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Alexander J, Olsen AK. Selenium - a scoping review for Nordic Nutrition Recommendations 2023. Food Nutr Res 2023; 67:10320. [PMID: 38187789 PMCID: PMC10770655 DOI: 10.29219/fnr.v67.10320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 07/21/2023] [Accepted: 10/25/2023] [Indexed: 01/09/2024] Open
Abstract
Selenium is an essential trace element in humans, critical to the normal physiology in all animal species. The main form of selenium in food is selenomethionine, selenocysteine and a variety of organic compounds, while inorganic salts mainly occur in food supplements. In animals and humans, selenium occurs as selenocysteine in selenoproteins encoded by 25 genes (specific selenium pool). Several selenoproteins are part of the antioxidant enzyme system and serve as oxido-reductases and in thyroid hormone regulation. SelenoproteinP (SELENOP) transports selenium to peripheral tissues, is the main plasma selenoprotein, and has been used as biomarker of selenium status and intake. SELENOP in plasma represents a saturable pool of selenium and is maximised at a selenium concentration in plasma of about 110 µg/L or an intake of selenomethionine at about 1.2 µg/kg body weight in adults. In Finland, with an estimated selenium intake of 88 µg/day in men and 68 µg/day in women, the average selenium concentration in plasma is about 110 µg/L. Imported wheat from selenium rich areas is an important dietary source in Norway. Dietary intakes in the Nordic and Baltic area vary from 39 to 88 µg/day in men and 22 to 68 µg/day in women, the highest levels were from Finland. Most intervention trials on the effect of selenium supplementation on health outcomes have been carried out in 'selenium-replete'-populations and show no beneficial effect, which from a nutritional point of view would rather not be expected. Some intervention studies conducted in populations low in selenium have showed a beneficial effect. Observational studies suggest an inverse relationship between selenium status and risk of cardiovascular diseases (CVDs), cancer and all-cause mortality, and some other outcomes at low levels of intake (<55 µg/day) or in plasma or serum (<100 µg/L). However, a lack of quantitative data and inconsistencies between studies precludes these studies to be used to derive dietary reference values. At high intakes above 330 to 450 µg/day selenium may cause toxic effects affecting liver, peripheral nerves, skin, nails, and hair. An upper tolerable level (UL) of 255 µg selenium/day in adults was established by EFSA.
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Seferović PM, Polovina M, Rosano G, Bozkurt B, Metra M, Heymans S, Mullens W, Bauersachs J, Sliwa K, de Boer RA, Farmakis D, Thum T, Olivotto I, Rapezzi C, Linhart A, Corrado D, Tschöpe C, Milinković I, Bayes Genis A, Filippatos G, Keren A, Ašanin M, Krljanac G, Maksimović R, Skouri H, Ben Gal T, Moura B, Volterrani M, Abdelhamid M, Lopatin Y, Chioncel O, Coats AJS. State-of-the-art document on optimal contemporary management of cardiomyopathies. Eur J Heart Fail 2023; 25:1899-1922. [PMID: 37470300 DOI: 10.1002/ejhf.2979] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/27/2023] [Accepted: 07/05/2023] [Indexed: 07/21/2023] Open
Abstract
Cardiomyopathies represent significant contributors to cardiovascular morbidity and mortality. Over the past decades, a progress has occurred in characterization of the genetic background and major pathophysiological mechanisms, which has been incorporated into a more nuanced diagnostic approach and risk stratification. Furthermore, medications targeting core disease processes and/or their downstream adverse effects have been introduced for several cardiomyopathies. Combined with standard care and prevention of sudden cardiac death, these novel and emerging targeted therapies offer a possibility of improving the outcomes in several cardiomyopathies. Therefore, the aim of this document is to summarize practical approaches to the treatment of cardiomyopathies, which includes the evidence-based novel therapeutic concepts and established principles of care, tailored to the individual patient aetiology and clinical presentation of the cardiomyopathy. The scope of the document encompasses contemporary treatment of dilated, hypertrophic, restrictive and arrhythmogenic cardiomyopathy. It was based on an expert consensus reached at the Heart Failure Association online Workshop, held on 18 March 2021.
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Affiliation(s)
- Petar M Seferović
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Marija Polovina
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | | | - Biykem Bozkurt
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Marco Metra
- Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Stephane Heymans
- Department of Cardiology, CARIM, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Wilfried Mullens
- Hasselt University, Hasselt, Belgium
- Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Karen Sliwa
- Cape Heart Institute, Division of Cardiology, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Rudolf A de Boer
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany
- Fraunhofer Cluster of Excellence Immune-Mediated Diseases (CIMD), Hannover, Germany
- Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hannover, Germany
| | - Iacopo Olivotto
- Department of Experimental and Clinical Medicine, University of Florence, Meyer Children's Hospital and Careggi University Hospital, Florence, Italy
| | - Claudio Rapezzi
- Cardiology Centre, University of Ferrara, Ferrara, Italy
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Aleš Linhart
- Second Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Domenico Corrado
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Carsten Tschöpe
- Berlin Institute of Health (BIH) at Charité-Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany
- German Centre for Cardiovascular Research, Berlin, Germany
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ivan Milinković
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Antoni Bayes Genis
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, CIBERCV, Universidad Autónoma de Barcelona, Badalona, Spain
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Department of Cardiology, Attikon University Hospital, Athens, Greece
| | - Andre Keren
- Heart Institute, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Milika Ašanin
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Gordana Krljanac
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Ružica Maksimović
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Center for Radiology and Magnetic Resonance, University Clinical Center of Serbia, Belgrade, Serbia
| | - Hadi Skouri
- Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Tuvia Ben Gal
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Brenda Moura
- Armed Forces Hospital, Porto, & Faculty of Medicine, University of Porto, Porto, Portugal
| | - Maurizio Volterrani
- IRCCS San Raffaele Pisana, Rome, Italy
- Department of Human Science and Promotion of Quality of Life, San Raffaele Open University of Rome, Rome, Italy
| | - Magdy Abdelhamid
- Department of Cardiovascular Medicine, Faculty of Medicine, Kasr Al Ainy, Cairo University, Giza, Egypt
| | - Yuri Lopatin
- Volgograd Medical University, Cardiology Centre, Volgograd, Russian Federation
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C.C. Iliescu' Bucharest; University for Medicine and Pharmacy 'Carol Davila' Bucharest, Bucharest, Romania
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Bretón I, Ballesteros-Pomar MD, Calle-Pascual A, Alvarez-Sala LA, Rubio-Herrera MA. Micronutrients in Pregnancy after Bariatric Surgery: A Narrative Review. J Clin Med 2023; 12:5429. [PMID: 37629473 PMCID: PMC10455502 DOI: 10.3390/jcm12165429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Bariatric surgery is increasingly used in women of childbearing age due to the rising prevalence of obesity and the effectiveness and availability of this treatment. Pregnancy in women with previous bariatric surgery deserves special attention. Weight loss induced by surgery reduces the risks that obesity poses to pregnancy. But on the other hand, decreased intake and malabsorption may increase the risk of malnutrition and micronutrient deficiency and negatively affect maternal and foetal health. The aim of this narrative review is to provide an updated analysis of the impact of different bariatric surgery techniques on mineral and micronutrient nutritional status during pregnancy and the possible effect on maternal-foetal health.
