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Vitamin B12 and vitamin B12 supplementation effects on cognitive functions after bariatric surgery
Letters to the Editor
References 1. Comajuncosas J, Hermoso J, Gris P, et al. Risk factors for umbilical trocar site incisional hernia in laparoscopic cholecystectomy: a prospective 3-year follow-up study. Am J Surg 2014;207: 1–6. 2. Sørensen LT, Hemmingsen UB, Kirkeby LT, et al. Smoking is a risk factor for incisional hernia. Arch Surg 2005;140:119–23.
425 3. Sørensen LT, Karlsmark T, Gottrup F. Abstinence from smoking reduces incisional wound infection: a randomized controlled trial. Ann Surg 2003;238:1–5. 4. Owens M, Barry M, Janjua AZ, et al. A systematic review of laparoscopic port site hernias in gastrointestinal surgery. Surgeon 2011;9:218–24. 5. Bunting DM. Port-site hernia following laparoscopic cholecystectomy. JSLS 2010;14:490–7. 6. Helgstrand F, Rosenberg J, Bisgaard T. Trocar site hernia after laparoscopic surgery: a qualitative systematic review. Hernia 2011;15:113–21.
Vitamin B12 and vitamin B12 supplementation effects on cognitive functions after bariatric surgery To the Editor: With great interest, we read the recent article by Alosco et al1 regarding the long-term effect of bariatric surgery on cognitive functions. The authors very clearly discussed the cognitive improvement associated with bariatric surgery. They concluded that bariatric surgery may lead to lasting improvements in cognition. In addition to their fluent discussion, we aimed to emphasize a possible factor that may be associated with cognitive improvement in the study population, which does not take place in manuscript. Nutritional deficiencies are one of the possible problems which may occur in the postoperative period among people undergoing bariatric surgery and often require lifelong supplementation.2 Cobalamin (vitamin B12) is one of the most common micronutrient deficiencies affecting this population.3 It is very well known that Vitamin B12 deficiency may be associated with cognitive impairment especially in elderly population.4,5 Therefore, patients undergoing bariatric and gastric surgery may receive oral and/or parenteral vitamin and mineral supplement.6,7 Although the results of studies regarding the relation between B12 supplementation and cognitive improvement are inconsistent, B12 supplementation may improve cognitive functions.8,9 It is unclear whether the population of the study has used oral or parenteral B12 that may have a possible effect on cognitive improvement. We believe that future studies to assess the effect of surgical treatment of obesity on cognitive functions should consider monitoring preoperative and postoperative vitamin B12 status (serum level vs supplement).
Ertugrul Kargı, M.D. Department of General Surgery, Faculty of Medicine, Abant Izzet Baysal University, Golkoy, Bolu 14280, Turkey Ugur C¸akır, M.D. Osman Yıldırım, M.D. Department of Psychiatry, Faculty of Medicine, Abant Izzet Baysal University, Golkoy, Bolu, Turkey http://dx.doi.org/10.1016/j.amjsurg.2014.06.020
References 1. Alosco ML, Galioto R, Spitznagel MB, et al. Cognitive function after bariatric surgery: evidence for improvement 3 years after surgery. Am J Surg 2014;207:870–6. 2. Brolin RE, LaMarca LB, Kenler HA, et al. Malabsorptive gastric bypass in patients with superobesity. J Gastrointest Surg 2002;6:195–203. 3. Majumder S, Soriano J, Louie Cruz A, et al. Vitamin B12 deficiency in patients undergoing bariatric surgery: preventive strategies and key recommendations. Surg Obes Relat Dis 2013;9:1013–9. 4. Clarke R, Birks J, Nexo E, et al. Low vitamin B-12 status and risk of cognitive decline in older adults. Am J Clin Nutr 2007;86:1384–91. 5. Agarwal R. Vitamin B12 deficiency & cognitive impairment in elderly population. Indian J Med Res 2011;134:410–2. 6. Parkes E. Nutritional management of patients after bariatric surgery. Am J Med Sci 2006;331:207–13. 7. Rhode BM, Tamim H, Gilfix BM, et al. Treatment of vitamin B12 deficiency after gastric surgery for severe obesity. Obes Surg 1995;5:154–8. 8. Bryan J, Calvaresi E, Hughes D. Short-term folate, vitamin B-12 or vitamin B-6 supplementation slightly affects memory performance but not mood in women of various ages. J Nutr 2002;132:1345–56. 9. Kwok T, Tang C, Woo J, et al. Randomized trial of the effect of supplementation on the cognitive function of older people with subnormal cobalamin levels. Int J Geriatr Psychiatry 1998;13:611–6.
