Article

Huerta S, Rogers LM, Li Z, et al. Vitamin A deficiency in a newborn resulting from maternal hypovitaminosis A after biliopancreatic diversion for the treatment of morbid obesity

University of California, Los Angeles, Los Ángeles, California, United States
American Journal of Clinical Nutrition (Impact Factor: 6.77). 09/2002; 76(2):426-9.
Source: PubMed

ABSTRACT

Biliopancreatic diversion (BPD) has been advocated for the treatment of morbid obesity. This procedure has the theoretical advantage that patients retain normal eating capacity and lose weight irrespective of their eating habits. However, vitamin deficiencies may develop because BPD causes malabsorption.
This report describes a 40-y-old mother and her newborn infant, who developed vitamin A deficiency as a result of iatrogenic maternal malabsorption after BPD. Our primary objective is to show that BPD patients need close follow-up and lifelong micronutrient supplementation to prevent nutrient deficiencies in themselves and their offspring.
The medical records of the mother and infant were reviewed, and their clinical course was followed until 10 mo postpartum. The mother was also interviewed on several occasions about her medical care, follow-up, and supplemental vitamin use.
The mother developed night blindness with undetectable serum vitamin A concentrations in the third trimester of her pregnancy. Her vitamin A deficiency was untreated until she delivered her infant. At delivery, the infant also had vitamin A deficiency. He may have permanent retinal damage, but this is still unclear because the ophthalmologic examination performed at 2 mo of age was inconclusive.
Complications of BPD may take many years to develop, and the signs and symptoms may be subtle. Because of the malabsorption that results from BPD, patients need lifelong follow-up and appropriate vitamin supplementation to prevent deficiencies. These nutrient deficiencies can also affect the offspring of female BPD patients.

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    • "Additional supplementation may be required in menstruating women at risk of iron deficiency anemia, during pregnancy with increased maternal and fetal requirements, and in obese adolescents [73]. Maternal malabsorption after BPD has resulted in vitamin A deficiency with development of night blindness during the third trimester of pregnancy and in vitamin A deficiency in the newborn infant [74]. The prevalence of overweight in female children and adolescents has increased from 14% in 1999 to 2000 to 16% in 2003 to 2004, with an increase in the prevalence of overweight in male Table 1 Postoperative nutritional supplements after bariatric surgery "

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    • "HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol S. P. Donadelli et al. / Nutrition 28 (2012) 391–396 393 Despite this incidence of low vitamin A levels, clinical manifestations of deficiency are rare after gastric bypass and respond rapidly to vitamin A supplementation. However, case reports have shown the occurrence of ophthalmologic complications such as night blindness and corneal xerosis after a biliopancreatic diversion [33] [34] [35]. "
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    • "Additional supplementation may be required in menstruating women at risk of iron deficiency anemia, during pregnancy with increased maternal and fetal requirements, and in obese adolescents [73]. Maternal malabsorption after BPD has resulted in vitamin A deficiency with development of night blindness during the third trimester of pregnancy and in vitamin A deficiency in the newborn infant [74]. The prevalence of overweight in female children and adolescents has increased from 14% in 1999 to 2000 to 16% in 2003 to 2004, with an increase in the prevalence of overweight in male Table 1 Postoperative nutritional supplements after bariatric surgery "
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    ABSTRACT: Nutritional deficiencies are already present in many morbidly obese patients before weight-loss surgery. Appropriate preoperative detection and correction is essential. The severity and pattern of deficiencies is dependent on the presence of preoperative uncorrected deficiency, the type of procedure performed varying with the degree of restriction or the length of bypassed small intestine, the modification of eating behavior, the development of complications, compliance with oral multivitamin and mineral supplementation, and compliance with follow-up. Rigorous control of fluids and electrolytes with establishment of adequate oral nutrition is important in the immediate postoperative period. Regular follow-up of the metabolic and nutritional status of the patient is essential, with life-long multivitamin and mineral supplementation.
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