Vitamin and Micronutrient Deficiency and Peripheral Polyneuropathy Following Intragastric Balloon Technique Used For Obese People: Preliminary Study

Abstract

Aim: Complications from malnourishment when treating obesity are common, especially following bariatric surgery. Peripheral polyneuropathy due to vitamin and micronutrient deficiency is the most commonly encountered complication of bariatric surgery. The objective of this study was to investigate if this technique may lead to peripheral polyneuropathy due to vitamin B1, B2, B6, B12,folate, zinc, iron, and copper deficiency. Material and Methods: In this study nine patients whose obesity was treated with the Spatz3 intragastric balloon technique wereinvestigated for vitamin and micronutrient deficiencies and any consequent peripheral polyneuropathy. Vitamin B1, B2, B6, B12,zinc, copper, iron and folate were measured. Electromyography (EMG) was used to evaluate peripheral polyneuropathy, based on the Toronto Clinical Neuropathy Score (TCNS). Results: None of the patients had vitamin B1, B2 or B6 deficiency, whereas one patient (11%) had vitamin B12 and another one patient (11%) had folate deficiency. Copper deficiency was seen in five patients (55.6%), iron deficiency was seen in seven patients (77.8%) and zinc deficiency was seen in eight patients (88.9%). Two patients (22.2%) had abnormal sensory nevre velocity and were diagnosed with polyneuropathy. However, these two had normal concentrations of B vitamins and folate but were deficient for copper, iron, and zinc. Conclusion: The intragastric balloon technique does not appear to be associated with peripheral polyneuropathy due to vitamin B deficiency. In our opinion it is a safe approach for obesity treatment in terms of the risk of peripheral polyneuropathy due to vitamin B deficiency.

Keywords

• Obesity
• gastric balloon
• malnourishment
• vitamin B deficiency
• polyneuropathy

Obez Kişilerde Kullanılan İntragastrik Balon Tekniği Sonrası Vitamin ve Mikrobesin Eksikliği ve Periferik Polinöropati: Ön Çalışma

Abstract

Amaç: Obezite tedavisi sırasında yetersiz beslenmeden kaynaklanan komplikasyonlar, özellikle bariatrik cerrahiyi takiben yaygındır. Vitamin ve mikrobesin eksikliğine bağlı periferik polinöropati, obezite cerrahisinin en sık karşılaşılan komplikasyonudur. Bu çalışmanın amacı, bu tekniğin vitamin B1, B2, B6, B12, folat, çinko, demir ve bakır eksikliğine bağlı periferik polinöropatiye yol açıp açamayacağını araştırmaktır. Gereç ve Yöntemler: Bu çalışmada, obezitesi Spatz3 intragastrik balon tekniği ile tedavi edilen dokuz hasta, vitamin ve mikrobesin eksiklikleri ve buna bağlı periferik polinöropati açısından araştırıldı. Vitamin B1, B2, B6, B12, çinko, bakır, demir ve folat değerleri ölçüldü. Toronto Klinik Nöropati Skoru (TCNS)’na göre periferik polinöropatiyi değerlendirmek için elektromiyografi (EMG) kullanıldı. Bulgular: Hastaların hiçbirinde vitamin B1, B2 veya B6 eksikliği yoktu, bir hastada (%11) vitamin B12 ve başka bir hastada (%11) folat eksikliği vardı. Beş hastada (%55.6) bakır eksikliği, yedi hastada (%77.8) demir eksikliği ve sekiz hastada (%88.9) çinko eksikliği görüldü. İki hastada (%22.2) anormal duyu siniri hızı vardı ve polinöropati tanısı konuldu. Bununla birlikte bu ikisinin B vitamini ve folat konsantrasyonları normaldi ancak bakır, demir ve çinko eksikliği vardı. Sonuç: İntragastrik balon tekniği, B vitamini eksikliğinden kaynaklanan periferik polinöropati ile ilişkili görünmemektedir. B vitamini eksikliğine bağlı periferik polinöropati riski açısından obezite tedavisi için güvenli bir yaklaşım olduğunu düşünüyoruz.

