Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, Broniewskiego Str. 24, 71-460, Szczecin, Poland.
Independent Provincial Public Hospital Complex in Szczecin - Zdunowo, Szczecin, Poland.
Obes Surg. 2019 Nov;29(11):3735-3742. doi: 10.1007/s11695-019-04100-2.
Obesity is currently one of the biggest global health problems. In the case of severe obesity, bariatric surgeries are considered to be the most important method of treatment. The 2 most commonly performed bariatric surgery procedures include Roux-en-Y gastric bypass and sleeve gastrectomy. However, these methods are not free from complications, and the most common ones (moderately long or long term) are micronutrient deficiencies. The deficiency of vitamins B6, B12, and folic acid as cofactors of the folate cycle contributes to the development of hyperhomocysteinemia. It seems that apart from nutritional factors, there are other aspects that have a significant influence on the concentration of homocysteine in blood, such as the type of conducted bariatric surgery, the post-surgical concentration of betaine and creatinine, and the clearance of methionine (i.e., the mutations of the gene that encodes the MTHFR reductase as well as other genes associated with the process of methylation, e.g., methionine synthase). Their presence might be one of the causes of the increased concentration of homocysteine after surgery despite the fact that patients take vitamin-mineral supplementation.
肥胖目前是全球最大的健康问题之一。在严重肥胖的情况下，减重手术被认为是最重要的治疗方法。两种最常进行的减重手术包括 Roux-en-Y 胃旁路术和袖状胃切除术。然而，这些方法并非没有并发症，最常见的并发症（中短期或长期）是微量营养素缺乏。维生素 B6、B12 和叶酸作为叶酸循环的辅助因子的缺乏导致高同型半胱氨酸血症的发展。除了营养因素外，似乎还有其他因素对血液同型半胱氨酸浓度有显著影响，例如所进行的减重手术类型、手术后甜菜碱和肌酐的浓度以及蛋氨酸的清除率（即编码 MTHFR 还原酶的基因突变以及与甲基化过程相关的其他基因，例如蛋氨酸合酶）。尽管患者服用维生素矿物质补充剂，但这些因素可能是手术后同型半胱氨酸浓度升高的原因之一。
