supplements in avoiding catastrophic consequences.",
keywords = "Bariatric surgery, Cobalamin, Gastric banding, Gastric bypass, RYGB, Vitamin B",
author = "Shounak Majumder and Jose Soriano and {Louie Cruz}, Allan and Dasanu, {Constantin A.}",
year = "2013",
month = "11",
day = "1",
doi = "10.1016/j.soard.2013.04.017",
language = "English (US)",
volume = "9",
pages = "1013--1019",
journal = "Surgery for Obesity and Related Diseases",
issn = "1550-7289",
publisher = "Elsevier Inc.",
number = "6",

}

TY - JOUR

T1 - Vitamin B12 deficiency in patients undergoing bariatric surgery

T2 - Preventive strategies and key recommendations

AU - Majumder, Shounak

AU - Soriano, Jose

AU - Louie Cruz, Allan

AU - Dasanu, Constantin A.

PY - 2013/11/1

Y1 - 2013/11/1

N2 - Background Advances in bariatric surgery have brought about a paradigm shift in the management of obesity, with benefits extending beyond weight loss. However, nutritional deficiencies are an inherent problem in the postoperative period and often require lifelong supplementation. Vitamin B12, also referred to as cobalamin, is one of the most common micronutrient deficiencies affecting this population. This review explores the pathophysiology of cobalamin deficiency in patients undergoing bariatric surgery and provides an overview of the effectiveness of various available vitamin B12 formulations. Methods To identify the relevant literature, a systematic review of MEDLINE was conducted from the earliest dates through September 2012 for English-language articles describing the prevention and management of vitamin B12 deficiency in patients undergoing bariatric surgery. Results Intramuscular vitamin B12 continues to be the gold standard of therapy for vitamin B12 deficiency, especially in symptomatic patients. In select patients with asymptomatic vitamin B12 deficiency after Roux-en-Y gastric bypass (RYGB), high-dose oral cyanocobalamin should be given a consideration, especially when there are concerns with the adherence to intramuscular therapy or if compliance comes into question. Unlike patients post-RYGB, those undergoing restrictive procedures such as gastric banding and sleeve gastrectomy may be maintained postoperatively on a lower-dose daily vitamin B12 supplementation. Efficacy data of nasal and sublingual routes for maintenance therapy is currently awaited. Conclusion Patients undergoing bariatric surgery must be continuously educated on proper nutrition, the risk of developing significant vitamin B12 deficiency, and the role of supplements in avoiding catastrophic consequences.

AB - Background Advances in bariatric surgery have brought about a paradigm shift in the management of obesity, with benefits extending beyond weight loss. However, nutritional deficiencies are an inherent problem in the postoperative period and often require lifelong supplementation. Vitamin B12, also referred to as cobalamin, is one of the most common micronutrient deficiencies affecting this population. This review explores the pathophysiology of cobalamin deficiency in patients undergoing bariatric surgery and provides an overview of the effectiveness of various available vitamin B12 formulations. Methods To identify the relevant literature, a systematic review of MEDLINE was conducted from the earliest dates through September 2012 for English-language articles describing the prevention and management of vitamin B12 deficiency in patients undergoing bariatric surgery. Results Intramuscular vitamin B12 continues to be the gold standard of therapy for vitamin B12 deficiency, especially in symptomatic patients. In select patients with asymptomatic vitamin B12 deficiency after Roux-en-Y gastric bypass (RYGB), high-dose oral cyanocobalamin should be given a consideration, especially when there are concerns with the adherence to intramuscular therapy or if compliance comes into question. Unlike patients post-RYGB, those undergoing restrictive procedures such as gastric banding and sleeve gastrectomy may be maintained postoperatively on a lower-dose daily vitamin B12 supplementation. Efficacy data of nasal and sublingual routes for maintenance therapy is currently awaited. Conclusion Patients undergoing bariatric surgery must be continuously educated on proper nutrition, the risk of developing significant vitamin B12 deficiency, and the role of supplements in avoiding catastrophic consequences.

KW - Bariatric surgery

KW - Cobalamin

KW - Gastric banding

KW - Gastric bypass

KW - RYGB

KW - Vitamin B

UR - http://www.scopus.com/inward/record.url?scp=84890440347&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84890440347&partnerID=8YFLogxK

U2 - 10.1016/j.soard.2013.04.017

DO - 10.1016/j.soard.2013.04.017

M3 - Review article

C2 - 24091055

AN - SCOPUS:84890440347

VL - 9

SP - 1013

EP - 1019

JO - Surgery for Obesity and Related Diseases

JF - Surgery for Obesity and Related Diseases

SN - 1550-7289

IS - 6

ER -