Keywords

• Obezite
• mide balonu
• yetersiz beslenme
• B vitamini eksikliği
• polinöropati

References

1. [1]. Kalabin A, Mani VR, Mishra A, Depaz H, Ahmed L. Acute Pancreatitis with Splenic Infarction as Early Postoperative Complication following Laparoscopic Sleeve Gastrectomy. Case Rep Surg. 2017;2017:8398703. doi: 10.1155/2017/8398703.
2. [2]. Organization for Economic Cooperation and Development (OECD). Obesity UPDATE. 2017. Available online: https://www.oecd.org/els/health-systems/Obesity-Update-2017.pdf (accessed 1 May 2018).
3. [3]. Wijga AH, Scholtens S, Bemelmans WJ, de Jongste JC, Kerkhof M, Schipper M, Sanders EA, Gerritsen J, Brunekreef B, Smit HA. Comorbidities of obesity in school children: a cross-sectional study in the PIAMA birth cohort. BMC Public Health 2010;10:184. doi: 10.1186/1471-2458-10-184.
4. [4]. Li C, Ford ES, Zhao G, Croft JB, Balluz LS, Mokdad AH. Prevalence of self-reported clinically diagnosed sleep apnea according to obesity status in men and women: National Health and Nutrition Examination Survey, 2005-2006. Prev Med. 2010 Jul;51(1):18-23. doi: 10.1016/j.ypmed.2010.03.016.
5. [5]. Behrns KE, Smith CD, Sarr MG. Prospective evaluation of gastric acid secretion and cobalamin absorption following gastric bypass for clinically severe obesity. Dig Dis Sci. 1994 Feb;39(2):315-20. doi: 10.1007/BF02090203.
6. [6]. Chapin BL, LeMar HJ Jr, Knodel DH, Carter PL. Secondary hyperparathyroidism following biliopancreatic diversion. Arch Surg 1996; 131: 1048-1052.
7. [7]. Gleysteen JJ. A history of intragastric balloons. Surg Obes Relat Dis 2016; 12: 430-435. doi: 10.1016/ j.soard.2015.10.074.
8. [8]. Bonazzi P, Petrelli MD, Lorenzini I, Peruzzi E, Nicolai A, Galeazzi R. Gastric emptying and intragastric balloon in obese patients. Eur Rev Med Pharmacol Sci 2005; 9: 15-21.