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Affiliation(s)
- Irene Bretón
- Department of Endocrinology and Nutrition, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- Department of Medicine, Facultad de Medicina, Universidad Complutense, 28040 Madrid, Spain
| | - María D. Ballesteros-Pomar
- Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, 24008 León, Spain
| | - Alfonso Calle-Pascual
- Department of Medicine, Facultad de Medicina, Universidad Complutense, 28040 Madrid, Spain
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029 Madrid, Spain
| | - Luis Antonio Alvarez-Sala
- Department of Medicine, Facultad de Medicina, Universidad Complutense, 28040 Madrid, Spain
- Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Miguel Angel Rubio-Herrera
- Department of Medicine, Facultad de Medicina, Universidad Complutense, 28040 Madrid, Spain
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, 28040 Madrid, Spain
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Selenium Deficiency After Bariatric Surgery, Incidence and Symptoms: a Systematic Review and Meta-Analysis. Obes Surg 2022; 32:1719-1725. [PMID: 35218005 DOI: 10.1007/s11695-022-05932-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/15/2022] [Accepted: 01/23/2022] [Indexed: 10/19/2022]
Abstract
This study review the prevalence of selenium deficiency after bariatric surgery, incidence, and symptoms. A systematic literature search and meta-analysis was performed in PubMed and Scopus for articles published by November 1, 2021, including the keywords "Roux-en Y gastric bypass", "RYGB", "Omega bypass", "Mini bypass", "One anastomosis gastric bypass", "Bariatric surgery", "Weight loss surgery", "Metabolic surgery", "Gastric bypass", "Loop gastric bypass", "Selenium", "Selenium deficiency", or a combination of aimed tothem in the title or abstract. In this review, nine studies examining a total of 1174 patients were included in this meta-analysis. The mean age of the patients was 41.14 ± 7.69 years. The mean interval between bariatric surgery and selenium deficiency was 40.36 ± 43.29 months. Mean BMI before surgery and at the time of selenium deficiency was 43.68 ± 4.91 kg/m2 and 28.41 ± 9.09 kg/m2, respectively. Additionally, the results showed a prevalence of 16% and 2% of selenium deficiency at 1- and 2-year follow-up after bariatric surgery, respectively. Symptoms included weakness, myopathy, and cardiomyopathy, loss of muscle mass, erythematous desquamating eruption, lethargy, dyspnea, and bilateral lower extremity pitting edema. Forty percent of studies reported "Selenium orally (100 μg once daily)" as treatment option. A multidisciplinary team of healthcare professionals, including dietitians, should be involved in the bariatric patient's care. As a result, clinicians should encourage patients to take supplements for the rest of their lives, and patients should be monitored after surgery if necessary.
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Zhang B, Yeh DD, Ortiz-Reyes LA, Chang Y, Quraishi SA. Impact of nationwide essential trace element shortages: A before-after, single-center analysis of hospitalized adults receiving home parenteral nutrition therapy. Nutr Clin Pract 2021; 37:442-450. [PMID: 34339061 DOI: 10.1002/ncp.10730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Recent data on the prevalence of essential trace element (ETE) deficiencies in home parenteral nutrition (HPN) patients are scarce. We investigated whether ETE deficiencies are still an important issue for HPN patients and whether the prevalence of such deficiencies may be influenced by nationwide drug shortages. METHODS We conducted a single-institution, retrospective analysis from 2006 to 2015 of hospitalized HPN patients who continued PN during and in between hospitalizations. In subgroup analysis, patients were dichotomized as those with HPN duration <1 vs ≥1 year. Zinc (Zn), copper (Cu), and selenium (Se) levels were abstracted for patients over the study period. Prevalence of ETE deficiency was compared using chi-squared test for patients hospitalized during nonshortage vs shortage (2011-2014) periods. RESULTS Ninety-six patients were included in the analysis. Prevalence of ETE deficiency during nonshortage vs shortage periods was 48% vs 54% (Zn), 15% vs 21% (Cu), and 24% vs 48% (Se; P = .01), respectively. When comparing patients who received HPN <1 year vs ≥1 year, the prevalence of Se deficiency doubled during shortage in both subgroups (24% to 42% vs 26% to 49%); and Cu deficiency tripled during shortage period in the group receiving HPN ≥1 year (5% to 16%). CONCLUSION ETE deficiency is prevalent in hospitalized HPN patients and was exacerbated during nationwide shortages of parenteral supplements. Statistical significance may be limited by small sample size. Future studies are needed to determine optimal ETE supplementation strategies for minimizing the impacts of nationwide drug shortages on HPN patients.
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Affiliation(s)
- Bin Zhang
- Department of Pharmacy, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - D Dante Yeh
- Ryder Trauma Center, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Luis Alfonso Ortiz-Reyes
- Clinical Evaluation Research Unit, Kingston General Hospital, Department of Critical Care, Queen's University, Kingston, Ontario, Canada
| | - Yuchiao Chang
- Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sadeq A Quraishi
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
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Mauhin W, Bouzidi H, Colson A, Lejour G, Miao Y, Montagner C, London J, Subran B, Amathieu R, Lazard T, Lidove O. [Fatal nutrient deficiencies after gastric bypass]. Rev Med Interne 2021; 42:729-733. [PMID: 34144843 DOI: 10.1016/j.revmed.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 04/01/2021] [Accepted: 05/09/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Bariatric surgery is a very effective treatment for obesity. After gastric bypass, micronutrient deficiencies frequently occur which can have dramatic consequences. CASE REPORT We report the case of a 55-year-old woman who was admitted for psychomotor retardation, bilateral leg pitting edema and psoriasis-like rash that had been ongoing for 3 months. Pancytopenia, encephalopathy and heart failure rapidly occurred leading to multiorgan dysfunction syndrome and death. We retrospectively identified severe selenium deficiency with possible secondary cardiomyopathy, niacin deficiency resulting in pellagrous encephalopathy with skin lesions and gelatinous transformation of bone marrow. CONCLUSION Micronutrient deficiency should systematically be assessed when new symptoms occur in a patient with a history of bariatric surgery. Selenium deficiency should be considered in the presence of any heart failure in this context.
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Affiliation(s)
- W Mauhin
- Service de médecine interne, groupe hospitalier Diaconesses Croix-Saint-Simon, site Avron, 75020 Paris, France.
| | - H Bouzidi
- Service de réanimation, groupe hospitalier Diaconesses Croix-Saint-Simon, site Avron, 75020 Paris, France
| | - A Colson
- Service transversal de nutrition et diététique, Paris, France
| | - G Lejour
- Service de réanimation, groupe hospitalier Diaconesses Croix-Saint-Simon, site Avron, 75020 Paris, France
| | - Y Miao
- Service de médecine interne, groupe hospitalier Diaconesses Croix-Saint-Simon, site Avron, 75020 Paris, France
| | - C Montagner
- Service de médecine interne, groupe hospitalier Diaconesses Croix-Saint-Simon, site Avron, 75020 Paris, France
| | - J London
- Service de médecine interne, groupe hospitalier Diaconesses Croix-Saint-Simon, site Avron, 75020 Paris, France
| | - B Subran
- Service de médecine interne, groupe hospitalier Diaconesses Croix-Saint-Simon, site Avron, 75020 Paris, France
| | - R Amathieu
- Service de réanimation, groupe hospitalier Diaconesses Croix-Saint-Simon, site Avron, 75020 Paris, France
| | - T Lazard
- Service de réanimation, groupe hospitalier Diaconesses Croix-Saint-Simon, site Avron, 75020 Paris, France
| | - O Lidove
- Service de médecine interne, groupe hospitalier Diaconesses Croix-Saint-Simon, site Avron, 75020 Paris, France
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Vilallonga R, Pereira-Cunill JL, Morales-Conde S, Alarcón I, Breton I, Domínguez-Adame E, Ferrer JV, Ruiz-de-Gordejuela AG, Goday A, Lecube A, García-Almenta EM, Rubio MÁ, Tinahones FJ, García-Luna PP. A Spanish Society joint SECO and SEEDO approach to the Post-operative management of the patients undergoing surgery for obesity. Obes Surg 2020; 29:3842-3853. [PMID: 31342249 DOI: 10.1007/s11695-019-04043-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Bariatric surgery is the method of choice for the management or treatment of obesity. Bariatric surgery brings about several physiological changes in the body and is associated with set of complications. The aim of this study is to provide guidelines on post bariatric surgery management based on consensus by the Spanish society for Obesity Surgery (Sociedad Española de Cirugía de la Obesidad) (SECO) and the Spanish Society for the Study of Obesity (Sociedad Española para el Estudio de la Obesidad) (SEEDO). METHOD The boards proposed seven experts from each society. The experts provided the evidence and a grade of recommendation on the selected topics based on systematic reviews/meta-analysis. A list of clinical practical recommendations levels of evidence and grades of these recommendations was derived from the consensus statements from the members of these societies. RESULTS Seventeen topics related to post-operative management were reviewed after bariatric surgery. The experts came with 47 recommendations and statements. The mean number of persons voting at each statement was 54 (range 36-76). CONCLUSION In this consensus, we have designed a set of guidelines to be followed while managing patients after bariatric surgery. Expertise and knowledge of the clinicians are required to convey suitable considerations to the post-bariatric patients. There should also be extensive follow-up plans for the bariatric surgery patients.
