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The Effects of Bariatric Surgery on Vitamin B Status and Mental Health.
Al Mansoori, A, Shakoor, H, Ali, HI, Feehan, J, Al Dhaheri, AS, Cheikh Ismail, L, Bosevski, M, Apostolopoulos, V, Stojanovska, L
Nutrients. 2021;(4)
Abstract
Diet is a modifiable factor that ensures optimal growth, biochemical performance, improved mood and mental functioning. Lack of nutrients, notably vitamin B, has an impact on human health and wellbeing. The United Arab Emirates is facing a serious problem of micronutrient deficiencies because of the growing trend for bariatric surgery, including Roux-en-Y gastric bypass and sleeve gastrectomy. People undergoing bariatric surgery are at high risk of developing neurological, cognitive, and mental disabilities and cardiovascular disease due to deficiency in vitamin B. Vitamin B is involved in neurotransmitter synthesis, including γ-aminobutyric acid, serotonin, dopamine, and noradrenaline. Deficiency of vitamin B increases the risk of depression, anxiety, dementia and Alzheimer's disease. In addition, vitamin B deficiency can disrupt the methylation of homocysteine, leading to hyperhomocysteinemia. Elevated homocysteine levels are detrimental to human health. Vitamin B deficiency also suppresses immune function, increases the production of pro-inflammatory cytokines and upregulates NF-κB. Considering the important functions of vitamin B and the severe consequences associated with its deficiency following bariatric surgery, proper dietary intervention and administration of adequate supplements should be considered to prevent negative clinical outcomes.
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Immunometabolism, Micronutrients, and Bariatric Surgery: The Use of Transcriptomics and Microbiota-Targeted Therapies.
Galyean, S, Sawant, D, Shin, AC
Mediators of inflammation. 2020;:8862034
Abstract
BACKGROUND Obesity is associated with the gut microbiota and decreased micronutrient status. Bariatric surgery is a recommended therapy for obesity. It can positively affect the composition of the gut bacteria but also disrupt absorption of nutrients. Low levels of micronutrients can affect metabolic processes, like glycolysis, TCA cycle, and oxidative phosphorylation, that are associated with the immune system also known as immunometabolism. METHODS MEDLINE, PUBMED, and Google Scholar were searched. Articles involving gut microbiome, micronutrient deficiency, gut-targeted therapies, transcriptome analysis, micronutrient supplementation, and bariatric surgery were included. RESULTS Studies show that micronutrients play a pivotal role in the intestinal immune system and regulating immunometabolism. Research demonstrates that gut-targeting therapies may improve the microbiome health for bariatric surgery populations. There is limited research that examines the role of micronutrients in modulating the gut microbiota among the bariatric surgery population. CONCLUSIONS Investigations are needed to understand the influence that micronutrient deficiencies have on the gut, particularly immunometabolism. Nutritional transcriptomics shows great potential in providing this type of analysis to develop gut-modulating therapies as well as more personalized nutrition recommendations for bariatric surgery patients.
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Interplay between the Adaptive Immune System and Insulin Resistance in Weight Loss Induced by Bariatric Surgery.
Villarreal-Calderón, JR, Cuéllar, RX, Ramos-González, MR, Rubio-Infante, N, Castillo, EC, Elizondo-Montemayor, L, García-Rivas, G
Oxidative medicine and cellular longevity. 2019;:3940739
Abstract
Low-grade chronic inflammation plays a pivotal role among other pathophysiological mechanisms involved in obesity. Innate and adaptive immune cells undergo systemic proinflammatory polarization that gives rise to an increased secretion of proinflammatory cytokines, which in turn leads to insulin resistance. Bariatric surgery is currently the most effective treatment for obesity, as it brings on significant weight loss, glucose metabolism improvement, and a decrease in systemic inflammation biomarkers. After bariatric surgery, several changes have been reported to occur in adaptive immunity, including reduction in CD4+ and CD8+ T cell counts, a decrease in the Th1/Th2 ratio, an increase in B regulatory cells, and reduction in proinflammatory cytokine secretion. Overall, there seems to be a major shift in several lymphocyte populations from a proinflammatory to an anti-inflammatory phenotype. Furthermore, increased antioxidant activity and reduced lipid and DNA oxidation products have been reported after bariatric surgery in circulating mononuclear cells. This paper highlights the shift in the adaptive immune system in response to weight loss and improved insulin sensitivity, as well as the interplay between immunological and metabolic adaptations as a result of bariatric surgery. Finally, based on data from research, we propose several mechanisms such as changes in adaptive immune cell phenotypes and their by-products, recruitment in adipose tissue, reduced oxidative stress, and modification in metabolic substrate availability as drivers to reduce low-grade chronic inflammation after bariatric surgery in severe obesity.
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What Bariatric Surgery Can Teach Us About Endoluminal Treatment of Obesity and Metabolic Disorders.