9. [9]. Su HJ, Kao CH, Chen WC, Chang TT, Lin CY. Effect of intragastric balloon on gastric emptying time in humans for weight control. Clin Nucl Med 2013; 38:863-868. doi: 10.1097/RLU.0000000000000224.
10. [10]. Geliebter A. Gastric distension and gastric capacity in relation to food intake in humans. Physiol Behav. 1988;44(4-5):665-8. doi: 10.1016/0031-9384(88)90333-2.
11. [11]. UpToDate. Uptodatecom. 2018. Available at: https://www.uptodate.com/contents/intragastric-balloon-therapy-for-weight-loss. (accessed 18 June 2018).
12. [12]. Kim SH, Chun HJ, Choi HS, Kim ES, Keum B, Jeen YT. Current status of intragastric balloon for obesity treatment. World J Gastroenterol 2016; 22: 5495 - 5504. doi: 10.3748/wjg.v22.i24.5495.
13. [13]. Bloomberg RD, Fleishman A, Nalle JE, Herron DM, Kini S. Nutritional deficiencies following bariatric surgery: what have we learned? Obes Surg 2005; 15: 145 – 154. doi: 10.1381/0960892053268264.
14. [14]. Garcia OP, Long KZ, Rosado JL. Impact of micronutrient deficiencies on obesity. Nutr Rev 2009; 67: 559 – 572. doi: 10.1111/j.1753-4887.2009.00228.x.
15. [15]. Aasheim ET, Hofso D, Hjelmesaeth J, Birkeland KI, Bohmer T. Vitamin status in morbidly obese patients: a cross-sectional study. Am J Clin Nutr 2008; 87: 362 – 369. doi: 10.1093/ajcn/87.2.362.
16. [16]. Clark N. Neuropathy following bariatric surgery. Semin Neurol 2010; 30: 433 - 435. doi: 10.1055/s-0030-1267287.
17. [17]. Koffman BM, Greenfield LJ, Ali II, Pirzada NA. Neurologic complications after surgery for obesity. Muscle Nerve 2006; 33:166–176. doi: 10.1002/mus.20394.
18. [18]. Thaisetthawatkul P, Collazo-Clavell ML, Sarr MG, Norell JE, Dyck PJ. A controlled study of peripheral neuropathy after bariatric surgery. Neurology 2004; 63: 1462 – 1470. doi: 10.1212/01.wnl.0000142038.43946.06.
19. [19]. Elias WJ, Pouratian N, Oskouian RJ, Schirmer B, Burns T. Peroneal neuropathy following successful bariatric surgery. Case report and review of the literature. J Neurosurg 2006; 105: 631 – 635. doi: 10.3171/jns.2006.105.4.631.
20. [20]. Chaves LC, Faintuch J, Kahwage S, Alencar Fde A. A cluster of polyneuropathy and Wernicke-Korsakoff syndrome in a bariatric unit. Obes Surg 2002; 12: 328 - 334. doi: 10.1381/096089202321088093.
21. [21]. Boylan LM, Sugerman HJ, Driskell JA. Vitamin E, vitamin B-6, vitamin B-12, and folate status of gastric bypass surgery patients. J Am Diet Assoc 1988; 88: 579 – 585.
22. [22]. Landais A. Neurological complications of bariatric surgery. Obes Surg 2014; 24: 1800 – 1807. doi: 10.1007/s11695-014-1376-x.
23. [23]. Rhode BM, Arseneau P, Cooper BA, Katz M, Glifx BM, MacLean LD. Vitamin B-12 deficiency after gastric surgery for obesity. Am J Clin Nutr 1996; 63: 103–109.
24. [24]. Kumar N, Gross JB Jr, Ahlskog JE. Myelopathy due to copper deficiency. Neurology 2003; 61: 273 - 274. doi: 10.1212/01.wnl.0000073542.02761.5f.
25. [25]. Tan JC, Burns DL, Jones HR. Severe ataxia, myelopathy, and peripheral neuropathy due to acquired copper deficiency in a patient with history of gastrectomy. JPEN J Parenter Enteral Nutr 2006; 30: 446 – 450. doi: 10.1177/0148607106030005446.
26. [26]. Halverson, JD. Micronutrient deficiencies after gastric bypass for morbid obesity. Am Surg 1986; 52: 594 – 598.
27. [27]. World Health Organization. (2018). Obesity and overweight. [online] Available at: http://www.who.int/en/news-room/fact-sheets/detail/obesity-and-overweight (accessed 1 May 2018).
28. [28]. Berger JR. The neurological complications of bariatric surgery. Arch Neurol 2004; 6: 1185 – 1189. doi:10.1001/archneur.61.8.1185
29. [29]. Flancbaum L, Belsley S, Drake V, Colarusso T, Tayler E. Preoperative nutritional status of patients undergoing Roux-en-Y gastric bypass for morbid obesity. J Gastrointest Surg 2006; 10: 1033 – 1037. doi: 10.1016/j.gassur.2006.03.004.
30. [30]. Becker DA, Balcer LJ, Galetta SL. The Neurological Complications of Nutritional Deficiency following Bariatric Surgery. J Obes 2012; 2012: 608534. doi: 10.1155/2012/608534.