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Affiliation(s)
- R Vilallonga
- Endocrine, metabolic and bariatric Unit, General Surgery Department, Hospital Vall d'Hebron, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - J L Pereira-Cunill
- Clinical Nutritión Unit, Endocrinology and Nutrition Service, University Hospital "Virgen del Rocío", Seville, Spain
| | - S Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of Surgery, University Hospital "Virgen del Rocío", Hospital Quironsalud Sagrado Corazón, University of Sevilla, Sevilla, Spain
| | - I Alarcón
- Unit of Innovation in Minimally Invasive Surgery, Department of Surgery, University Hospital "Virgen del Rocío", Hospital Quironsalud Sagrado Corazón, University of Sevilla, Sevilla, Spain
| | - I Breton
- Unidad de Nutrición Clínica y Dietética del Servicio de Endocrinología y Nutrición del Hospital Gregorio Marañón, Madrid, Spain
| | - E Domínguez-Adame
- UGC Cirugía General y Aparato Digestivo, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Sevilla, Spain
| | | | - A Garcia Ruiz-de-Gordejuela
- Endocrine, metabolic and bariatric Unit, General Surgery Department, Hospital Vall d'Hebron, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Goday
- Servicio de Endocrinología, Hospital del Mar de Barcelona, Departament de Medicina, CIBERobn, ISCIII, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Lecube
- Servicio deEndocrinología y Nutrición, Hospital Universitari Arnau de Vilanova de Lleida, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida (UdL), Avda. Rovira Roure, 80 25198, Lleida, Spain
| | - E Martín García-Almenta
- Unidad Cirugía Esófago-Gástrica, Metabólica y Bariátrica, Hospital Clínico San Carlos, Madrid, Spain
| | - M Á Rubio
- Servicio de Endocrinología y Nutrición, Hospital Clínico San Carlos, Idissc, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - F J Tinahones
- Service of Endocrinology and Nutrition, Hospital Clínico Universitario Virgen de Victoria de Malaga, Málaga, Spain
| | - P P García-Luna
- Unidad de Nutrición Clínica y de la Unidad de Obesidad Mórbida (Unidad de Gestión de Endocrinología y Nutrición, UGEN), Hospital Universitario Virgen del Rocío, Seville, Spain
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Abstract
GENERAL PURPOSE To provide information on obesity, bariatric surgery, and the nutrient deficiency-related dermatoses that may result from these surgeries. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, NPs, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant should be better able to:1. Examine issues related to obesity and bariatric surgery.2. Identify the sources and role of specific nutrients.3. Recognize the clinical signs and symptoms of nutrient deficiency following bariatric surgery. ABSTRACT Obesity is a global epidemic that increases the risk of weight-related comorbidities in modern society. It is complex, multifactorial, and largely preventable. Noninvasive treatments for obesity include diet, exercise, and medication. However, bariatric surgeries are becoming popular procedures for those who do not achieve success with noninvasive weight management treatment. Bariatric surgeries often result in dietary restriction and/or malabsorption, which lead to drastic weight loss. Individuals who had bariatric surgeries need lifelong follow-up and monitoring to ensure adequate intake of nutrients. Nutrient deficiencies can ensue when long-term vitamin and mineral supplementation is not followed. Severe nutrient deficiencies may lead to dermatoses that can be corrected by nutrient repletion and careful monitoring. A case report of nutrient deficiency-related dermatoses is followed by a review of obesity and its treatments with a focus on bariatric surgeries.
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Wang S, Nong X, Yang G. Selenium-Rich Diet Induces Myocardial Structural and Functional Abnormalities by Activating Caspase-9 and Caspase-3 in Gpx-1P198L-Overexpression Transgenic Mice. Med Sci Monit 2019; 25:61-70. [PMID: 30602716 PMCID: PMC6327778 DOI: 10.12659/msm.911120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background Selenium (Se) deficiency and supplementation result in multiple effects. GPx-1 (Pro198Leu) polymorphism is associated with Se deficiency. This study aimed to observe associations between Se-deficiency/supplement and GPx-1-198Leu overexpression in myocardial injuries. Material/Methods GPx-1P198L transgenic (Tg) mice and non-transgenic wild-type (WT) littermates were divided into Control (CON, 0.1–0.2 mg/kg), Se-deficiency (SD, <0.02 mg/kg), and Se-supplement (SS, 0.4 mg/kg) groups. Cardiac functions were observed with animal M-mode echocardiography. Se level was measured using 2,3-diamino Kenai fluorospectrophotometry. Total cardiac GPx activity was also measured. Myocardial histopathology was determined with HE and Masson’s trichrome staining. Caspase-9 and caspase-3 were measured with Western blot analysis. Results In WT Se-deficient mice, cardiac GPx activity was significantly decreased, and was not elevated by overexpression of GPx-1-198Leu gene. Increased GPx activity was observed in WT Se-supplemented mice and Tg Se-supplemented mice (much more). Se deficiency as well as supplementation resulted in cardiac systolic dysfunction, which was not affected by GPx-1-198Leu gene. Se deficiency led to myocardial fibrosis and pathological changes accompanied by increased activation of caspase-9 and caspase-3. Se supplementation significantly reduced pathological changes, as well as caspase-9 and caspase-3 levels in the presence of increased myocardial fibrosis. In Se-deficient mice, GPx-1-198Leu overexpression did not significantly decrease myocardial pathological injuries and fibrosis. In Se-supplemented Tg mice, myocardial fibrosis and caspase-9 level were increased, although pathological injuries and caspase-3 were similar to that in Se-supplemented WT mice. Conclusions Se deficiency as well as supplementation induced myocardial structural and functional abnormalities through activation of caspase-9 and caspase-3 in GPx-1P198L overexpression transgenic mice.
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Affiliation(s)
- Suqin Wang
- Department of Cardiology, Fuwai Central China Cardiovascular Hospital, Zhengzhou, Henan, China (mainland).,Department of Cardiology, People's Hospital of Henan Province, Zhengzhou, Henan, China (mainland)
| | - Xiting Nong
- Department of Endocrinology, Xi'an Central Hospital, Xi'an, Shaanxi, China (mainland)
| | - Guang Yang
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China (mainland)
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Yahalom M, Koren O, Rozner E, Turgeman Y. Cardiomyopathy Associated with Zinc Deficiency after Bariatric Surgery. Int J Angiol 2018; 28:145-146. [PMID: 31384114 DOI: 10.1055/s-0038-1666848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Noncompliance with vitamin and mineral supplement protocol after bariatric surgery may lead to true-elements deficiency. Among them, zinc and selenium deficiencies were closely related to cardiac complications, such as myocardial fibrosis, heart failure, and arrhythmias. We describe a 30-year-old female, 6 weeks after delivery and 5 years after bariatric surgery, who was admitted to the cardiology department because of dyspnea and clinical evidence of heart failure, as well as an echocardiogram that demonstrated reduced systolic left ventricular function. Standard antifailure regimen shows mild benefit. Zinc supplements added to treatment lead to significant clinical and echocardiographic improvement.
