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Obesity Surgery

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01-01-2011 | Clinical Research

Determinants of Hyperhomocysteinemia After Gastric Bypass Surgery in Obese Subjects

Authors: Séverine Ledoux, Muriel Coupaye, Catherine Bogard, Cristine Clerici, Simon Msika

Published in: Obesity Surgery | Issue 1/2011

Abstract

Background

Effectiveness of gastric bypass (GBP) on reduction of vascular risk factors is well established, but GBP induces nutritional deficits that could reduce the cardiovascular benefit of weight loss. Particularly, hyperhomocysteinemia, now clearly identified as a vascular risk factor, has been described after GBP. The aim of this study was to clarify the factors associated with increased homocysteine concentration after GBP.

Methods

Homocysteine concentration and multiple nutritional parameters were measured in 213 consecutive subjects. One hundred and eight subjects were studied before surgery (control (CT)), 115 one to 6 years after GBP, and 41 both before and 6 months after GBP.

Results

Homocysteine concentration did not differ before and after GBP (9.1 ± 3.2 vs 8.6 ± 3.4 μmol/l), but 94% of subjects had been supplemented with a multivitamin preparation after surgery. The nutritional parameters best correlated with homocysteine concentration both before and after GBP were folate and creatinine concentrations (p < 0.0001). In contrast, vitamin B12 and metabolic parameters (including glucose, insulin, lipids and C-reactive protein) were not associated with homocysteine concentration. After GBP, homocysteine concentration was significantly lower in subjects taking a multivitamin supplementation containing a high dose of folate than those who did not (7.7 ± 2.8 vs 10.1 ± 3.9 μmol/l, p < 0.0001).

Conclusions

The main determinants of homocysteine concentration identified in this study are folate and serum creatinine. Multivitamin supplementation with a high dose of folate prevents hyperhomocysteinemia after GBP.

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Basdevant A, Paita M, Rodde-Dunet MH, et al. A nationwide survey on bariatric surgery in France: two years prospective follow-up. Obes Surg. 2007;17(1):39–44.CrossRefPubMed

Solomon CG, Dluhy RG. Bariatric surgery–quick fix or long-term solution? N Engl J Med. 2004;351(26):2751–3.CrossRefPubMed

Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.CrossRefPubMed

Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142(7):547–59.PubMed

Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52.CrossRefPubMed

Williams DB, Judith CH, Elise HL, et al. Gastric bypass reduces biochemical cardiac risk factors. Surg Obes Relat Dis. 2007;3(1):8–13.CrossRefPubMed

Ukleja A, Stone RL. Medical and gastroenterologic management of the post-bariatric surgery patient. J Clin Gastroenterol. 2004;38(4):312–21.CrossRefPubMed

Shah M, Simha V, Garg A. Review: long-term impact of bariatric surgery on body weight, comorbidities, and nutritional status. J Clin Endocrinol Metab. 2006;91(11):4223–31.CrossRefPubMed

Coupaye M, Puchaux K, Bogard C, et al. Nutritional consequences of adjustable gastric banding and gastric bypass: a 1-year prospective study. Obes Surg. 2009;19(1):56–65.CrossRefPubMed

10.

Antoniades C, Antonopoulos AS, Tousoulis D, et al. Homocysteine and coronary atherosclerosis: from folate fortification to the recent clinical trials. Eur Heart J. 2009;30(1):6–15.CrossRefPubMed

11.

McNulty H, Pentieva K, Hoey L, et al. Homocysteine, B-vitamins and CVD. Proc Nutr Soc. 2008;67(2):232–7.CrossRefPubMed

12.

Maron BA, Loscalzo J. The treatment of hyperhomocysteinemia. Annu Rev Med. 2009;60:39–54.CrossRefPubMed

13.

Jacovina AT, Deora AB, Ling Q, et al. Homocysteine inhibits neoangiogenesis in mice through blockade of annexin A2-dependent fibrinolysis. J Clin Invest. 2009;119(11):3384–94.PubMed

14.

Borson-Chazot F, Harthe C, Teboul F, et al. Occurrence of hyperhomocysteinemia 1 year after gastroplasty for severe obesity. J Clin Endocrinol Metab. 1999;84(2):541–5.CrossRefPubMed

15.

Dixon JB, Dixon ME, O'Brien PE. Elevated homocysteine levels with weight loss after Lap-Band surgery: higher folate and vitamin B12 levels required to maintain homocysteine level. Int J Obes Relat Metab Disord. 2001;25(2):219–27.CrossRefPubMed

16.

Jazet IM, de Groot GH, Tuijnebreyer WE, et al. Cardiovascular risk factors after bariatric surgery: Do patients gain more than expected from their substantial weight loss? Eur J Intern Med. 2007;18(1):39–43.CrossRefPubMed

17.

Sheu WH, Wu HS, Wang CW, et al. Elevated plasma homocysteine concentrations six months after gastroplasty in morbidly obese subjects. Intern Med. 2001;40(7):584–8.CrossRefPubMed

18.

Sledzinski T, Goyke E, Smolenski RT, et al. Decrease in serum protein carbonyl groups concentration and maintained hyperhomocysteinemia in patients undergoing bariatric surgery. Obes Surg. 2009;19(3):321–6.CrossRefPubMed

19.

Toh SY, Zarshenas N, Jorgensen J. Prevalence of nutrient deficiencies in bariatric patients. Nutrition. 2009;25(11–12):1150–6.CrossRefPubMed

20.

