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Published in: Obesity Surgery 9/2018

01-09-2018 | Original Contributions

Probiotic Supplementation in Morbid Obese Patients Undergoing One Anastomosis Gastric Bypass-Mini Gastric Bypass (OAGB-MGB) Surgery: a Randomized, Double-Blind, Placebo-Controlled, Clinical Trial

Authors: Zohreh Karbaschian, Zeinab Mokhtari, Abdolreza Pazouki, Ali Kabir, Mahdi Hedayati, Somayeh Soleymanzadeh Moghadam, Parvin Mirmiran, Azita Hekmatdoost

Published in: Obesity Surgery | Issue 9/2018

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Abstract

Background

Bariatric surgery is known as one of the most effective treatments for sustainable weight loss; however, it may be associated with some complications. This study was designed to examine the effects of probiotic supplementation on some morbidities related to this surgery.

Methods

This was a placebo-controlled, double-blind, randomized clinical trial on morbid obese patients referred for One Anastomosis Gastric Bypass- Mini Gastric Bypass (OAGB-MGB) surgery to a tertiary referral center. Patients were assigned to receive a probiotic supplement (Familact®) or placebo from 4 weeks prior to surgery to 12 weeks after surgery. Anthropometric, biochemical, and inflammatory indices were evaluated at the beginning and the end of the study.

Results

At the end of study, significant improvements in some serum inflammatory markers, vitamin D status, and anthropometric measurements were observed (p < 0.05), which were significantly more in probiotic group rather than placebo group (p < 0.05). Moreover, significant improvements in glycemic indices and lipid profile were observed in both groups; however, these changes were not significantly different between the groups. There was no significant difference in serum levels of vitamin B12, folate, and homocysteine between groups at week 16 of the study.

Discussion

Our results indicate that probiotic supplementation promotes inflammatory markers, body weight loss, and status of vitamin D in patients undergoing OAGB-MGB bypass. Whether these findings will sustain in longer treatment duration remained to be elucidated in future studies.