Kaplan, LM
Gastrointestinal endoscopy clinics of North America. 2017;(2):213-231
Abstract
Bariatric surgical procedures, including gastric bypass, vertical sleeve gastrectomy, and biliopancreatic diversion, are the most effective and durable treatments for obesity. In addition, These operations induce metabolic changes that provide weight-independent improvement in type 2 diabetes, fatty liver disease and other metabolic disorders. Initially thought to work by mechanical restriction of food intake or malabsorption of ingested nutrients, these procedures are now known to work through complex changes in neuroendocrine and immune signals emanating from the gut, including peptide hormones, bile acids, vagal nerve activity, and metabolites generated by the gut microbiota, all collaborating to reregulate appetite, food preference, and energy expenditure. Development of less invasive means of achieving these benefits would allow much greater dissemination of effective, gastrointestinal (GI)-targeted therapies for obesity and metabolic disorders. To reproduce the benefits of bariatric surgery, however, these endoscopic procedures and devices will need to mimic the physiological rather than the mechanical effects of these operations.
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Impact of Bariatric Surgery on White Adipose Tissue Inflammation.
Labrecque, J, Laforest, S, Michaud, A, Biertho, L, Tchernof, A
Canadian journal of diabetes. 2017;(4):407-417
Abstract
Excess fat mass accumulation can lead to a wide range of metabolic and cardiovascular complications resulting from dysfunctional adipose tissue (AT). The latter includes immune cell infiltration and altered secretion of anti- and proinflammatory mediators, which contribute to systemic, low-grade inflammation. In this article, we review available literature documenting the impact of surgery-induced weight loss on macrophage infiltration and tissue expression or circulating levels of a broad spectrum of inflammatory mediators. Reports generally show that bariatric surgery may reverse both macrophage infiltration and the altered secretory profile observed in the AT of patients with severe obesity. However, further studies are needed to confirm or elucidate the effects of specific bariatric surgery procedures on white AT inflammation and to shed light on the mechanisms involved in these effects.
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Vitamin D status following bariatric surgery: implications and recommendations.
Cole, AJ, Beckman, LM, Earthman, CP
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition. 2014;(6):751-8
Abstract
Individuals with extreme obesity who qualify for bariatric surgery are frequently vitamin D deficient before and after surgery. The anatomical changes that occur during some bariatric procedures may lead to decreased absorption of vitamin D, although vitamin D absorption and metabolism has not been quantified or compared across surgeries, and multiple other factors could influence vitamin D status in these individuals. Vitamin D treatment and dosing studies show that there is variability in how individuals respond to supplementation regimens regardless of the bariatric procedure. It is unknown if improving vitamin D status before and/or after bariatric surgery can affect health-related outcomes in this population beyond the traditional roles of vitamin D. Vitamin D has been purported to positively influence a variety of obesity-related comorbidities. Furthermore, in light of the potential role of vitamin D in immunity and inflammation, it seems important to consider the ramifications of vitamin D deficiency in the postbariatric individual in the critical care setting and particularly in the context of aging. Additional research is needed to develop evidence-based guidelines for optimal treatment of vitamin D deficiency in individuals before and after bariatric surgery and to determine the impact of vitamin D repletion on non-bone health-related outcomes in these individuals.
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Mineral malnutrition following bariatric surgery.
Gletsu-Miller, N, Wright, BN
Advances in nutrition (Bethesda, Md.). 2013;(5):506-17
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Abstract
Moderate/severe obesity is on the rise in the United States. Weight management includes bariatric surgery, which is effective and can alleviate morbidity and mortality from obesity-associated diseases. However, many individuals are dealing with nutritional complications. Risk factors include: 1) preoperative malnutrition (e.g., vitamin D, iron); 2) decreased food intake (due to reduced hunger and increased satiety, food intolerances, frequent vomiting); 3) inadequate nutrient supplementation (due to poor compliance with multivitamin/multimineral regimen, insufficient amounts of vitamins and/or minerals in supplements); 4) nutrient malabsorption; and 5) inadequate nutritional support (due to lack of follow-up, insufficient monitoring, difficulty in recognizing symptoms of deficiency). For some nutrients (e.g., protein, vitamin B-12, vitamin D), malnutrition issues are reasonably addressed through patient education, routine monitoring, and effective treatment strategies. However, there is little attention paid to other nutrients (e.g., zinc, copper), which if left untreated may have devastating consequences (e.g., hair loss, poor immunity, anemia, defects in neuro-muscular function). This review focuses on malnutrition in essential minerals, including calcium (and vitamin D), iron, zinc, and copper, which commonly occur following popular bariatric procedures. There will be emphasis on the complexities, including confounding factors, related to screening, recognition of symptoms, and, when available, current recommendations for treatment. There is an exceptionally high risk of malnutrition in adolescents and pregnant women and their fetuses, who may be vulnerable to problems in growth and development. More research is required to inform evidence-based recommendations for improving nutritional status following bariatric surgery and optimizing weight loss, metabolic, and nutritional outcomes.
