Treatment of Vitamin B12 Deficiency after Gastric Surgery for Severe Obesity

Background: Vitamin B₁₂ deficiency after gastric surgery for obesity is due to a failure of separation of vitamin B₁₂ from protein foodstuffs and to a failure of absorption of crystalline vitamin B₁₂ in the presence of intrinsic factor. The purpose of this study was to determine which of four oral doses of crystalline vitamin B₁₂ was most effective in treating vitamin B₁₂ deficiency in 102 patients. Methods and Results: At time of entry into the study, the patients had a serum vitamin B₁₂ < 100 pmol L ⁻¹, were 29.9 ± 21.7 months post-op, were 37 ± 8 years old and had a body mass index of 30 ± 6 kg m⁻². Eight (8%) had had a vertical banded gastroplasty and 94 (92%) a gastric bypass. For the first 3 months all patients received 350 μg per day of crystalline vitamin B₁₂ and all increased their serum vitamin B₁₂ levels to over 100 pmol L⁻¹. The patients were then assigned to receive for a further 3 month period one of four oral doses of crystalline vitamin B₁₂-100 μg, 250 μg, 350 μg and 600 μg. Serum vitamin B₁₂ levels were greater than 150 pmol L⁻¹ after 6 months in 83.3% of patients who received 100 μg; 92.3% of patients who received 250 μg; 94.7% after 350 μg and 95.2% after 600 μg (p%0.525). Conclusion: At least 350 μg per day is the appropriate oral dose of crystalline vitamin B₁₂ after gastric surgery for obesity to correct low serum vitamin B₁₂ levels in 95% of patients.     

Anthropometric Characteristics of Mohawk Children Aged 6 to 11 Years: A Population Perspective

OBJECTIVE: Recent studies have concluded that Native North American children have higher proportions of overweight and obesity than children from the general North American population. This study presents anthropometric data on a representative sample of children from the Mohawk Nation that can be used for comparison with other Native American populations. DESIGN: This is a cross-sectional study comparing distributions of anthropometric characteristics of Mohawk children to the corresponding age and gender data from the Second National Health and Nutrition Examination Survey (NHANES II). Weight, height, triceps and subscapular skinfold thickness, and waist and hip circumferences were measured in 527 children. SUBJECTS/SETTING: All children in grades 1 to 6 (aged 6 to 11 years) in the 3 elementary schools of 2 Mohawk communities in Canada, for whom parental consent was obtained, were enrolled in the present study. There were no exclusion criteria. With a participation rate of 83%, the 527 children enrolled in this study represent an unbiased sample of the population from 2 Mohawk territories. RESULTS: Compared with children studied in NHANES II, Mohawk children were similar in height and triceps skinfolds but were generally heavier, had thicker subscapular skinfolds, and had greater waist and hip circumferences. These differences were greater in older children. Mohawk children who had extreme-high weight values compared with their population means were heavier than their NHANES II counterparts. APPLICATIONS/CONCLUSIONS: Results indicated that, on average, Mohawk children seem to be slightly heavier than children in NHANES II. Except for those with extreme overweight values, Mohawk children show less variation of weight and body mass index than children in NHANES II. Finally, overweight Mohawk children seem to be more likely to carry their excess body fat truncally, compared with overweight children from NHANES II. Health practitioners working with Native American populations should be careful when assessing childhood obesity. Simple comparisons of weight or body mass index with NHANES standards may lead to inappropriate risk assessments.     

Long-or short-limb gastric bypass?

The aim of this study was to determine whether longer limb length improved results of gastric bypass in patients who were morbidly obese (body mass index <50 kg/m²) or superobese (body mass index >50 kg/m²). A total of 242 patients were followed for a mean of 5.5 years. The standard operation was a Roux-en-Y gastric bypass with a 40 cm Roux limb and a 10 cm afferent limb. The long-limb operation had a 100 cm Roux limb and a 100 cm afferent limb. Morbidly obese patients did not benefit from a long-limb bypass. The final body mass index was 28.6 ±4.7 kg/m² in the short-limb group and 28.5 ± 3.8 kg/m² in the long-limb group. The superobese patients did benefit from a long-limb bypass. Final body mass index was 35.8 ±6.7 kg/m² in the short-limb patients and 32.7 ±5.1 in the long-limb patients (P = 0.049). A subgroup of 20 patients, all of whom had a body mass index greater than 60 kg/m², benefited the most from long-limb bypass. No macronutritional side effects unique to the long-limb bypass were encountered.     

Impact of Health Conditions on Food Intakes Among Older Adults

ABSTRACT

Even well older adults may experience a range of age-related physiological changes and chronic health conditions and may become increasingly sedentary—key factors that could affect appetite and hunger and lead to changes in diet composition. The present article reviews recent literature on the impact of prevalent health conditions on dietary choice. Research shows some evidence that older adults make positive dietary changes following the onset of certain chronic health conditions. However, most chronic diseases appear to lead to dietary restrictions that compromise nutritional status. The nature of the health condition and its effect on physiological function will drive the dietary change process. The extent to which health care providers counsel their patients to incorporate changes into their diet and the mindset and belief system of each individual may also have a strong impact on food choices. A recurring theme in the research examined in this review was older adults' desire to improve their diet, coupled with their frustration at not being offered sufficient counseling by their health care providers. The role of health care professionals, particularly nutritionists, in guiding older adults toward an improved diet cannot be overstated.     