Trial Registration

This study has been registered at Clinicaltrial.​gov with registration number NCT02708589.
Literature
1.
go back to reference Swinburn BA, Sacks G, Hall KD, et al. The global obesity pandemic: shaped by global drivers and local environments. Lancet. 2011;378(9793):804–14.CrossRef Swinburn BA, Sacks G, Hall KD, et al. The global obesity pandemic: shaped by global drivers and local environments. Lancet. 2011;378(9793):804–14.CrossRef
2.
go back to reference Gregor MF, Hotamisligil GS. Inflammatory mechanisms in obesity. Annu Rev Immunol. 2011;29:415–45.CrossRef Gregor MF, Hotamisligil GS. Inflammatory mechanisms in obesity. Annu Rev Immunol. 2011;29:415–45.CrossRef
3.
go back to reference Mahawar KK, Kumar P, Carr WRJ, et al. Current status of mini-gastric bypass. Journal of Minimal Access Surgery. 2016;12(4):305–10.CrossRef Mahawar KK, Kumar P, Carr WRJ, et al. Current status of mini-gastric bypass. Journal of Minimal Access Surgery. 2016;12(4):305–10.CrossRef
4.
go back to reference Almalki OM, Lee W-J, Chen J-C, et al. Revisional gastric bypass for failed restrictive procedures: comparison of single-anastomosis (mini-) and Roux-en-Y gastric bypass. Obes Surg. 2017;27(11):2861–2867 Almalki OM, Lee W-J, Chen J-C, et al. Revisional gastric bypass for failed restrictive procedures: comparison of single-anastomosis (mini-) and Roux-en-Y gastric bypass. Obes Surg. 2017;27(11):2861–2867
5.
go back to reference Maciejewski ML, Arterburn DE, Van Scoyoc L, et al. Bariatric surgery and long-term durability of weight loss. JAMA surgery. 2016;151(11):1046–55.CrossRef Maciejewski ML, Arterburn DE, Van Scoyoc L, et al. Bariatric surgery and long-term durability of weight loss. JAMA surgery. 2016;151(11):1046–55.CrossRef
6.
go back to reference Mahawar KK, Jennings N, Brown J, et al. "Mini" gastric bypass: systematic review of a controversial procedure. Obes Surg. 2013;23(11):1890–8.CrossRef Mahawar KK, Jennings N, Brown J, et al. "Mini" gastric bypass: systematic review of a controversial procedure. Obes Surg. 2013;23(11):1890–8.CrossRef
7.
go back to reference Tack J, Deloose E. Complications of bariatric surgery: dumping syndrome, reflux and vitamin deficiencies. Best Pract Res Clin Gastroenterol. 2014;28(4):741–9.CrossRef Tack J, Deloose E. Complications of bariatric surgery: dumping syndrome, reflux and vitamin deficiencies. Best Pract Res Clin Gastroenterol. 2014;28(4):741–9.CrossRef
8.
go back to reference Faintuch J, Ishida RK, Jacabi M, et al. Increased gastric cytokine production after Roux-en-Y gastric bypass for morbid obesity. Arch Surg. 2007;142(10):962–8.CrossRef Faintuch J, Ishida RK, Jacabi M, et al. Increased gastric cytokine production after Roux-en-Y gastric bypass for morbid obesity. Arch Surg. 2007;142(10):962–8.CrossRef
9.
go back to reference Van Dielen F, Buurman W, Hadfoune M, et al. Macrophage inhibitory factor, plasminogen activator inhibitor-1, other acute phase proteins, and inflammatory mediators normalize as a result of weight loss in morbidly obese subjects treated with gastric restrictive surgery. J Clin Endocrinol Metab. 2004;89(8):4062–8.CrossRef Van Dielen F, Buurman W, Hadfoune M, et al. Macrophage inhibitory factor, plasminogen activator inhibitor-1, other acute phase proteins, and inflammatory mediators normalize as a result of weight loss in morbidly obese subjects treated with gastric restrictive surgery. J Clin Endocrinol Metab. 2004;89(8):4062–8.CrossRef
10.
go back to reference Dalmas E, Rouault C, Abdennour M, et al. Variations in circulating inflammatory factors are related to changes in calorie and carbohydrate intakes early in the course of surgery-induced weight reduction. Am J Clin Nutr. 2011;94(2):450–8.CrossRef Dalmas E, Rouault C, Abdennour M, et al. Variations in circulating inflammatory factors are related to changes in calorie and carbohydrate intakes early in the course of surgery-induced weight reduction. Am J Clin Nutr. 2011;94(2):450–8.CrossRef
11.
go back to reference Pitsouni E, Alexiou V, Saridakis V, et al. Does the use of probiotics/synbiotics prevent postoperative infections in patients undergoing abdominal surgery? A meta-analysis of randomized controlled trials. Eur J Clin Pharmacol. 2009;65(6):561–70.CrossRef Pitsouni E, Alexiou V, Saridakis V, et al. Does the use of probiotics/synbiotics prevent postoperative infections in patients undergoing abdominal surgery? A meta-analysis of randomized controlled trials. Eur J Clin Pharmacol. 2009;65(6):561–70.CrossRef
