Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Paper
  • Published:

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 volume 25, pages 219–227 (2001)Cite this article

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) µmol/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) µmol/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 B12 levels. There is an altered dose–response relationship with higher serum B12 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.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Brolin R, Gorman R, Milgrim L, Kenler H . Multivitamin prophylaxis in the prevention of post-gastric bypass vitamin and mineral deficiencies Int J Obes Relat Metab Disord 1991 15: 661–667.

    CAS  Google Scholar 

  2. Crowley L, Seay J, Mullin G . Late effects of gastric bypass for obesity Am J Gastroenterol 1984 79: 850–860.

    CAS  PubMed  Google Scholar 

  3. Amaral J, Thompson W, Cardwell M . Prospective hematological evaluation of gastric exclusion surgery for morbid obesity Ann Surg 1985 210: 186–193.

    Article  Google Scholar 

  4. Sileo F, Bonassi U, Bolognin C . Bilopancreatic bypass in the treatment of severe obesity: long term clinical, nutritional and metabolic evaluation Minerva Gastroenterol e Dietol 1995 41: 149–155.

    CAS  Google Scholar 

  5. Halverson J . Metabolic risk of obesity surgery and long term follow-up Am J Clin Nutr 1992 55 (Suppl 2): 602S–605S.

    Article  CAS  Google Scholar 

  6. Sumner A, Chin M, Abrahm J, Berry G, Gracely E, Allen R, Stabler S . Elevated methylmalonic acid and total homocysteine levels show high prevalence of vitamin B12 deficency after gastric surgery Ann Intern Med 1996 124: 469–476.

    Article  CAS  Google Scholar 

  7. Welsh G, Loscalzo J . Mechanisms of disease: homocysteine and atherothrombosis New Engl J Med 1998 338: 1042–1050.

    Article  Google Scholar 

  8. Mills J, Conley M . Folic acid to prevent neural tube defects: scientific advances and public health issues Curr Opin Obstet Gynecol 1996 8: 394–397.

    Article  CAS  Google Scholar 

  9. Printen K, Halverson J . Hemic micronutrients following vertical banded gastroplasty Am Surg 1988 54: 267–268.

    CAS  PubMed  Google Scholar 

  10. Borson-Chazot F, Harthe C, Teboul F, Labrousse F, Gaume C, Guadagnino L, Claustrat B, Berthezene F, Moulin P . Occurrence of hyperhomocysteinemia 1 y after gastroplasty for severe obesity J Clin Endocrinol Metab 1999 84: 541–545.

    Article  CAS  Google Scholar 

  11. Henning B, Tepel M, Riezler R, Gillessen A, Doberauer C . Vitamin supplementation during weight reduction—favourable effect on homocysteine metabolism Res Exp Med 1998 198: 37–42.

    Article  CAS  Google Scholar 

  12. WHO . Obesity: preventing and managing the global epidemic WHO: Geneva 1998.

    Google Scholar 

  13. O'Brien P, Brown W, Smith A, McMurrick P, Stephens M . Prospective study of a laparoscopically placed, adjustable gastric band in the treatment of morbid obesity Br J Surg 1999 86: 113–118.

    Article  CAS  Google Scholar 

  14. Malinow M, Bostom A, Krauss R . Homocysteine, diet and cardiovascular disease: A statement for health care professionals from the nutrition committee, American Heart Association Circulation 1999 99: 178–182.

    Article  CAS  Google Scholar 

  15. Mills J, McPartlin J, Kirke P, Lee Y, Conley M, Weir D, Scott J . Homocysteine metabolism in pregnancy complicated by neural-tube defects Lancet 1995 345: 149–151.

    Article  CAS  Google Scholar 

  16. Selhub J . Homocysteine metabolism A Rev Nutr 1999 19: 217–246.

    Article  CAS  Google Scholar 

  17. Lewis C, Pancharuniti N, Sauber H . Plasma folate adequacy as determined by homocysteine level Ann NY Acad Sci 1992 669: 360–362.

    Article  CAS  Google Scholar 

  18. Stampfer M, Malinow M, Willett W et al. A prospective study of plasma homocysteine and risk of myocardial infarction in US physicians JAMA 1992 268: 877–881.

    Article  CAS  Google Scholar 

  19. Al-Obaidi M, Stubbs P, Amersey R, Conroy R, Granam I, Noble M . Admission plasma homocysteine predicts long term mortality in patients presenting with acute coronary syndromes Circulation 1998 98 (Suppl 17): 5551.

