Page 28 - Read Online

Page 4 of 7 Çalapkorur et al. Mini-invasive Surg 2020;4:15 I http://dx.doi.org/10.20517/2574-1225.2019.51

It is recommended that vitamin C deficiency, which is observed frequently after bariatric surgery, should
be treated with 200 mg/day oral vitamin C supplementation [20,23,24] .

Biotin
Biotin deficiency after bariatric surgery has not been reported in studies examining biotin deficiency after
bariatric surgery [33,34] . A case regarding the loss of sense of taste after SG is reported in the literature. The
patient’s loss of taste was eliminated by oral biotin supplementation of 20 mg/day for several weeks [20,23,35] .

FAT-SOLUBLE VITAMINS

Vitamin A
Data from the literature suggest that vitamin A deficiency is more common in patients who have undergone
biliopancreatic diversion (BPD) and RYGB surgeries in which the duodenal channel was bypassed [36,37] .
The presence of bile and bile acids in this channel was suggested as the cause of this situation. The relative
reduction in bile and bile acids is accompanied by the deconjugation of bile acids, which occurs as a result
[24]
of bacterial overgrowth in the small intestine, and, thus, vitamin A deficiency is observed in patients .
In the studies on the subject, it was also reported that 10%-11% of vitamin A deficiency occurs in the first
year following RYGB and BPD [36,38] .

As an initial treatment for vitamin A deficiency, 10,000 international unit (IU)/day vitamin A oral
supplementation is recommended. Since β-carotene-related vitamin A toxicity was not reported in the
literature, the use of this compound in the treatment of vitamin A deficiency is recommended [20,23,24] .

Vitamin D
Vitamin D deficiency is a condition observed frequently after bariatric surgery that causes bone losses and
[39]
fractures, thus morbidity in the long term . After bariatric surgery, decreased absorption areas in the
small intestine, pancreatic secretion, and changes in bile distribution are the factors that lead to decreased
[40]
absorption of vitamin D .
Vitamin D deficiency is also quite common in morbidly obese patients waiting for bariatric surgery. The
prevalence of vitamin D deficiency before surgery is reported to be between 54% and 80%. Inadequate
vitamin D intake, insufficient exposure to sunlight, and low bioavailability of vitamin D are reported as the
[40]
reasons for this condition . In the case of vitamin D deficiency, parathyroid hormone levels increase in
order to maintain calcium balance in the body. This secondary hyperparathyroidism effect increases bone
[41]
resorption and is associated with osteoporosis and osteomalacia in adults . It is reported in the literature
[42]
that the prevalence of secondary hyperparathyroidism after bariatric surgery is up to 58% . Due to the
increased incidence of secondary hyperparathyroid syndrome and vitamin D deficiency after surgery, the
effect of different surgical procedures on vitamin D levels has been investigated in several studies [13,43-47] .

Studies have shown that vitamin D deficiency is observed only after SG, which is known as a restrictive
method [43,44] . In a study following patients for one year after SG, vitamin D deficiency was found in 39% of
[43]
patients despite using daily multivitamin support . In another study, a significant loss in bone mass and
[44]
bone structure was observed one year following SG .
Vitamin D deficiency was reported to be 7% in the first year following RYGB, which is a malabsorptive
[13]
method . This rate was reported to be 65% in the 10th postoperative year and suggested to be due to
[41]
increased levels of parathyroid hormone .
The prevalence of vitamin D deficiency was determined as 63% in the fourth year after BPD and 73% in
the eighth year [45,46] . In adjustable gastric band surgery, vitamin D deficiency has been reported to be the
[47]
second most common micronutrient deficiency after iron (Fe) deficiency .