12.
go back to reference Cox AJ, West NP, Cripps AW. Obesity, inflammation, and the gut microbiota. The lancet Diabetes & endocrinology. 2015;3(3):207–15.CrossRef Cox AJ, West NP, Cripps AW. Obesity, inflammation, and the gut microbiota. The lancet Diabetes & endocrinology. 2015;3(3):207–15.CrossRef
13.
go back to reference Eslamparast T, Eghtesad S, Hekmatdoost A, et al. Probiotics and nonalcoholic fatty liver disease. Middle East J Dig Dis. 2013;5(3):129–36. Eslamparast T, Eghtesad S, Hekmatdoost A, et al. Probiotics and nonalcoholic fatty liver disease. Middle East J Dig Dis. 2013;5(3):129–36.
14.
go back to reference Eslamparast T, Poustchi H, Zamani F, et al. Synbiotic supplementation in nonalcoholic fatty liver disease: a randomized, double-blind, placebo-controlled pilot study. Am J Clin Nutr. 2014;99(3):535–42.CrossRef Eslamparast T, Poustchi H, Zamani F, et al. Synbiotic supplementation in nonalcoholic fatty liver disease: a randomized, double-blind, placebo-controlled pilot study. Am J Clin Nutr. 2014;99(3):535–42.CrossRef
15.
go back to reference Eslamparast T, Zamani F, Hekmatdoost A, et al. Effects of synbiotic supplementation on insulin resistance in subjects with the metabolic syndrome: a randomised, double-blind, placebo-controlled pilot study. Br J Nutr. 2014;112(3):438–45.CrossRef Eslamparast T, Zamani F, Hekmatdoost A, et al. Effects of synbiotic supplementation on insulin resistance in subjects with the metabolic syndrome: a randomised, double-blind, placebo-controlled pilot study. Br J Nutr. 2014;112(3):438–45.CrossRef
16.
go back to reference Hekmatdoost A, Feizabadi MM, Djazayery A, et al. The effect of dietary oils on cecal microflora in experimental colitis in mice. Indian J Gastroenterol. 2008;27(5):186–9. Hekmatdoost A, Feizabadi MM, Djazayery A, et al. The effect of dietary oils on cecal microflora in experimental colitis in mice. Indian J Gastroenterol. 2008;27(5):186–9.
17.
go back to reference Mofidi F, Poustchi H, Yari Z, et al. Synbiotic supplementation in lean patients with non-alcoholic fatty liver disease: a pilot, randomised, double-blind, placebo-controlled, clinical trial. Br J Nutr. 2017;117(5):662–8.CrossRef Mofidi F, Poustchi H, Yari Z, et al. Synbiotic supplementation in lean patients with non-alcoholic fatty liver disease: a pilot, randomised, double-blind, placebo-controlled, clinical trial. Br J Nutr. 2017;117(5):662–8.CrossRef
18.
go back to reference Mofidi F, Yari Z, Poustchi H, et al. Effects of synbiotics supplementation in lean patients with nonalcoholic fatty liver disease: study protocol of a pilot randomized double-blind clinical trial. Arch Iran Med. 2016;19(4):282–4. Mofidi F, Yari Z, Poustchi H, et al. Effects of synbiotics supplementation in lean patients with nonalcoholic fatty liver disease: study protocol of a pilot randomized double-blind clinical trial. Arch Iran Med. 2016;19(4):282–4.
19.
go back to reference Mokhtari Z, Gibson DL, Hekmatdoost A. Nonalcoholic fatty liver disease, the gut microbiome, and diet. Adv Nutr. 2017;8(2):240–52.CrossRef Mokhtari Z, Gibson DL, Hekmatdoost A. Nonalcoholic fatty liver disease, the gut microbiome, and diet. Adv Nutr. 2017;8(2):240–52.CrossRef
20.
go back to reference Shavakhi A, Minakari M, Firouzian H, et al. Effect of a probiotic and metformin on liver aminotransferases in non-alcoholic steatohepatitis: a double blind randomized clinical trial. Int J Prev Med. 2013;4(5):531–7. Shavakhi A, Minakari M, Firouzian H, et al. Effect of a probiotic and metformin on liver aminotransferases in non-alcoholic steatohepatitis: a double blind randomized clinical trial. Int J Prev Med. 2013;4(5):531–7.
21.
go back to reference Ley RE, Turnbaugh PJ, Klein S, et al. Microbial ecology: human gut microbes associated with obesity. Nature. 2006;444(7122):1022–3. Ley RE, Turnbaugh PJ, Klein S, et al. Microbial ecology: human gut microbes associated with obesity. Nature. 2006;444(7122):1022–3.
22.