Surgery for Obesity - An Update of a Randomized Trial

Background: A prospective, randomized trial comparing vertical banded gastroplasty (VBG) and gastric bypass (GB) was performed on 106 patients between 1987 and 1990. Methods and Results: Failures of these two operations (manifested by failure to lose weight, late weight gain or intolerance of adequate oral intake) were treated by means of a third operation, isolated gastric bypass (IGB), in which the small gastric pouch was isolated from the gastric fundus. The latter operation was significantly better than VBG or GB and achieved a 63% success rate, i.e. body mass index (BMI) < 35 kg m⁻² and less than 50% excess weight. During the year following this trial an additional 54 patients underwent IGB. When this operation was performed for morbid obesity and was the initial procedure, 96% of the patients achieved a successful result. If IGB was performed as a revision procedure or for super obesity (BMI > 50 kg m⁻²), the success rate was 63% with 100% follow-up at 40 months. Major morbidity occurred in six of the 160 patients who underwent 195 operations (the trial period and subsequent year). There were no deaths and follow-up was 98%. Conclusions: The ideal gastric operation based on this study emphasizes the following requirements: a small pouch (< 15ml) totally separated from the stomach, a pouch not dependent on staples, placed in the dependent position to prevent stasis, constructed without foreign material and with an anastomosis which permits ingestion of solid food.     

A Nutritional Rehabilitation Program for Persons With Severe Physical and Developmental Disabilities

Our purpose was to design and implement a nutritional rehabilitation program for persons with severe developmental disabilities who resided in a long-term-care facility or a group home. We used weight for height (WH) to classify residents of both facilities into three groups: group 1 (n-32), WH less than 5th percentile (Z scores ≤ −1.650), goal=gain weight; group 2 (n=21), WH between the 5th and 85th percentile (Z scores ranging from −1.645 to +1.030), goal=maintain present rate of weight gain; and group 3 (n=8), WH greater than 85th percentile (Z scores ≥ +1.036), goal=slow down rate of weight gain. The challenge in all groups was to bring about these changes without increasing the quantity of food (as assessed by 3-day food records) fed to the residents and to increase their fluid intake. For each subject, the project dietitian developed individualized menus that specified quantities and consistencies of food. Foodservice delivery was changed to a centralized system in the long-term-care facility to allow for closer control of the subjects' intake. A dietitian monitored the program with biweekly visits to the wards and frequent consultation with staff. Only a limited increase in fluid intake was noted; however, after 6 months of the program, the other goals were met. Our results suggest that nutritional rehabilitation of residents with developmental disabilities is enhanced by the involvement of a dietitian. J Am Diet Assoc. 1997;97:162–166.     

Inverse Dose Effect of Pretest Dietary Lactose Intake on Breath Hydrogen Results and Symptoms in Lactase Nonpersistent Subjects

The aim of this study was to determine a relationship between pretest intake of lactose and outcome of lactose breath hydrogen test. Patients presented at a testing laboratory participated in the study. A 3-hour breath hydrogen, 50-g lactose challenge was carried out. Results were tabulated and patients completed a 3-day recall diet questionnaire. Daily lactose intake was independently calculated and was associated with breath hydrogen and total symptom score. Statistical analysis used Spearman's correlation, Mann-Whitney U-test and χ² or Fisher exact test. Of 118 patients, 50% were lactose maldigesters. In these patients, measured breath hydrogen and symptom scores were significantly higher in the lowest intake group (< 5 g/d) than in the highest intake group (> 20 g/d) (P < .05). In the presumed lactose digesters, 59% experienced some symptoms during testing for unclear reasons. Pretest dietary intake of lactose inversely affects results of breath hydrogen.     

Biliary lipid,bile acid composition,and dietary correlations in Micmac Indian women

The precursor state for cholesterol gallstone formation is cholesterol-saturated bile. We studied a high-risk group for cholesterol gallstones to determine whether dietary variables affect bile cholesterol. Bile samples were analyzed from 46 Micmac Indian women without gallstones and 13 with gallstones for molar percentage cholesterol (MPC) and bile acid composition. The data were analyzed by multiple regression analysis with MPC as the dependent variable and the dietary variables, obtained from four consecutive-day food records, and biliary bile acid composition as the independent variables. In the 46 women without gallstones, obesity, calorie range/calorie intake, and iron and calcium intake were, in their order of importance, significant factors. In normal weight subjects (ponderal index>12.5) relative obesity was still a significant correlate. Obesity and iron intake were positive correlates while calorie range/calorie intake and calcium intake varied inversely. When the effect of obesity was controlled, these factors were still significant in this group, as they were in the gallstone group. In addition, the duration of overnight fast obtained by history, together with the proportions of deoxycholic and chenodeoxycholic acids in bile were correlates of the biliary molar percentage cholesterol.Presented in part at the Tenth International Congress of Gastroenterology, Budapest, June 1976, and at the Bile Lipid Seminar, American Gastroenterology Association, Given Institute, Aspen, Colorado, August 1977.This project was supported under National Health Research and Development Project Number 603-1008-30, Health and Welfare Canada.