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Metabolic surgery and cancer: protective effects of bariatric procedures.
Ashrafian, H, Ahmed, K, Rowland, SP, Patel, VM, Gooderham, NJ, Holmes, E, Darzi, A, Athanasiou, T
Cancer. 2011;(9):1788-99
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Abstract
The worldwide epidemic of obesity and the global incidence of cancer are both increasing. There is now epidemiological evidence to support a correlation between obesity, weight gain, and some cancers. Metabolic or bariatric surgery can provide sustained weight loss and reduced obesity-related mortality. These procedures can also improve the metabolic profile to decrease cardiovascular risk and resolve diabetes in morbidly obese patients. The operations offer several physiological steps, the so-called BRAVE effects: 1) bile flow alteration, 2) reduction of gastric size, 3) anatomical gut rearrangement and altered flow of nutrients, 4) vagal manipulation and 5) enteric gut hormone modulation. Metabolic operations are also associated with a significant reduction of cancer incidence and mortality. The cancer-protective role of metabolic surgery is strongest for female obesity-related tumors; however, the underlying mechanisms may involve both weight-dependent and weight-independent effects. These include the improvement of insulin resistance with attenuation of the metabolic syndrome as well as decreased oxidative stress and inflammation in addition to the beneficial modulation of sex steroids, gut hormones, cellular energetics, immune system, and adipokines. Elucidating the precise metabolic mechanisms of cancer prevention by metabolic surgery can increase our understanding of how obesity, diabetes, and metabolic syndrome are associated with cancer. It may also offer novel treatment strategies in the management of tumor generation and growth.
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Adiposopathy and bariatric surgery: is 'sick fat' a surgical disease?
Bays, HE, Laferrère, B, Dixon, J, Aronne, L, González-Campoy, JM, Apovian, C, Wolfe, BM, ,
International journal of clinical practice. 2009;(9):1285-300
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Abstract
OBJECTIVE To review how bariatric surgery in obese patients may effectively treat adiposopathy (pathogenic adipose tissue or 'sick fat'), and to provide clinicians a rationale as to why bariatric surgery is a potential treatment option for overweight patients with type 2 diabetes, hypertension, and dyslipidaemia. METHODS A group of clinicians, researchers, and surgeons, all with a background in treating obesity and the adverse metabolic consequences of excessive body fat, reviewed the medical literature regarding the improvement in metabolic disease with bariatric surgery. RESULTS Bariatric surgery improves metabolic disease through multiple, likely interrelated mechanisms including: (i) initial acute fasting and diminished caloric intake inherent with many gastrointestinal surgical procedures; (ii) favourable alterations in gastrointestinal endocrine and immune responses, especially with bariatric surgeries that reroute nutrient gastrointestinal delivery such as gastric bypass procedures; and (iii) a decrease in adipose tissue mass. Regarding adipose tissue mass, during positive caloric balance, impaired adipogenesis (resulting in limitations in adipocyte number or size) and visceral adiposity are anatomic manifestations of pathogenic adipose tissue (adiposopathy). This may cause adverse adipose tissue endocrine and immune responses that lead to metabolic disease. A decrease in adipocyte size and decrease in visceral adiposity, as often occurs with bariatric surgery, may effectively improve adiposopathy, and thus effectively treat metabolic disease. It is the relationship between bariatric surgery and its effects upon pathogenic adipose tissue that is the focus of this discussion. CONCLUSIONS In selective obese patients with metabolic disease who are refractory to medical management, adiposopathy is a surgical disease.
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Potential impacts of nutritional deficiency of postbariatric patients on body contouring surgery.
Agha-Mohammadi, S, Hurwitz, DJ
Plastic and reconstructive surgery. 2008;(6):1901-1914
Abstract
BACKGROUND Bariatric surgery is currently the most effective method of sustainable weight loss for the morbidly obese patient. In the months to years that follow, many patients develop nutritional deficiencies of proteins, vitamins, and minerals as they present for plastic surgery and body contouring operations. METHODS The aim of this review is to highlight the nutritional deficiencies of postbariatric patients as related to their planned body contouring surgery. This review was prepared by an extensive search of the PubMed and Ovid databases for terms such as "bariatric surgery," "nutritional deficiency," "wound healing," and "immune response." RESULTS The current review indicates that many of the deficient macronutrients and micronutrients of postbariatric patients are implicated in wound healing and optimal immune response. CONCLUSIONS Although the optimal nutrient intake to promote wound healing is unknown, it is clear that proteins, vitamin A, vitamin C, vitamin B complex, arginine, glutamine, iron, zinc, and selenium can have significant beneficial effects on wound healing and optimization of the immune system. Furthermore, vitamin B complex can reduce homocysteine levels, which is inversely associated with the risk of venous thrombosis and endothelial cell dysfunction. The authors' preliminary experience with a nutritional blend that contains all of the aforementioned ingredients has significantly reduced their complication rates.