Vitamin B12 deficiency in patients undergoing bariatric surgery: Preventive strategies and key recommendations

Background: Advances in bariatric surgery have brought about a paradigm shift in the management of obesity, with benefits extending beyond weight loss. However, nutritional deficiencies are an inherent problem in the postoperative period and often require lifelong supplementation. Vitamin B-12, also referred to as cobalamin, is one of the most common micronutrient deficiencies affecting this population. This review explores the pathophysiology of cobalamin deficiency in patients undergoing bariatric surgery and provides an overview of the effectiveness of various available vitamin B-12 formulations. Methods: To identify the relevant literature, a systematic review of MEDLINE was conducted from the earliest dates through September 2012 for English-language articles describing the prevention and management of vitamin B-12 deficiency in patients undergoing bariatric surgery. Results: Intramuscular vitamin B-12 continues to be the gold standard of therapy for vitamin B-12 deficiency, especially in symptomatic patients. In select patients with asymptomatic vitamin B-12 deficiency after Roux-en-Y gastric bypass (RYGB), high-dose oral cyanocobalamin should be given a consideration, especially when there are concerns with the adherence to intramuscular therapy or if compliance comes into question. Unlike patients post-RYGB, those undergoing restrictive procedures such as gastric banding and sleeve gastrectomy may be maintained postoperatively on a lower-dose daily vitamin B-12 supplementation. Efficacy data of nasal and sublingual routes for maintenance therapy is currently awaited. Conclusion: Patients undergoing bariatric surgery must be continuously educated on proper nutrition, the risk of developing significant vitamin B-12 deficiency, and the role of supplements in avoiding catastrophic consequences. (C) 2013 American Society for Metabolic and Bariatric Surgery. All rights reserved.