Gomez-Ambrosi J, Pastor C, Salvador J, et al. Influence of waist circumference on the metabolic risk associated with impaired fasting glucose: effect of weight loss after gastric bypass. Obes Surg. 2007;17(5):585–91.CrossRefPubMed

21.

Rhode BM, Arseneau P, Cooper BA, et al. Vitamin B-12 deficiency after gastric surgery for obesity. Am J Clin Nutr. 1996;63(1):103–9.PubMed

22.

Msika S. Surgical treatment of morbid obesity by gastrojejunal bypass using laparoscopic roux-en-Y (gastric short circuit). J Chir (Paris). 2002;139(4):214–7.

23.

Fried M, Hainer V, Basdevant A, et al. Inter-disciplinary European guidelines on surgery of severe obesity. Int J Obes (Lond). 2007;31(4):569–77.

24.

Mikael LG, Wang XL, Wu Q, et al. Hyperhomocysteinemia is associated with hypertriglyceridemia in mice with methylenetetrahydrofolate reductase deficiency. Mol Genet Metab. 2009;98(1–2):187–94.CrossRefPubMed

25.

Nouri-Majalan N, Masoumi R, Nafisi R, et al. Relationship between serum homocysteine and other parameters in renal transplant patients. Transplant Proc. 2009;41(7):2826–8.CrossRefPubMed

26.

Varela-Moreiras G, Murphy MM, Scott JM. Cobalamin, folic acid, and homocysteine. Nutr Rev. 2009;67 Suppl 1:S69–72.CrossRefPubMed

27.

Henning BF, Tepel M, Riezler R, et al. Vitamin supplementation during weight reduction–favourable effect on homocysteine metabolism. Res Exp Med (Berl). 1998;198(1):37–42.CrossRef

28.

Meigs JB, Jacques PF, Selhub J, et al. Fasting plasma homocysteine levels in the insulin resistance syndrome: the Framingham offspring study. Diab Care. 2001;24(8):1403–10.CrossRef

29.

Konukoglu D, Serin O, Turhan MS. Plasma total homocysteine concentrations in obese and non-obese female patients with type 2 diabetes mellitus; its relations with plasma oxidative stress and nitric oxide levels. Clin Hemorheol Microcirc. 2005;33(1):41–6.PubMed

30.

Gil-Prieto R, Hernandez V, Cano B, et al. Plasma homocysteine in adolescents depends on the interaction between methylenetetrahydrofolate reductase genotype, lipids and folate: a seroepidemiological study. Nutr Metab (Lond). 2009;6:39.CrossRef

31.

Taskinen MR, Sullivan DR, Ehnholm C, et al. Relationships of HDL cholesterol, ApoA-I, and ApoA-II with homocysteine and creatinine in patients with type 2 diabetes treated with fenofibrate. Arterioscler Thromb Vasc Biol. 2009;29(6):950–5.CrossRefPubMed

32.

Serpa Neto A, Bianco Rossi FM, Dal Moro Amarante R, et al. Effect of weight loss after Roux-en-Y gastric bypass, on renal function and blood pressure in morbidly obese patients. J Nephrol. 2009;22(5):637–46.PubMed

33.

Oh R, Brown DL. Vitamin B12 deficiency. Am Fam Physician. 2003;67(5):979–86.PubMed

34.

Mason JB, Miller JW. The effects of vitamins B12, B6, and folate on blood homocysteine levels. Ann NY Acad Sci. 1992;669:197–203. discussion 203-194.CrossRefPubMed

35.

Hoey L, McNulty H, Strain JJ. Studies of biomarker responses to intervention with riboflavin: a systematic review. Am J Clin Nutr. 2009;89(6):1960S–80.CrossRefPubMed

36.

Heidarian E, Amini M, Parham M, et al. Effect of zinc supplementation on serum homocysteine in type 2 diabetic patients with microalbuminuria. Rev Diabet Stud. 2009;6(1):64–70.CrossRefPubMed

37.

Sauer J, Mason JB, Choi SW. Too much folate: a risk factor for cancer and cardiovascular disease? Curr Opin Clin Nutr Metab Care. 2009;12(1):30–6.CrossRefPubMed

38.

Koh KK, Oh PC, Quon MJ. Does reversal of oxidative stress and inflammation provide vascular protection? Cardiovasc Res. 2009;81(4):649–59.CrossRefPubMed

39.

Pocobelli G, Peters U, Kristal AR, et al. Use of supplements of multivitamins, vitamin C, and vitamin E in relation to mortality. Am J Epidemiol. 2009;170(4):472–83.CrossRefPubMed

40.

Vollset SE, Refsum H, Irgens LM, et al. Plasma total homocysteine, pregnancy complications, and adverse pregnancy outcomes: the Hordaland Homocysteine study. Am J Clin Nutr. 2000;71(4):962–8.PubMed

Title: Determinants of Hyperhomocysteinemia After Gastric Bypass Surgery in Obese Subjects
Authors: Séverine Ledoux
Muriel Coupaye
Catherine Bogard
Cristine Clerici
Simon Msika
Publication date: 01-01-2011
Publisher: Springer-Verlag
Published in: Obesity Surgery / Issue 1/2011
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-010-0269-x

At a glance: The STEP trials

Springer Medicine

Determinants of Hyperhomocysteinemia After Gastric Bypass Surgery in Obese Subjects

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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