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Elevated homocysteine levels with weight loss after Lap-Band surgery: higher folate and vitamin B12 levels required to maintain homocysteine level.
Int J Obes Relat Metab Disord 2001; 25(2):219-27IJ

Abstract

OBJECTIVE

To investigate homocysteine levels and their relationship with serum folate and vitamin B12 concentrations with weight loss after the Lap-Band form of gastric restrictive surgery, with the view to minimizing risk.

METHODS

We measured levels of fasting plasma homocysteine (tHcy), folate (serum and RBC) and vitamin B12 in two groups. The study group was 293 consecutive patients at 12 (n=192) or 24 (n=101) months review after surgery. The controls were 244 consecutive patients presenting for this surgery.

RESULTS

The group losing weight had higher geometric mean tHcy levels: 10.4 (95% CI, 9.8-10.8) micromol/l compared with 9.2 (95% CI, 8.9-9.7) in controls (P<0.001). This occurred with higher folate levels and unchanged vitamin B12 levels. Levels of folate and B12 together explained 35% (r (2)) of the homocysteine variance in the weight loss group compared with only 9% (r (2)) in controls (P<0.001). Those taking regular multivitamin supplements had lower tHcy levels: 9.6 (9.1-10.0) micromol/l vs 12.3 (11.4-13.3) in those not taking supplements (P<0.001). A low normal plateau of tHcy levels occurred at levels of folate >15 ng/l and B12)600 ng/ml. A curvilinear relationship exists between these cofactors and tHcy levels, with the dose-response relationship shifted to the right in the weight loss group.

CONCLUSION

This study shows elevated tHcy levels with weight loss, without lower serum folate or vitamin B(12) levels. There is an altered dose-response relationship with higher serum B(12) and folate levels required to maintain recommended tHcy levels. Patients losing weight have significant health benefits; however, they may be at greater risk of vascular events or fetal abnormality in association with raised tHcy levels. Multivitamin supplementation is effective in lowering tHcy levels.

Authors+Show Affiliations

Monash University Department of Surgery, Alfred Hospital, Melbourne, Victoria, 3181 Australia. john.dixon@med.monash.edu.auNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11410823

Citation

Dixon, J B., et al. "Elevated Homocysteine Levels With Weight Loss After Lap-Band Surgery: Higher Folate and Vitamin B12 Levels Required to Maintain Homocysteine Level." International Journal of Obesity and Related Metabolic Disorders : Journal of the International Association for the Study of Obesity, vol. 25, no. 2, 2001, pp. 219-27.
Dixon JB, Dixon ME, O'Brien PE. Elevated homocysteine levels with weight loss after Lap-Band surgery: higher folate and vitamin B12 levels required to maintain homocysteine level. Int J Obes Relat Metab Disord. 2001;25(2):219-27.
Dixon, J. B., Dixon, M. E., & O'Brien, P. E. (2001). Elevated homocysteine levels with weight loss after Lap-Band surgery: higher folate and vitamin B12 levels required to maintain homocysteine level. International Journal of Obesity and Related Metabolic Disorders : Journal of the International Association for the Study of Obesity, 25(2), pp. 219-27.
Dixon JB, Dixon ME, O'Brien PE. Elevated Homocysteine Levels With Weight Loss After Lap-Band Surgery: Higher Folate and Vitamin B12 Levels Required to Maintain Homocysteine Level. Int J Obes Relat Metab Disord. 2001;25(2):219-27. PubMed PMID: 11410823.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Elevated homocysteine levels with weight loss after Lap-Band surgery: higher folate and vitamin B12 levels required to maintain homocysteine level. AU - Dixon,J B, AU - Dixon,M E, AU - O'Brien,P E, PY - 2000/01/21/received PY - 2000/02/26/revised PY - 2000/07/28/accepted PY - 2001/6/19/pubmed PY - 2002/1/5/medline PY - 2001/6/19/entrez SP - 219 EP - 27 JF - International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity JO - Int. J. Obes. Relat. Metab. Disord. VL - 25 IS - 2 N2 - OBJECTIVE: To investigate homocysteine levels and their relationship with serum folate and vitamin B12 concentrations with weight loss after the Lap-Band form of gastric restrictive surgery, with the view to minimizing risk. METHODS: We measured levels of fasting plasma homocysteine (tHcy), folate (serum and RBC) and vitamin B12 in two groups. The study group was 293 consecutive patients at 12 (n=192) or 24 (n=101) months review after surgery. The controls were 244 consecutive patients presenting for this surgery. RESULTS: The group losing weight had higher geometric mean tHcy levels: 10.4 (95% CI, 9.8-10.8) micromol/l compared with 9.2 (95% CI, 8.9-9.7) in controls (P<0.001). This occurred with higher folate levels and unchanged vitamin B12 levels. Levels of folate and B12 together explained 35% (r (2)) of the homocysteine variance in the weight loss group compared with only 9% (r (2)) in controls (P<0.001). Those taking regular multivitamin supplements had lower tHcy levels: 9.6 (9.1-10.0) micromol/l vs 12.3 (11.4-13.3) in those not taking supplements (P<0.001). A low normal plateau of tHcy levels occurred at levels of folate >15 ng/l and B12)600 ng/ml. A curvilinear relationship exists between these cofactors and tHcy levels, with the dose-response relationship shifted to the right in the weight loss group. CONCLUSION: This study shows elevated tHcy levels with weight loss, without lower serum folate or vitamin B(12) levels. There is an altered dose-response relationship with higher serum B(12) and folate levels required to maintain recommended tHcy levels. Patients losing weight have significant health benefits; however, they may be at greater risk of vascular events or fetal abnormality in association with raised tHcy levels. Multivitamin supplementation is effective in lowering tHcy levels. UR - https://www.unboundmedicine.com/medline/citation/11410823/Elevated_homocysteine_levels_with_weight_loss_after_Lap_Band_surgery:_higher_folate_and_vitamin_B12_levels_required_to_maintain_homocysteine_level_ L2 - https://ClinicalTrials.gov/search/term=11410823 [PUBMED-IDS] DB - PRIME DP - Unbound Medicine ER -