Smelt H J M, Smulders J F, Said M, Nienhuijs S W, Boer A K
Department of Dietetics, Catharina Hospital, Michelangelolaan 2, P.O. Box 1350, 5602 ZA, Eindhoven, The Netherlands.
Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
Obes Surg. 2016 Jul;26(7):1500-4. doi: 10.1007/s11695-015-1952-8.
Vitamin B12 deficiency is common after bariatric surgery. Vitamin B12 is a poor predictor of functional vitamin B12 status, since deficiencies might even occur within the reference limits. Therefore, vitamin B12 deficiencies with serum vitamin B12 levels are between 140 and 200 pmol/L remain undetected. Methylmalonic acid (MMA), however, will detect these deficiencies as accumulates due to functional intracellular vitamin B12 deficiencies. MMA is a relative expensive analysis and is therefore not generally available. To lower the costs, we only request MMA when vitamin B12 levels are between these levels. As a result, more biochemical deficiencies are found. However, it was not known whether bariatric patients with vitamin B12 levels between 140 and 200 pmol/L would benefit from supplementation.
Bariatric patients with vitamin B12 levels between 140 and 200 pmol/L with (n = 45) and without (n = 45) intramuscular hydroxocobalamin injections were compared.
Treated patients showed a significant increase of vitamin B12 levels (P < 0.001) and a significant decrease in MMA levels (P < 0.001). Biochemical improvement occurs in both patients with and without clinical symptoms. The control group showed a significant increase of MMA levels (P < 0.001). To examine whether biochemical benefits of vitamin B12 supplementation are correlated with clinical improvement, patient records were checked for complaints. Complaints were disappeared after treatment, while no improvement was seen in untreated patients.
This study shows that all bariatric patients with vitamin B12 levels between 140 and 200 pmol/L benefit clinical and biochemical from vitamin B12 supplementation, regardless the MMA levels.
减肥手术后维生素B12缺乏很常见。维生素B12对功能性维生素B12状态的预测能力较差，因为即使在参考范围内也可能出现缺乏情况。因此，血清维生素B12水平在140至200 pmol/L之间的维生素B12缺乏仍未被发现。然而，甲基丙二酸（MMA）会因细胞内功能性维生素B12缺乏而积累，从而检测出这些缺乏情况。MMA分析相对昂贵，因此一般无法进行。为了降低成本，我们仅在维生素B12水平处于这些范围时才要求检测MMA。结果，发现了更多的生化缺乏情况。然而，尚不清楚维生素B12水平在140至200 pmol/L之间的减肥患者是否能从补充剂中获益。
比较了维生素B12水平在140至200 pmol/L之间接受（n = 45）和未接受（n = 45）肌肉注射羟钴胺素的减肥患者。
接受治疗的患者维生素B12水平显著升高（P < 0.001），MMA水平显著降低（P < 0.001）。有临床症状和无临床症状的患者均出现生化改善。对照组MMA水平显著升高（P < 0.001）。为了检查补充维生素B12的生化益处是否与临床改善相关，检查了患者记录中的主诉。治疗后主诉消失，而未治疗的患者未见改善。
本研究表明，所有维生素B12水平在140至200 pmol/L之间的减肥患者，无论MMA水平如何，补充维生素B12均能在临床和生化方面获益。