go back to reference Woodard GA, Encarnacion B, Downey JR, et al. Probiotics improve outcomes after Roux-en-Y gastric bypass surgery: a prospective randomized trial. J Gastrointest Surg. 2009;13(7):1198–204.CrossRef Woodard GA, Encarnacion B, Downey JR, et al. Probiotics improve outcomes after Roux-en-Y gastric bypass surgery: a prospective randomized trial. J Gastrointest Surg. 2009;13(7):1198–204.CrossRef
23.
go back to reference Sabate JM, Coupaye M, Ledoux S, et al. Consequences of small intestinal bacterial overgrowth in obese patients before and after bariatric surgery. Obes Surg. 2017;27(3):599–605.CrossRef Sabate JM, Coupaye M, Ledoux S, et al. Consequences of small intestinal bacterial overgrowth in obese patients before and after bariatric surgery. Obes Surg. 2017;27(3):599–605.CrossRef
24.
go back to reference Stoll LL, Denning GM, Weintraub NL. Potential role of endotoxin as a proinflammatory mediator of atherosclerosis. Arterioscler Thromb Vasc Biol. 2004;24(12):2227–36.CrossRef Stoll LL, Denning GM, Weintraub NL. Potential role of endotoxin as a proinflammatory mediator of atherosclerosis. Arterioscler Thromb Vasc Biol. 2004;24(12):2227–36.CrossRef
25.
go back to reference Hegazy SK, El-Bedewy MM. Effect of probiotics on pro-inflammatory cytokines and NF-κB activation in ulcerative colitis. World J Gastroenterol: WJG. 2010;16(33):4145–51.CrossRef Hegazy SK, El-Bedewy MM. Effect of probiotics on pro-inflammatory cytokines and NF-κB activation in ulcerative colitis. World J Gastroenterol: WJG. 2010;16(33):4145–51.CrossRef
26.
go back to reference Ashraf R, Shah NP. Immune system stimulation by probiotic microorganisms. Crit Rev Food Sci Nutr. 2014;54(7):938–56.CrossRef Ashraf R, Shah NP. Immune system stimulation by probiotic microorganisms. Crit Rev Food Sci Nutr. 2014;54(7):938–56.CrossRef
27.
go back to reference Dror T, Dickstein Y, Dubourg G, et al. Microbiota manipulation for weight change. Microb Pathog. 2017;106:146–61.CrossRef Dror T, Dickstein Y, Dubourg G, et al. Microbiota manipulation for weight change. Microb Pathog. 2017;106:146–61.CrossRef
28.
go back to reference LeBlanc J, Laiño J, del Valle MJ, et al. B-group vitamin production by lactic acid bacteria—current knowledge and potential applications. J Appl Microbiol. 2011;111(6):1297–309.CrossRef LeBlanc J, Laiño J, del Valle MJ, et al. B-group vitamin production by lactic acid bacteria—current knowledge and potential applications. J Appl Microbiol. 2011;111(6):1297–309.CrossRef
29.
go back to reference Jones ML, Martoni CJ, Prakash S. Oral supplementation with probiotic L. reuteri NCIMB 30242 increases mean circulating 25-hydroxyvitamin D: a post hoc analysis of a randomized controlled trial. The Journal of Clinical Endocrinology & Metabolism. 2013;98(7):2944–51.CrossRef Jones ML, Martoni CJ, Prakash S. Oral supplementation with probiotic L. reuteri NCIMB 30242 increases mean circulating 25-hydroxyvitamin D: a post hoc analysis of a randomized controlled trial. The Journal of Clinical Endocrinology & Metabolism. 2013;98(7):2944–51.CrossRef
30.
go back to reference Vargas-Ruiz AG, Hernández-Rivera G, Herrera MF. Prevalence of iron, folate, and vitamin B12 deficiency anemia after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2008;18(3):288–93.CrossRef Vargas-Ruiz AG, Hernández-Rivera G, Herrera MF. Prevalence of iron, folate, and vitamin B12 deficiency anemia after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2008;18(3):288–93.CrossRef
31.
go back to reference Sherf-Dagan S, Zelber-Sagi S, Zilberman-Schapira G, et al. Probiotics administration following sleeve gastrectomy surgery: a randomized double-blind trial. Int J Obes. 2017;1:9. Sherf-Dagan S, Zelber-Sagi S, Zilberman-Schapira G, et al. Probiotics administration following sleeve gastrectomy surgery: a randomized double-blind trial. Int J Obes. 2017;1:9.
32.
go back to reference Chen J-C, Lee W-J, Tsou J-J, et al. Effect of probiotics on postoperative quality of gastric bypass surgeries: a prospective randomized trial. Surg Obes Relat Dis. 2016;12(1):57–61.CrossRef Chen J-C, Lee W-J, Tsou J-J, et al. Effect of probiotics on postoperative quality of gastric bypass surgeries: a prospective randomized trial. Surg Obes Relat Dis. 2016;12(1):57–61.CrossRef
33.