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Affiliation(s)
- Malka Yahalom
- Heart Institute, HaEmek Medical Center, Afula, Israel
| | - Ofir Koren
- Heart Institute, HaEmek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ehud Rozner
- Heart Institute, HaEmek Medical Center, Afula, Israel
| | - Yoav Turgeman
- Heart Institute, HaEmek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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Erick M. Breast milk is conditionally perfect. Med Hypotheses 2017; 111:82-89. [PMID: 29407004 DOI: 10.1016/j.mehy.2017.12.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 09/24/2017] [Accepted: 12/13/2017] [Indexed: 02/08/2023]
Abstract
Breast milk is the universal preferred nutrition for the newborn human infant. New mother have been encouraged to exclusively breastfeed by health care professionals and consumer-advocacy forums for years, citing "breast milk is the perfect food". The benefits are numerous and include psychological, convenience, economical, ecological and nutritionally superior. Human milk is a composite of nutritional choices of the mother, commencing in the pre-conceptual era. Events influencing the eventual nutritional profile of breast milk for the neonate start with pre-conceptual dietary habits through pregnancy and finally to postpartum. Food choices do affect the nutritional profile of human breast milk. It is not known who coined the phrase "breast milk is the perfect food" but it is widely prevalent in the literature. While breast milk is highly nutritive, containing important immunological and growth factors, scientific investigation reveals a few short-falls. Overall, human breast milk has been found to be low in certain nutrients in developed countries: vitamin D, iodine, iron, and vitamin K. Additional nutrient deficiencies have been documented in resource-poor countries: vitamin A, vitamin B 12, zinc, and vitamin B 1/thiamin. Given these findings, isn't it more accurate to describe breast milk as "conditionally perfect"? Correcting the impression that breast milk is an inherently, automatically comprehensive enriched product would encourage women who plan to breastfeed an opportunity to concentrate on dietary improvement to optimizes nutrient benefits ultimately to the neonate. The more immediate result would improve pre-conceptual nutritional status. Here, we explore the nutritional status of groups of young women; some of whom will become pregnant and eventually produce breast milk. We will review the available literature profiling vitamin, mineral, protein and caloric content of breast milk. We highlight pre-existing situations needing correction to optimize conception and fetal development. While alternative forms of infant nutrition carry standard product labels of nutrient adequacy, this information does not apply universally to all breast milk. Infant formulas are fortified with various amounts of vitamins, minerals, supplemental protein concentrates, nucleic factors, omega 3 fatty acids and any important new nutritional finding. Infant formulas are manufactured to be consistent in composition and are monitored closely for quality. Not true for human breast milk. Any nutrient deficiency existing in pregnancy will ultimately be carried forward via lactation. It is a biological impossibility for a lactating woman to transfer nutrients via breast milk she does not have!
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Affiliation(s)
- Miriam Erick
- Department of Nutrition, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Munguti CM, Al Rifai M, Shaheen W. A Rare Cause of Cardiomyopathy: A Case of Selenium Deficiency Causing Severe Cardiomyopathy that Improved on Supplementation. Cureus 2017; 9:e1627. [PMID: 29098137 PMCID: PMC5659335 DOI: 10.7759/cureus.1627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Selenium-associated cardiomyopathy is a rare but potentially fatal condition that has previously been described in the literature. Once identified, the condition may be reversible via supplementation. Gastrointestinal operations, especially bariatric and bowel resection, are increasingly associated with multiple deficiencies, including a deficiency of the micronutrient selenium (Se). This case report presents a patient with Se-deficient cardiomyopathy whose condition improved due to Se replacement.
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Affiliation(s)
- Cyrus M Munguti
- Internal Medicine, University of Kansas School of Medicine - Wichita
| | - Mahmoud Al Rifai
- Internal Medicine, University of Kansas School of Medicine - Wichita
| | - Wassim Shaheen
- Heartland Cardiology, University of Kansas School of Medicine - Wichita
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Panchal SK, Wanyonyi S, Brown L. Selenium, Vanadium, and Chromium as Micronutrients to Improve Metabolic Syndrome. Curr Hypertens Rep 2017; 19:10. [PMID: 28197835 DOI: 10.1007/s11906-017-0701-x] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Trace metals play an important role in the proper functioning of carbohydrate and lipid metabolism. Some of the trace metals are thus essential for maintaining homeostasis, while deficiency of these trace metals can cause disorders with metabolic and physiological imbalances. This article concentrates on three trace metals (selenium, vanadium, and chromium) that may play crucial roles in controlling blood glucose concentrations possibly through their insulin-mimetic effects. For these trace metals, the level of evidence available for their health effects as supplements is weak. Thus, their potential is not fully exploited for the target of metabolic syndrome, a constellation that increases the risk for cardiovascular disease and type 2 diabetes. Given that the prevalence of metabolic syndrome is increasing throughout the world, a simpler option of interventions with food supplemented with well-studied trace metals could serve as an answer to this problem. The oxidation state and coordination chemistry play crucial roles in defining the responses to these trace metals, so further research is warranted to understand fully their metabolic and cardiovascular effects in human metabolic syndrome.
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Affiliation(s)
- Sunil K Panchal
- Institute for Agriculture and the Environment, University of Southern Queensland, QLD, Toowoomba, 4350, Australia
| | - Stephen Wanyonyi
- Institute for Agriculture and the Environment, University of Southern Queensland, QLD, Toowoomba, 4350, Australia
| | - Lindsay Brown
- Institute for Agriculture and the Environment, University of Southern Queensland, QLD, Toowoomba, 4350, Australia.
- School of Health and Wellbeing, University of Southern Queensland, QLD, Toowoomba, 4350, Australia.
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Bilateral leg oedema after bariatric surgery: A selenium-deficient cardiomyopathy. Obes Res Clin Pract 2017; 11:622-626. [PMID: 28610944 DOI: 10.1016/j.orcp.2017.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 05/06/2017] [Accepted: 05/13/2017] [Indexed: 12/21/2022]
Abstract
This report describes a case of selenium-deficient cardiomyopathy secondary to bariatric surgery (Roux-en-Y gastric bypass surgery). A 40 year-old woman presented with bilateral leg oedema nine months after the surgical procedure. Timely diagnosis of selenium-deficient cardiomyopathy was due to the recognition of symptoms of heart failure, increased NT pro-BNP level, detection of myocardial diastolic dysfunction and impaired left ventricular global longitudinal strain by echocardiography, and early identification of selenium deficiency. Symptoms resolution, cardiac biomarkers and echocardiographic abnormalities normalization were observed after 3 months of oral selenium supplementation and conventional heart failure therapy. Any sign of heart failure after bariatric surgery should require screening for a nutrient-deficient cardiomyopathy.
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Impact by Citations and Downloads: What are Heart, Lung and Circulation's Top 25 Articles of All Time? Heart Lung Circ 2016; 25:743-9. [DOI: 10.1016/j.hlc.2016.05.108] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Obesity has attained pandemic proportions, and bariatric surgery is increasingly being employed resulting in turn to more neurological complications which must be recognized and managed. Neurological complications may result from mechanical or inflammatory mechanisms but primarily result from micro-nutritional deficiencies. Vitamin B12, thiamine, and copper constitute the most frequent deficiencies. Neurological complications may occur at reasonably predictable times after bariatric surgery and are associated with the type of surgery used. During the early post-operative period, compressive or stretch peripheral nerve injury, rhabdomyolysis, Wernicke's encephalopathy, and inflammatory polyradiculoneuropathy may occur. Late complications ensue after months to years and include combined system degeneration (vitamin B12 deficiency) and hypocupric myelopathy. Bariatric surgery patients require careful nutritional follow-up with routine monitoring of micronutrients at 6 weeks and 3, 6, and 12 months post-operatively and then annually after surgery and multivitamin supplementation for life. Sustained vigilance for common and rare neurological complications is essential.