References 1. Comajuncosas J, Hermoso J, Gris P, et al. Risk factors for umbilical trocar site incisional hernia in laparoscopic cholecystectomy: a prospective 3-year follow-up study. Am J Surg 2014;207: 1–6. 2. Sørensen LT, Hemmingsen UB, Kirkeby LT, et al. Smoking is a risk factor for incisional hernia. Arch Surg 2005;140:119–23.
425 3. Sørensen LT, Karlsmark T, Gottrup F. Abstinence from smoking reduces incisional wound infection: a randomized controlled trial. Ann Surg 2003;238:1–5. 4. Owens M, Barry M, Janjua AZ, et al. A systematic review of laparoscopic port site hernias in gastrointestinal surgery. Surgeon 2011;9:218–24. 5. Bunting DM. Port-site hernia following laparoscopic cholecystectomy. JSLS 2010;14:490–7. 6. Helgstrand F, Rosenberg J, Bisgaard T. Trocar site hernia after laparoscopic surgery: a qualitative systematic review. Hernia 2011;15:113–21.
Vitamin B12 and vitamin B12 supplementation effects on cognitive functions after bariatric surgery To the Editor: With great interest, we read the recent article by Alosco et al1 regarding the long-term effect of bariatric surgery on cognitive functions. The authors very clearly discussed the cognitive improvement associated with bariatric surgery. They concluded that bariatric surgery may lead to lasting improvements in cognition. In addition to their fluent discussion, we aimed to emphasize a possible factor that may be associated with cognitive improvement in the study population, which does not take place in manuscript. Nutritional deficiencies are one of the possible problems which may occur in the postoperative period among people undergoing bariatric surgery and often require lifelong supplementation.2 Cobalamin (vitamin B12) is one of the most common micronutrient deficiencies affecting this population.3 It is very well known that Vitamin B12 deficiency may be associated with cognitive impairment especially in elderly population.4,5 Therefore, patients undergoing bariatric and gastric surgery may receive oral and/or parenteral vitamin and mineral supplement.6,7 Although the results of studies regarding the relation between B12 supplementation and cognitive improvement are inconsistent, B12 supplementation may improve cognitive functions.8,9 It is unclear whether the population of the study has used oral or parenteral B12 that may have a possible effect on cognitive improvement. We believe that future studies to assess the effect of surgical treatment of obesity on cognitive functions should consider monitoring preoperative and postoperative vitamin B12 status (serum level vs supplement).
Ertugrul Kargı, M.D. Department of General Surgery, Faculty of Medicine, Abant Izzet Baysal University, Golkoy, Bolu 14280, Turkey Ugur C¸akır, M.D. Osman Yıldırım, M.D. Department of Psychiatry, Faculty of Medicine, Abant Izzet Baysal University, Golkoy, Bolu, Turkey http://dx.doi.org/10.1016/j.amjsurg.2014.06.020
References 1. Alosco ML, Galioto R, Spitznagel MB, et al. Cognitive function after bariatric surgery: evidence for improvement 3 years after surgery. Am J Surg 2014;207:870–6. 2. Brolin RE, LaMarca LB, Kenler HA, et al. Malabsorptive gastric bypass in patients with superobesity. J Gastrointest Surg 2002;6:195–203. 3. Majumder S, Soriano J, Louie Cruz A, et al. Vitamin B12 deficiency in patients undergoing bariatric surgery: preventive strategies and key recommendations. Surg Obes Relat Dis 2013;9:1013–9. 4. Clarke R, Birks J, Nexo E, et al. Low vitamin B-12 status and risk of cognitive decline in older adults. Am J Clin Nutr 2007;86:1384–91. 5. Agarwal R. Vitamin B12 deficiency & cognitive impairment in elderly population. Indian J Med Res 2011;134:410–2. 6. Parkes E. Nutritional management of patients after bariatric surgery. Am J Med Sci 2006;331:207–13. 7. Rhode BM, Tamim H, Gilfix BM, et al. Treatment of vitamin B12 deficiency after gastric surgery for severe obesity. Obes Surg 1995;5:154–8. 8. Bryan J, Calvaresi E, Hughes D. Short-term folate, vitamin B-12 or vitamin B-6 supplementation slightly affects memory performance but not mood in women of various ages. J Nutr 2002;132:1345–56. 9. Kwok T, Tang C, Woo J, et al. Randomized trial of the effect of supplementation on the cognitive function of older people with subnormal cobalamin levels. Int J Geriatr Psychiatry 1998;13:611–6.