go back to reference Initiative, N.O.E., N. Heart, Lung et al. The practical guide: identification, evaluation, and treatment of overweight and obesity in adults. Lung, and Blood Institute: National Heart; 2002. Initiative, N.O.E., N. Heart, Lung et al. The practical guide: identification, evaluation, and treatment of overweight and obesity in adults. Lung, and Blood Institute: National Heart; 2002.
34.
go back to reference Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity. 2013;21(0 1):S1–27 Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity. 2013;21(0 1):S1–27
35.
go back to reference Deitel M, Gawdat K, Melissas J. Reporting weight loss 2007. Obes Surg. 2007;17(5):565–8.CrossRef Deitel M, Gawdat K, Melissas J. Reporting weight loss 2007. Obes Surg. 2007;17(5):565–8.CrossRef
36.
go back to reference Organization, W.H. STEPwise approach to surveillance (STEPS) Geneva, Switzerland: WHO; 2016. 2016. Organization, W.H. STEPwise approach to surveillance (STEPS) Geneva, Switzerland: WHO; 2016. 2016.
37.
go back to reference Matthews D, Hosker J, Rudenski A, et al. Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28(7):412–9.CrossRef Matthews D, Hosker J, Rudenski A, et al. Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28(7):412–9.CrossRef
38.
go back to reference Katz A, Nambi SS, Mather K, et al. Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. The Journal of Clinical Endocrinology & Metabolism. 2000;85(7):2402–10.CrossRef Katz A, Nambi SS, Mather K, et al. Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. The Journal of Clinical Endocrinology & Metabolism. 2000;85(7):2402–10.CrossRef
39.
go back to reference Gareau MG, Sherman PM, Walker WA. Probiotics and the gut microbiota in intestinal health and disease. Nature Reviews Gastroenterology and Hepatology. 2010;7(9):503–14.CrossRef Gareau MG, Sherman PM, Walker WA. Probiotics and the gut microbiota in intestinal health and disease. Nature Reviews Gastroenterology and Hepatology. 2010;7(9):503–14.CrossRef
40.
go back to reference Fernandes R, Beserra BT, Mocellin MC, et al. Effects of prebiotic and synbiotic supplementation on inflammatory markers and anthropometric indices after Roux-en-Y gastric bypass: a randomized, triple-blind, placebo-controlled pilot study. J Clin Gastroenterol. 2016;50(3):208–17.CrossRef Fernandes R, Beserra BT, Mocellin MC, et al. Effects of prebiotic and synbiotic supplementation on inflammatory markers and anthropometric indices after Roux-en-Y gastric bypass: a randomized, triple-blind, placebo-controlled pilot study. J Clin Gastroenterol. 2016;50(3):208–17.CrossRef
41.
go back to reference Groeger D, O’Mahony L, Murphy EF, et al. Bifidobacterium infantis 35624 modulates host inflammatory processes beyond the gut. Gut Microbes. 2013;4(4):325–39.CrossRef Groeger D, O’Mahony L, Murphy EF, et al. Bifidobacterium infantis 35624 modulates host inflammatory processes beyond the gut. Gut Microbes. 2013;4(4):325–39.CrossRef
42.
go back to reference Reddy B, Macfie J, Gatt M, et al. Randomized clinical trial of effect of synbiotics, neomycin and mechanical bowel preparation on intestinal barrier function in patients undergoing colectomy. Br J Surg. 2007;94(5):546–54.CrossRef Reddy B, Macfie J, Gatt M, et al. Randomized clinical trial of effect of synbiotics, neomycin and mechanical bowel preparation on intestinal barrier function in patients undergoing colectomy. Br J Surg. 2007;94(5):546–54.CrossRef
43.
go back to reference Kekkonen, R.A., N. Lummela, H. Karjalainen, , S. Latvala, S. Tynkkynen, S. Järvenpää, H. Kautiainen, I. Julkunen, H. Vapaatalo, R. Korpela et al., Probiotic intervention has strain-specific anti-inflammatory effects in healthy adults. World J Gastroenterol: WJG, 2008. 14(13): p. 2029, 2036.CrossRef Kekkonen, R.A., N. Lummela, H. Karjalainen, , S. Latvala, S. Tynkkynen, S. Järvenpää, H. Kautiainen, I. Julkunen, H. Vapaatalo, R. Korpela et al., Probiotic intervention has strain-specific anti-inflammatory effects in healthy adults. World J Gastroenterol: WJG, 2008. 14(13): p. 2029, 2036.CrossRef
44.
go back to reference Thomas CM, Versalovic J. Probiotics-host communication: modulation of signaling pathways in the intestine. Gut Microbes. 2010;1(3):148–63.CrossRef Thomas CM, Versalovic J. Probiotics-host communication: modulation of signaling pathways in the intestine. Gut Microbes. 2010;1(3):148–63.CrossRef
45.