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Chen CH, Harris MB, Partipilo ML, Welch KB, Teitelbaum DH, Blackmer AB. Impact of the Nationwide Intravenous Selenium Product Shortage on the Development of Selenium Deficiency in Infants Dependent on Long-Term Parenteral Nutrition. JPEN J Parenter Enteral Nutr 2016; 40:851-9. [PMID: 26738204 DOI: 10.1177/0148607115572834] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 12/23/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND For patients dependent on parenteral nutrition (PN), selenium must be supplemented intravenously. A nationwide intravenous selenium shortage began in April 2011. The impact of this shortage on PN-dependent infants was evaluated by examining the provision of selenium, development of biochemical deficiency, and costs associated with the shortage. MATERIALS AND METHODS This single-center, retrospective study included PN-dependent infants aged ≤1 year who weighed ≤30 kg, received PN for ≥1 month, and had ≥1 serum selenium measurement. The primary outcome was the incidence of biochemical selenium deficiency. Secondary outcomes included severity of biochemical deficiency, clinical manifestations, costs, and relationship between serum selenium levels and selenium dose. RESULTS The average selenium dose decreased 2-fold during the shortage (2.1 ± 1.2 µg/kg/d; range, 0.2-4.6 µg/kg/d) versus the nonshortage period (3.8 ± 1 µg/kg/d; range, 2.4-6 µg/kg/d; P < .001). A linear relationship between serum selenium concentration and selenium dose was observed (r(2) = 0.42), with a dose of 6 µg/kg/d expected to result in normal serum levels in most cases. Similar proportions of patients developed biochemical deficiency in both groups: shortage period, 59.1%; nonshortage, 66.7%; P = .13. The severity of biochemical deficiency was similar between groups. A significant increase in incremental cost during the shortage was observed. CONCLUSION This is the first study examining the impact of the intravenous selenium shortage on PN-dependent infants. Both groups exhibited similarly high incidences of biochemical selenium deficiency, suggesting higher empiric doses may benefit this population. However, ongoing shortages limit the ability to provide supplementation.
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Affiliation(s)
- Connie H Chen
- College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
| | - Mary Beth Harris
- Children's Intestinal Rehabilitation Program, University of Michigan C.S. Mott Children's Hospital, Patient Food and Nutrition Services, Ann Arbor, Michigan, USA
| | - M Luisa Partipilo
- Intestinal Rehabilitation/Homemed, College of Pharmacy, The University of Michigan Health Systems, C.S. Mott Children's and Women's Hospital, Ann Arbor, Michigan, USA
| | - Kathleen B Welch
- Center for Statistical Consultation and Research, The University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Daniel H Teitelbaum
- Section of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, The University of Michigan, Ann Arbor, Michigan, USA
| | - Allison B Blackmer
- Pediatric Surgery, The University of Michigan College of Pharmacy, Department of Clinical, Social and Administrative Sciences, Ann Arbor, Michigan, USA The University of Michigan Health System, Department of Pharmacy Services, Ann Arbor, Michigan, USA
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Sarker A, Meek CL, Park A. Biochemical consequences of bariatric surgery for extreme clinical obesity. Ann Clin Biochem 2015; 53:21-31. [DOI: 10.1177/0004563215588116] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2015] [Indexed: 01/01/2023]
Abstract
Obesity, defined as a body mass index over 30 kg/m2 for adults, poses a major healthcare challenge with important economic, personal and social consequences. Although public health measures, lifestyle change and pharmacological therapies have an important role in the management of obesity, patients with established morbid obesity (body mass index over 40 kg/m2) may also require bariatric surgery. Bariatric or metabolic surgery is associated with effective and enduring weight loss but is also known to improve glucose homeostasis, blood pressure and dyslipidaemia. Patients who have bariatric surgery need lifelong clinical follow-up to identify and prevent nutritional deficiencies and other complications. Clinical biochemistry laboratories have an important role in the nutritional assessment of obese patients and in the identification of complications following bariatric surgery. The aim of this article is to review the different bariatric procedures available and to summarize their complications, especially nutrient deficiencies and those of particular relevance to clinical biochemistry laboratories.
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Affiliation(s)
- Anita Sarker
- Department of Clinical Biochemistry and Immunology, Cambridge Universities NHS foundation trust, Addenbrooke’s Hospital, Cambridge, UK
| | - Claire L Meek
- Department of Clinical Biochemistry and Immunology, Cambridge Universities NHS foundation trust, Addenbrooke’s Hospital, Cambridge, UK
- Institute of Metabolic Science, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Adrian Park
- Department of Clinical Biochemistry and Immunology, Cambridge Universities NHS foundation trust, Addenbrooke’s Hospital, Cambridge, UK
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Stein J, Stier C, Raab H, Weiner R. Review article: The nutritional and pharmacological consequences of obesity surgery. Aliment Pharmacol Ther 2014; 40:582-609. [PMID: 25078533 DOI: 10.1111/apt.12872] [Citation(s) in RCA: 145] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 11/22/2013] [Accepted: 06/21/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Obesity surgery is acknowledged as a highly effective therapy for morbidly obese patients. Beneficial short-term effects on common comorbidities are practically undisputed, but a growing data pool from long-term follow-up reveals increasing evidence of potentially severe nutritional and pharmacological consequences. AIMS To assess the prevalence, causes and symptoms of complications after obesity surgery, to elucidate and compare therapy recommendations for macro- and micronutrient deficiencies, and to explore surgically-induced effects on drug absorption and bioavailability, discussing ramifications for long-term therapy and prophylaxis. METHODS PubMed, Embase and MEDLINE were searched using terms including, but not limited to, bariatric surgery, gastric bypass, obesity surgery and Roux-en-Y, coupled with secondary search terms, e.g. anaemia, micronutrients, vitamin deficiency, bacterial overgrowth, drug absorption, pharmacokinetics, undernutrition. All studies in English, French or German published January 1980 through March 2014 were included. RESULTS Macro- and micronutrient deficiencies are common after obesity surgery. The most critical, depending on surgical technique, are hypoalbuminemia (3-18%) and deficiencies of vitamins B1 (≤49%), B12 (19-35%) and D (25-73%), iron (17-45%) and zinc (12-91%). Many drugs commonly administered to obese patients (e.g. anti-depressants, anti-microbials, metformin) are subject to post-operative and/or PPI-associated changes affecting bioavailability and absorption. CONCLUSIONS Complications are associated with pre-operative and/or post-operative malnutrition or procedure-related changes in intake, absorption and drug bioavailability. The high prevalence of nutrient deficiencies after obesity surgery makes life-long nutritional monitoring and supplementation essential. Post-operative changes to drug absorption and bioavailability in bariatric patients cast doubt on the validity of standard drug dosage and administration recommendations.
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Affiliation(s)
- J Stein
- Department of Gastroenterology and Clinical Nutrition, Sachsenhausen Hospital, Frankfurt/Main, Germany; German Obesity Center (GOC), Frankfurt-Sachsenhausen, Frankfurt/Main, Germany
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Topart P, Becouarn G, Sallé A, Ritz P. Biliopancreatic diversion requires multiple vitamin and micronutrient adjustments within 2 years of surgery. Surg Obes Relat Dis 2014; 10:936-41. [PMID: 24837560 DOI: 10.1016/j.soard.2014.02.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 01/11/2014] [Accepted: 02/09/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Malabsorptive bariatric procedures require multiple vitamin supplements, especially regarding fat-soluble vitamins. The exact amount required to maintain normal serum concentrations is still largely unknown. Based on the initial postoperative prescription, we assessed the number of adjustments and the amount of vitamins/micronutrients to normalize the biological markers 2 years after the biliopancreatic diversion with duodenal switch (BPD/DS). METHODS A total of 112 consecutive patients had a laparoscopic BPD/DS between February 2007 and November 2010 for a body mass index of 53.1±5.9 kg/m² at a private hospital. Complete blood checks with vitamin status were obtained at each of the 3-month interval visits during the 1(st) postoperative year as well as twice during the 2(nd) year. RESULTS Initially, all of the patients were prescribed daily 25,000 International units (IU) of vitamin A, 1000 mg of calcium, multivitamins, and 1900 IU of vitamin D3. Significant adjustments were necessary 3.6±1.1 times during this period. A total of 80% of the patients required added vitamin A, vitamin D, as well as calcium, zinc, and iron. After 2 years,≥20% of patients exhibited vitamin A and iron deficiency with low prealbumin or micropenic anemia. Seventy percent had vitamin D deficiency and 50% secondary hyperparathyroidism. CONCLUSION The initial prescription was insufficient to cover the requirements after BPD/DS. At least 3000 mg of calcium with 7000 IU of vitamin D, 50,000 IU of vitamin A, 40 mg of zinc, and 200 mg of iron must be prescribed to start with. The trend toward a decrease in 25 OH vitamin D and hyperparathyroidism remains difficult to control although it can result from increased bone turnover during the early postoperative period.