    Google Scholar 

  20. Hodis H, Mack W, Selhub J, LaBree L, Selzer R, Liu C-R, Li Y, Kwong-Fu H, Lee Z, Liu C-H . Plasma homocysteine levels, multivitamin use, and subclinical atherosclerosis Circulation 1998 98 (Suppl 17): 6021.

    Google Scholar 

  21. Willinek W, Lennarz M, Dudek M, Ludwig M, Stumpe K . Serum homocysteine in the upper range of normal is an important and independent risk factor for carotid atherosclerosis in young to middle aged normotensives Circulation 1998 98 (Suppl 17): 1921.

    Google Scholar 

  22. den Heijer M, Kostor T, Blom H, Bos G, Briet E, Reitsma P, Vandenbroucke J, Rosendaal F . Homocysteine as a risk factor for deep-vein thrombosis New Engl J Med 1996 334: 759–762.

    Article  CAS  Google Scholar 

  23. Bellamy M, McDowell I, Ramsay M, Brownlee M, Bones C, Newcombe R, Lewis M . Hyperhomocysteinemia after oral methionine load acutely impairs endothelial function in healthy adults Circulation 1998 98: 1848–1852.

    Article  CAS  Google Scholar 

  24. Powers R, Evans R, Majors A, Ojimba J, Ness R, Crombleholme W, Roberts J . Plasma homocysteine concentration is increased in preeclampsia and is associated with evidence of endothelial activation Am J Obstet Gynecol 1998 179: 1605–1611.

    Article  CAS  Google Scholar 

  25. Chambers J, Obeid O, McGregor A, Powell-Tuck J, Kooner J . The relationship between hyperhomocysteinaemia and endothelial dysfunction is concentration-dependent, and present even at physiological levels Circulation 1998 98 (Suppl 17): 1921.

    Google Scholar 

  26. Landgren F, Israelsson B, Lindgren A, Hultberg B, Andersson A, Brattstrom L . Plasma homocysteine in acute myocardial infarction: homocysteine lowering effect of folic acid J Intern Med 1995 237: 381–388.

    Article  CAS  Google Scholar 

  27. Rimm E, Willett W, Hu F, Sampson L, Colditz G, Mason J, Hennekens C, Stampfer M . Folate and vitamin B6 from diet and supplements in relation to risk of coronary artery disease in women JAMA 1998 279: 359–564.

    Article  CAS  Google Scholar 

  28. Walker M, Wannamethee G, Whincup P, Shaper A . Weight change and the risk of heart attack in middle-aged British men Int J Epidemiol 1995 24: 694–703.

    Article  CAS  Google Scholar 

  29. MRC Vitamin Research Group . Prevention of neural tube defects: results of Medical Research Council Vitamin Study Lancet 1991 338: 131–137.

    Article  Google Scholar 

  30. Mills J, Scott J, Kirke P, McPartlin J, Conley M, Weir D, Molloy A, Lee Y . Homocysteine and neural tube defects J Nutr 1996 126: 756–760.

    Google Scholar 

  31. Cuskelly G, McNulty H, Scott J . Effect on increasing dietary folate on red-cell folate: implications for prevention of neural tube defects Lancet 1996 347: 657–659.

    Article  CAS  Google Scholar 

  32. Anonymous . Recommendation for the use of folic acid to reduce the number of cases of spina bifida and other neural tube defects MMWR Morb Mortal Wkly Rep 1992 41: 1–7.

    Google Scholar 

  33. Oakley GJ . Eat right and take a multivitamin New Engl J Med 1998 338: 1060–1061.

    Article  Google Scholar 

  34. Vollset SE, Refsum H, Irgens LM, Emblem BM, Tverdal A, Gjessing HK, Monsen AL, Ueland PM . Plasma total homocysteine, pregnancy complications, and adverse pregnancy outcomes: the Hordaland Homocysteine study Am J Clin Nutr 2000 71: 962–968.

    Article  CAS  Google Scholar 

  35. Brolin R, Leung M . Survey of vitamin and mineral supplementation after gastric bypass and bilopanceeatic diversion for morbid obesity Obes Surg 1999 9: 150–154.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Monash University Department of Surgery, Alfred Hospital, Melbourne, Victoria, 3181, Australia

    JB Dixon, ME Dixon & PE O'Brien

Authors
  1. JB Dixon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. ME Dixon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. PE O'Brien
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to JB Dixon.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dixon, J., Dixon, M. & O'Brien, P. Elevated homocysteine levels with weight loss after Lap-Band® surgery: higher folate and vitamin B12 levels required to maintain homocysteine level. Int J Obes 25, 219–227 (2001). https://doi.org/10.1038/sj.ijo.0801474

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ijo.0801474

Keywords

This article is cited by

Search

Advanced search

Quick links