• L S Kornerup, C L Hvas, C B Abild, B Richelsen, and E Nexo.
• Department of Clinical Biochemistry, Aarhus University Hospital, Denmark; Department of Medicine, Regional Hospital Unit West Jutland, Denmark. Electronic address: lindajen@rm.dk.
• Clin Nutr. 2019 Apr 1; 38 (2): 906-911.

Background & AimsBariatric surgery increases the risk of micronutrient deficiencies, including vitamin B12 (B12) deficiency. We analysed early changes in biomarkers of B12 status following bariatric surgery.MethodsWe prospectively included adult patients (n = 27) referred for either Roux-en-Y Gastric Bypass (RYGB) (n = 19) or Sleeve Gastrectomy (SG) (n = 8). Blood samples were drawn before surgery and 2 and 6 months following surgery for measurement of B12, holotranscobalamin (holoTC), and methylmalonic acid (MMA). The B12 absorption capacity was estimated from the increase in plasma holoTC two days after a standardised oral B12 challenge.ResultsB12 status decreased following both RYBG and SG. While a decrease in plasma B12 was not evident until 6 months postoperatively, we observed a statistically significant decrease in plasma holoTC and increase in MMA already 2 months postoperatively. These changes were more pronounced at 6 months post surgery. Correspondingly, the B12 absorption capacity was decreased following surgery.ConclusionsHoloTC and MMA were superior to B12 to detect early changes in B12 status following bariatric surgery. Our data challenge the current concept that liver B12 stores secure long-term maintenance of B12 status. They indicate that B12 treatment in pharmacological doses may be warranted immediately after surgery.Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.

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