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Affiliation(s)
- Philippe Topart
- Société de Chirurgie Viscérale, Clinique de l'Anjou, 142, avenue de Lattre de Tassigny, 49000 Angers, France.
| | - Guillaume Becouarn
- Société de Chirurgie Viscérale, Clinique de l'Anjou, 142, avenue de Lattre de Tassigny, 49000 Angers, France
| | - Agnès Sallé
- Service d'endocrinologie-nutrition, CHU, 4, rue Larrey, 49100, Angers, France
| | - Patrick Ritz
- UTNC, hôpital Larrey, 1, avenue du Pr. Jean Poulhès TSA 50032, 31059 Toulouse cedex 9, France
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Marinescu V, McCullough PA. Nutritional and micronutrient determinants of idiopathic dilated cardiomyopathy: diagnostic and therapeutic implications. Expert Rev Cardiovasc Ther 2014; 9:1161-70. [DOI: 10.1586/erc.11.95] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Bariatric surgery has been increasingly employed to manage morbid obesity. Approximately 150000 bariatric procedures are performed in the US annually. Neurologic complications arise in as many as 5% of individuals having this surgery. Although the etiology of some of these complications remains obscure, the majority are the consequence of vitamin (most commonly thiamine and vitamin B12) or mineral (most commonly copper) deficiency and familiarity with these disorders is essential. Their rapid diagnosis and appropriate treatment is essential to avoid long-term, irreversible consequences including, in some instances, death.
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Affiliation(s)
- Joseph R Berger
- Department of Neurology, University of Kentucky College of Medicine, Lexington, KY, USA.
| | - Divya Singhal
- Department of Neurology, University of Kentucky College of Medicine, Lexington, KY, USA
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Wang SQ, Niu XL, Liu ZW, Zhu YH, Gao DF. Selenium deficiency is associated with endoplasmic reticulum stress in a rat model of cardiac malfunction. Biol Trace Elem Res 2013; 156:196-201. [PMID: 24081780 DOI: 10.1007/s12011-013-9834-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Accepted: 09/23/2013] [Indexed: 01/02/2023]
Abstract
The relationship between selenium (Se) deficiency-induced cardiac malfunction and endoplasmic reticulum (ER) stress is poorly understood. In the present study, 18 weaning Sprague Dawley rats were randomly fed with three different Se diets, and myocardial glutathione peroxidase (GPx) activity was measured by an enzyme activity assay. Cardiac function was evaluated by hemodynamic parameters. ER stress markers immunoglobulin-binding protein (BiP)/glucose-regulated protein 78 (GRP78) and C/EBP homologous protein (CHOP) were detected by western blotting. Our data showed that myocardial GPx activity and cardiac function were conspicuously impaired in Se-deficient rats. Expression of GRP78 and CHOP was significantly upregulated by treatment of Se deficiency. Improvements in myocardial GPx activity and cardiac function, as well as decreases in expression of GRP78 and CHOP, were observed after Se supplementation. Consequently, our data show that ER stress was involved in Se deficiency-induced cardiac dysfunction.
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Affiliation(s)
- Su-Qin Wang
- Department of Cardiology, Second Affiliated Hospital, Xi'an Jiaotong University, 157 Road Xiwu, Xi'an, Shaanxi, 710004, People's Republic of China
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Nutritional Deficiencies Associated to Bariatric Surgery. ROMANIAN JOURNAL OF DIABETES NUTRITION AND METABOLIC DISEASES 2013. [DOI: 10.2478/rjdnmd-2013-0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract Obesity is an epidemic disease, increasingly addressed through surgical options for weight loss. Benefits of these surgical procedures, such as weight loss and improvement of obesity-related co-morbidities, are well established. However, postoperative complications do occur. Deficiencies in micronutrients, which include water and fat-soluble vitamins and minerals, are common after bariatric surgery. Recognition of the clinical signs and symptoms of micronutrient deficiencies is important to minimize long-term adverse effects.
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Abstract
Lifestyle intervention programmes often produce insufficient weight loss and poor weight loss maintenance. As a result, an increasing number of patients with obesity and related comorbidities undergo bariatric surgery, which includes approaches such as the adjustable gastric band or the 'divided' Roux-en-Y gastric bypass (RYGB). This Review summarizes the current knowledge on nutrient deficiencies that can develop after bariatric surgery and highlights follow-up and treatment options for bariatric surgery patients who develop a micronutrient deficiency. The major macronutrient deficiency after bariatric surgery is protein malnutrition. Deficiencies in micronutrients, which include trace elements, essential minerals, and water-soluble and fat-soluble vitamins, are common before bariatric surgery and often persist postoperatively, despite universal recommendations on multivitamin and mineral supplements. Other disorders, including small intestinal bacterial overgrowth, can promote micronutrient deficiencies, especially in patients with diabetes mellitus. Recognition of the clinical presentations of micronutrient deficiencies is important, both to enable early intervention and to minimize long-term adverse effects. A major clinical concern is the relationship between vitamin D deficiency and the development of metabolic bone diseases, such as osteoporosis or osteomalacia; metabolic bone diseases may explain the increased risk of hip fracture in patients after RYGB. Further studies are required to determine the optimal levels of nutrient supplementation and whether postoperative laboratory monitoring effectively detects nutrient deficiencies. In the absence of such data, clinicians should inquire about and treat symptoms that suggest nutrient deficiencies.
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Affiliation(s)
- Bikram S Bal
- Department of Medicine, Washington Hospital Center, POB North, Suite 3400, 106 Irving Street Northwest, Washington, DC 20010, USA
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Abstract
PURPOSE OF REVIEW Obesity is a growing worldwide epidemic. Obese patients are often deficient in micronutrients despite macronutrient excess. Bariatric surgery is an increasingly utilized modality in the treatment of obesity and obesity-related conditions. Bariatric surgery itself may cause or exacerbate micronutrient deficiencies with serious sequelae. This review will focus on perioperative strategies to detect, prevent and treat micronutrient deficiencies in patients undergoing bariatric surgery, and will highlight practical and clinical aspects of these nutritional problems. RECENT FINDINGS Micronutrient deficiency is common in obese patients undergoing bariatric surgery both preoperatively and postoperatively. Bariatric procedures with a malabsorptive component are more likely to result in postoperative micronutrient deficiency. A system-based approach will facilitate clinical suspicion of specific or combined micronutrient deficiencies, leading to appropriate laboratory tests for confirmation. Supplementation by the oral route is always tried first, reserving parenteral administration for specific situations. SUMMARY Clinicians should be aware that micronutrient deficiencies are common in obese patients who may have macronutrient excess. Micronutrient deficiency may exist preoperatively or be caused by bariatric procedures themselves. A systematic and team-based approach will decrease morbidity associated with delays in diagnosis and treatment.
