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Background: Bariatric surgery is widely performed to induce weight loss. Objective: The objective was to examine changes in vitamin status after 2 bariatric surgical techniques. Design: A randomized controlled trial was conducted in 2 Scandinavian hospitals. The subjects were 60 superobese patients [body mass index (BMI; in kg/[m.sup.2]): 50-60]. The surgical interventions were either laparoscopic Roux-en-Y gastric bypass or laparoscopic biliopancreatic diversion with duodenal switch. All patients received multivitamins, iron, calcium, and vitamin D supplements. Gastric bypass patients also received a vitamin B-12 substitute. The patients were examined before surgery and 6 wk, 6 mo, and 1 y after surgery. Results: Of 60 surgically treated patients, 59 completed the follow-up. After surgery, duodenal switch patients had lower mean vitamin A and 25-hydroxyvitamin D concentrations and a steeper decline in thiamine concentrations than did the gastric bypass patients. Other vitamins (riboflavin, vitamin B-6, vitamin C, and vitamin E adjusted for serum lipids) did not change differently in the surgical groups, and concentrations were either stable or increased. Furthermore, duodenal switch patients had lower hemoglobin and total cholesterol concentrations and a lower BMI (mean reduction: 41% compared with 30%) than did gastric bypass patients 1 y after surgery. Additional dietary supplement use was more frequent among duodenal switch patients (55%) than among gastric bypass patients (26%). Conclusions: Compared with gastric bypass, duodenal switch may be associated with a greater risk of vitamin A and D deficiencies in the first year after surgery and of thiamine deficiency in the initial months after surgery. Patients who undergo these 2 surgical interventions may require different monitoring and supplementation regimens in the first year after surgery. This trial was registered at clinicaltrials.gov as NCT00327912.

Background: Cobalamin attached to transcobalamin II (TC II), known as holo-TC II, is the active cobalamin fraction taken up by tissues. Holo-TC II is also the form in which absorbed cobalamin enters the circulation from the ileum. Therefore, holo-TC II has been proposed variously as a marker of cobalamin adequacy, cobalamin absorption, or both, including even its advocacy as a surrogate Schilling test. Such claims carry conflicting diagnostic implications because metabolic adequacy and absorption are not identical. Objective: The objective was to examine metabolic and absorptive influences on holo-TC II. Design: Treated patients with pernicious anemia (PA), who have abnormal absorption but a normal metabolic status, were chosen as the model to differentiate between the effects of the 2 cobalamin-related characteristics. Serum holo-TC II and indexes of cobalamin metabolism in 23 treated patients were compared with those of 6 untreated PA patients (abnormal absorption and metabolic status) and 33 control subjects (normal absorption and metabolic status). Results: Holo-TC II, which correlated directly with cobalamin and inversely with homocysteine, was significantly higher in treated PA patients in metabolic remission than in untreated PA patients (74 [+ or -] 59 compared with 9 [+ or -] 6 pmol/L) and was significantly lower than in control subjects (105 [+ or -] 58 pmol/L), although the latter difference was small and the values overlapped greatly. Conclusions: Metabolic cobalamin status is a major determinant of serum holo-TC II. Absorption status may have mild influence as well, although other explanations remain possible. Serum holo-TC II cannot be used clinically to diagnose cobalamin malabsorption because of overlap with normal values. The influences on holo-TC II are complex and require careful analysis. KEY WORDS Holo-transcobalamin II, cobalamin, cobalamin absorption, cobalamin deficiency, homocysteine

The case: A 21-year-old university student presented to hospital with a 1-week history of swelling and discomfort in his right calf. Compression ultrasonography revealed occlusive thrombi in the right superficial [...]

A 3-month-old African American boy was referred for evaluation of poor weight gain and vomiting. The infant had been evaluated by his primary care physician 15 times within the past [...]

People on a low-fat diet are at risk for developing vitamin deficiency syndromes. A low-fat diet puts one at risk for a reduced capability for absorbing such fat-soluble vitamins as A, D, E and beta-carotene.

Byline: Greenfield, Paige Hidden costs One possible side effect of your meds: nutrient deficiencies. Some pills (prescription and OTC) make your digestive system less effective at absorbing nutrients from food, [...]

Spinal surgery failures resulting from severe Vitamin D deficiency is examined through several case studies. Groups in Australia thought to be at risk for Vitamin D deficiency include nursing home residents, and dark-skinned women and children, but the case studies show that the problem is also present in middle-aged men and women.

Q I have a patient who recently underwent bariatric surgery. Her surgeon warned against the potential for vitamin [B.sub.1] and C deficiencies as well as corneal changes, but didn't elaborate. [...]