go back to reference Park S, Bae J-H. Probiotics for weight loss: a systematic review and meta-analysis. Nutr Res. 2015;35(7):566–75.CrossRef Park S, Bae J-H. Probiotics for weight loss: a systematic review and meta-analysis. Nutr Res. 2015;35(7):566–75.CrossRef
46.
go back to reference Arora T, Singh S, Sharma RK. Probiotics: interaction with gut microbiome and antiobesity potential. Nutrition. 2013;29(4):591–6.CrossRef Arora T, Singh S, Sharma RK. Probiotics: interaction with gut microbiome and antiobesity potential. Nutrition. 2013;29(4):591–6.CrossRef
47.
go back to reference Sun J, Buys NJ. Glucose- and glycaemic factor-lowering effects of probiotics on diabetes: a meta-analysis of randomised placebo-controlled trials. Br J Nutr. 2016;115(7):1167–77.CrossRef Sun J, Buys NJ. Glucose- and glycaemic factor-lowering effects of probiotics on diabetes: a meta-analysis of randomised placebo-controlled trials. Br J Nutr. 2016;115(7):1167–77.CrossRef
48.
go back to reference Guo Z, Liu X, Zhang Q, et al. Influence of consumption of probiotics on the plasma lipid profile: a meta-analysis of randomised controlled trials. Nutr Metab Cardiovasc Dis. 2011;21(11):844–50.CrossRef Guo Z, Liu X, Zhang Q, et al. Influence of consumption of probiotics on the plasma lipid profile: a meta-analysis of randomised controlled trials. Nutr Metab Cardiovasc Dis. 2011;21(11):844–50.CrossRef
49.
go back to reference LeBlanc JG, Chain F, Martín R, et al. Beneficial effects on host energy metabolism of short-chain fatty acids and vitamins produced by commensal and probiotic bacteria. Microb Cell Factories. 2017;16(1):79.CrossRef LeBlanc JG, Chain F, Martín R, et al. Beneficial effects on host energy metabolism of short-chain fatty acids and vitamins produced by commensal and probiotic bacteria. Microb Cell Factories. 2017;16(1):79.CrossRef
50.
go back to reference Rossi M, Amaretti A, Raimondi S. Folate production by probiotic bacteria. Nutrients. 2011;3(1):118–34.CrossRef Rossi M, Amaretti A, Raimondi S. Folate production by probiotic bacteria. Nutrients. 2011;3(1):118–34.CrossRef
51.
go back to reference Blom HJ, Smulders Y. Overview of homocysteine and folate metabolism. With special references to cardiovascular disease and neural tube defects. J Inherit Metab Dis. 2011;34(1):75–81.CrossRef Blom HJ, Smulders Y. Overview of homocysteine and folate metabolism. With special references to cardiovascular disease and neural tube defects. J Inherit Metab Dis. 2011;34(1):75–81.CrossRef
52.
go back to reference 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.CrossRef 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.CrossRef
53.
go back to reference Signori C, Zalesin KC, Franklin B, et al. Effect of gastric bypass on vitamin D and secondary hyperparathyroidism. Obes Surg. 2010;20(7):949–52.CrossRef Signori C, Zalesin KC, Franklin B, et al. Effect of gastric bypass on vitamin D and secondary hyperparathyroidism. Obes Surg. 2010;20(7):949–52.CrossRef
54.
go back to reference Coupaye M, Breuil MC, Rivière P, et al. Serum vitamin D increases with weight loss in obese subjects 6 months after Roux-en-Y gastric bypass. Obes Surg. 2013;23(4):486–93.CrossRef Coupaye M, Breuil MC, Rivière P, et al. Serum vitamin D increases with weight loss in obese subjects 6 months after Roux-en-Y gastric bypass. Obes Surg. 2013;23(4):486–93.CrossRef
55.
go back to reference 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.CrossRef 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.CrossRef
56.
go back to reference Shang M, Sun J. Vitamin D/VDR, probiotics, and gastrointestinal diseases. Curr Med Chem. 2017;24(9):876–87.CrossRef Shang M, Sun J. Vitamin D/VDR, probiotics, and gastrointestinal diseases. Curr Med Chem. 2017;24(9):876–87.CrossRef
Metadata
Title
Probiotic Supplementation in Morbid Obese Patients Undergoing One Anastomosis Gastric Bypass-Mini Gastric Bypass (OAGB-MGB) Surgery: a Randomized, Double-Blind, Placebo-Controlled, Clinical Trial
Authors
Zohreh Karbaschian
Zeinab Mokhtari
Abdolreza Pazouki
Ali Kabir
Mahdi Hedayati
Somayeh Soleymanzadeh Moghadam
Parvin Mirmiran
Azita Hekmatdoost
Publication date
01-09-2018
Publisher
Springer US
Published in
Obesity Surgery / Issue 9/2018
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-018-3280-2

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