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Affiliation(s)
- Daniel Valentino
- Division of Surgical Critical Care, Department of Surgery, Stroger Hospital of Cook County, Chicago, Illinois, USA
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Weber KT, Bhattacharya SK, Newman KP, Soberman JE, Ramanathan KB, McGee JE, Malik KU, Hickerson WL. Stressor states and the cation crossroads. J Am Coll Nutr 2011; 29:563-74. [PMID: 21677120 DOI: 10.1080/07315724.2010.10719895] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Neurohormonal activation involving the hypothalamic-pituitary-adrenal axis and adrenergic nervous and renin-angiotensin-aldosterone systems is integral to stressor state-mediated homeostatic responses. The levels of effector hormones, depending upon the degree of stress, orchestrate the concordant appearance of hypokalemia, ionized hypocalcemia and hypomagnesemia, hypozincemia, and hyposelenemia. Seemingly contradictory to homeostatic responses wherein the constancy of extracellular fluid would be preserved, upregulation of cognate-binding proteins promotes coordinated translocation of cations to injured tissues, where they participate in wound healing. Associated catecholamine-mediated intracellular cation shifts regulate the equilibrium between pro-oxidants and antioxidant defenses, a critical determinant of cell survival. These acute and chronic stressor-induced iterations in extracellular and intracellular cations are collectively referred to as the cation crossroads. Intracellular cation shifts, particularly excessive accumulation of Ca2+, converge on mitochondria to induce oxidative stress and raise the opening potential of their inner membrane permeability transition pores (mPTPs). The ensuing loss of cationic homeostasis and adenosine triphosphate (ATP) production, together with osmotic swelling, leads to organellar degeneration and cellular necrosis. The overall impact of iterations in extracellular and intracellular cations and their influence on cardiac redox state, cardiomyocyte survival, and myocardial structure and function are addressed herein.
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Affiliation(s)
- Karl T Weber
- Division of Cardiovascular Diseases, University of Tennessee Health Science Center, 956 Court Ave., Suite A312, Memphis, TN 38163, USA.
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Oxidative Stress and Cardiomyocyte Necrosis With Elevated Serum Troponins: Pathophysiologic Mechanisms. Am J Med Sci 2011; 342:129-34. [DOI: 10.1097/maj.0b013e3182231ee3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Borkowski BJ, Cheema Y, Shahbaz AU, Bhattacharya SK, Weber KT. Cation dyshomeostasis and cardiomyocyte necrosis: the Fleckenstein hypothesis revisited. Eur Heart J 2011; 32:1846-53. [PMID: 21398641 DOI: 10.1093/eurheartj/ehr063] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
An ongoing loss of cardiomyocytes to apoptotic and necrotic cell death pathways contributes to the progressive nature of heart failure. The pathophysiological origins of necrotic cell loss relate to the neurohormonal activation that accompanies acute and chronic stressor states and which includes effector hormones of the adrenergic nervous system. Fifty years ago, Albrecht Fleckenstein and coworkers hypothesized the hyperadrenergic state, which accompanies such stressors, causes cardiomyocyte necrosis based on catecholamine-initiated excessive intracellular Ca(2+) accumulation (EICA), and mitochondrial Ca(2+) overloading in particular, in which the ensuing dysfunction and structural degeneration of these organelles leads to necrosis. In recent years, two downstream factors have been identified which, together with EICA, constitute a signal-transducer-effector pathway: (i) mitochondria-based induction of oxidative stress, in which the rate of reactive oxygen metabolite generation exceeds their rate of detoxification by endogenous antioxidant defences; and (ii) the opening of the mitochondrial inner membrane permeability transition pore (mPTP) followed by organellar swelling and degeneration. The pathogenesis of stress-related cardiomyopathy syndromes is likely related to this pathway. Other factors which can account for cytotoxicity in stressor states include: hypokalaemia; ionized hypocalcaemia and hypomagnesaemia with resultant elevations in parathyroid hormone serving as a potent mediator of EICA; and hypozincaemia with hyposelenaemia, which compromise antioxidant defences. Herein, we revisit the Fleckenstein hypothesis of EICA in leading to cardiomyocyte necrosis and the central role played by mitochondria.
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Affiliation(s)
- Brian J Borkowski
- Division of Cardiovascular Diseases, University of Tennessee Health Science Center, 956 Court Ave., Suite A312, Memphis, TN 38162, USA
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Komplikationen und metabolische Störungen nach bariatrischen Operationen aus gastroenterologischer Sicht. DER GASTROENTEROLOGE 2011. [DOI: 10.1007/s11377-010-0469-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Whitted AD, Stanifer JW, Dube P, Borkowski BJ, Yusuf J, Komolafe BO, Davis RC, Soberman JE, Weber KT. A dyshomeostasis of electrolytes and trace elements in acute stressor states: impact on the heart. Am J Med Sci 2010; 340:48-53. [PMID: 20610973 DOI: 10.1097/maj.0b013e3181e5945b] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Acute stressor states are associated with a homeostatic activation of the hypothalamic-pituitary-adrenal axis. A hyperadrenergic state follows and leads to a dyshomeostasis of several intra- and extracellular cations, including K, Mg, and Ca. Prolongation of myocardial repolarization and corrected QT interval (QTc) of the ECG are useful biomarkers of hypokalemia and/or hypomagnesemia and should be monitored to address the adequacy of cation replacement. A dyshomeostasis of several trace elements, including Zn and Se, are also found in critically-ill patients to compromise metalloenzyme-based antioxidant defenses. Collectively, dyshomeostasis of these electrolytes and trace elements have deleterious consequences on the myocardium: atrial and ventricular arrhythmias; induction of oxidative stress with reduced antioxidant defenses; and adverse myocardial remodeling, including cardiomyocytes lost to necrosis and replaced by fibrous tissue. To minimize such consequences during hyperadrenergic states, systematic surveillance of electrolytes and trace elements, together with QTc, are warranted. Plasma K and Mg should be maintained at > or =4.0 mEq/L and > or =2.0 mg/dL, respectively (the 4 and 2 rule).
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Affiliation(s)
- Anthony D Whitted
- Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA
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Bal B, Koch TR, Finelli FC, Sarr MG. Managing medical and surgical disorders after divided Roux-en-Y gastric bypass surgery. Nat Rev Gastroenterol Hepatol 2010; 7:320-34. [PMID: 20458335 DOI: 10.1038/nrgastro.2010.60] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The National Longitudinal Study of Adolescent Health and the National Health and Nutrition Examination Survey reported that over 40% of the US population is overweight. The average weight loss attained by medical management programs is neither sufficient nor durable enough to treat medically complicated obesity. An estimated 220,000 bariatric procedures are performed yearly in the USA and Canada. The divided Roux-en-Y gastric bypass (RYGB) is performed most commonly in these countries and is considered the gold standard bariatric surgical procedure. The complexity of RYGB means that serious and potentially preventable perioperative complications can occur. RYGB alters the normal anatomy and physiology of the upper gut, which has predictable adverse effects and potential complications. Patients seek advice and care for symptoms that develop or persist after RYGB; although some symptoms are expected and predictable, others are complications that may or may not require active medical or surgical intervention. Physicians should be able to predict and manage most postoperative medical and nutritional disorders related to RYGB and should be prepared to assess patients for potential referral for surgical intervention or revision.
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Affiliation(s)
- Bikram Bal
- Section of Gastroenterology, Washington Hospital Center and Georgetown University School of Medicine, Washington, DC 20010, USA
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Shankar P, Boylan M, Sriram K. Micronutrient deficiencies after bariatric surgery. Nutrition 2010; 26:1031-7. [PMID: 20363593 DOI: 10.1016/j.nut.2009.12.003] [Citation(s) in RCA: 203] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Revised: 12/02/2009] [Accepted: 12/06/2009] [Indexed: 01/03/2023]
Abstract
It has been estimated that approximately 220,000 people with morbid obesity underwent bariatric surgery in 2008. Modification of the gastrointestinal tract affects absorption and health care professionals counseling bariatric patients need to be aware of possible micronutrient deficiencies and their symptoms. A systematic review of several databases and bariatric surgery center websites on the Internet was conducted from January 1980 to July 2009 to identify literature related to micronutrient deficiencies occurring after bariatric surgery. Keywords used individually or in combination were bariatric surgery, obesity, vitamin/mineral deficiencies, altered gastrointestinal function, nutrient absorption, nutrient supplementation, and metabolic complications, and were variously combined in the search list. Based on this review, all patients scheduled for bariatric surgery should receive daily multivitamin and multitrace mineral supplements. The literature suggests that bariatric surgery patients are at risk for deficiency of the following nutrients after surgery: vitamins B(12), B(1), C, folate, A, D, and K, along with the trace minerals iron, selenium, zinc, and copper. Over-the-counter multivitamin and mineral supplements do not provide adequate amounts of certain nutrients such as vitamin B(12), iron, or fat-soluble vitamins and patients will require additional doses of prophylactic supplementation life-long to maintain optimal micronutrient status. In addition, preconception care for adequate prenatal supplementation is critical for pregnant women who have undergone bariatric surgery, as iron, vitamin A, vitamin B(12), vitamin K, and folate deficiencies are associated with maternal and fetal complications, including severe anemia, congenital abnormalities, low birth weight, and failure to thrive. All bariatric surgery patients would be best served by receiving regular monitoring of serum nutrient levels starting at 3 mo after surgery and periodically thereafter.
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Affiliation(s)
- Padmini Shankar
- Department of Health and Kinesiology, Georgia Southern University, Statesboro, Georgia, USA.
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Arbogast S, Ferreiro A. Selenoproteins and protection against oxidative stress: selenoprotein N as a novel player at the crossroads of redox signaling and calcium homeostasis. Antioxid Redox Signal 2010; 12:893-904. [PMID: 19769461 DOI: 10.1089/ars.2009.2890] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Healthy cells continually produce low levels of reactive oxygen species (ROS), which are buffered by multiple antioxidant systems. Imbalance between ROS production and elimination results in oxidative stress, which has been implicated in aging and in numerous human diseases, including cancer and diabetes. Selenoproteins are a family of proteins that contain the amino acid selenocysteine, encoded by an in-frame UGA. Those selenoproteins whose function is identified are catalytically active in redox processes, representing one of the main enzymatic antioxidant systems and important mediators of the beneficial role of selenium in human health. Nevertheless, the function of most selenoproteins remains unknown; this included Selenoprotein N (SelN), the only selenoprotein directly associated with a human genetic disease. Mutations of the SelN gene cause SEPN1-related myopathy, a particular early-onset muscle disorder. Recent studies have identified SelN as a key protein in cell protection against oxidative stress and redox-related calcium homeostasis. Furthermore, an effective ex vivo treatment of SelN deficiency has been identified, paving the way to a clinical therapy. In this review we discuss the physiological and pathophysiological role of SelN and the interest of SEPN1-related myopathy as a model paradigm to understand and target therapeutically other selenoproteins involved in human health and disease.
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Micronutrient Deficiencies. J Am Coll Cardiol 2009; 54:1660-73. [DOI: 10.1016/j.jacc.2009.08.012] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Revised: 08/24/2009] [Accepted: 08/25/2009] [Indexed: 01/08/2023]
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Abstract
The presence of nutritional deficiencies in overweight and obesity may seem paradoxical in light of excess caloric intake, but several micronutrient deficiencies appear to be higher in prevalence in overweight and obese adults and children. Causes are multifactorial and include decreased consumption of fruits and vegetables, increased intake of high-calorie, but nutritionally poor-quality foods, and increased adiposity, which may influence the storage and availability of some nutrients. As the obesity epidemic continues unabated and the popularity of bariatric surgery rises for severely obese adults and adolescents, medical practitioners must be aware of pre-existing nutritional deficiencies in overweight and obese patients and appropriately recognize and treat common and rare nutritional deficiencies that may arise or worsen following bariatric surgery. This article reviews current knowledge of nutritional deficits in obese and overweight individuals and those that commonly present after bariatric surgery and summarizes current recommendations for screening and supplementation.
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Affiliation(s)
- Stavra A. Xanthakos
- Assistant Professor of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, Medical Director, Surgical Weight Loss Program for Teens, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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Singh NK. Morbid obesity, cardiac disease, and bariatric surgery. Clin Cardiol 2009; 32:289. [PMID: 19452492 PMCID: PMC6653326 DOI: 10.1002/clc.20375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2007] [Revised: 12/17/2007] [Indexed: 11/09/2022] Open
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Lei C, Niu X, Wei J, Zhu J, Zhu Y. Interaction of glutathione peroxidase-1 and selenium in endemic dilated cardiomyopathy. Clin Chim Acta 2009; 399:102-8. [DOI: 10.1016/j.cca.2008.09.025] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Revised: 09/16/2008] [Accepted: 09/18/2008] [Indexed: 11/28/2022]
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Malone M. Recommended nutritional supplements for bariatric surgery patients. Ann Pharmacother 2008; 42:1851-8. [PMID: 19017827 DOI: 10.1345/aph.1l321] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To review nutritional supplements commonly required after bariatric surgery to provide a practical guide and reference source for generalist healthcare providers. DATA SOURCES A PubMed literature search (1988-July 2008) was conducted, using the search term nutritional deficiency after bariatric surgery, and was limited to English-language literature on adult (aged >19 y) human subjects. Additional references from the selected literature were also included. STUDY SELECTION AND DATA EXTRACTION Data were extracted from large clinical series and practice guidelines whenever possible. Case reports were used only when they were the sole information source. DATA SYNTHESIS Nutritional deficiencies that occur after bariatric surgery depend significantly on the type of surgery performed. Restrictive procedures such as gastric banding are the least likely to cause nutritional deficits, since none of the intestine is bypassed. Malabsorptive procedures such as biliopancreatic diversion or mixed restrictive/malabsorptive procedures (eg, Roux-en-Y gastric bypass) can result in serious nutritional problems when patients do not take required supplements after surgery. Vitamins and minerals that are commonly deficient in this circumstance include vitamin B(12), calcium, vitamin D, thiamine, folic acid, iron, zinc, and magnesium. Rare ocular complications have been reported with hypovitaminosis A. CONCLUSIONS Healthcare professionals, especially those who practice outside large bariatric centers, must be aware of the supplements required by patients who have had bariatric surgery. Many patients fail to follow up with the surgery centers and are managed by their primary care teams and community pharmacists, especially in the selection of multivitamin and nutritional supplements.
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Affiliation(s)
- Margaret Malone
- Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, NY 12208, USA.
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Weber KT, Weglicki WB, Simpson RU. Macro- and micronutrient dyshomeostasis in the adverse structural remodelling of myocardium. Cardiovasc Res 2008; 81:500-8. [PMID: 18835843 DOI: 10.1093/cvr/cvn261] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Hypertension and heart failure are worldwide health problems of ever-increasing proportions. A failure of the heart, during either systolic and/or diastolic phases of the cardiac cycle, has its origins rooted in an adverse structural, biochemical, and molecular remodelling of myocardium that involves its cellular constituents, extracellular matrix, and intramural coronary vasculature. Herein we focus on the pathogenic role of a dyshomeostasis of several macro- (i.e. Ca(2+) and Mg(2+)) and micronutrients (i.e. Zn(2+), Se(2+), and vitamin D) in contributing to adverse remodelling of the myocardium and its failure as a pulsatile muscular pump. An improved understanding of how these macro- and micronutrients account for the causes and consequences of adverse myocardial remodelling carries with it the potential of identifying new biomarkers predictive of risk, onset and progression, and response to intervention(s), which could be monitored non-invasively and serially over time. Moreover, such incremental knowledge will serve as the underpinning to the development of novel strategies aimed at preventing and/or regressing the ongoing adverse remodelling of myocardium. The time is at hand to recognize the importance of macro- and micronutrient dyshomeostasis in the evaluation and management of hypertension and heart failure.
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Affiliation(s)
- Karl T Weber
- Division of Cardiovascular Diseases, University of Tennessee Health Science Center, 920 Madison Ave., Suite 300, Memphis, TN 38163, USA.
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Ristow B, Rabkin J, Haeusslein E. Improvement in Dilated Cardiomyopathy After Bariatric Surgery. J Card Fail 2008; 14:198-202. [DOI: 10.1016/j.cardfail.2007.12.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2007] [Revised: 12/09/2007] [Accepted: 12/18/2007] [Indexed: 10/22/2022]
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