Lifestyle intervention programmes often produce insufficient weight loss and poor weight loss maintenance. As a result, an increasing number of patients with obesity and related comorbidities undergo bariatric surgery, which includes approaches such as the adjustable gastric band or the 'divided' Roux-en-Y gastric bypass (RYGB). This Review summarizes the current knowledge on nutrient deficiencies that can develop after bariatric surgery and highlights follow-up and treatment options for bariatric surgery patients who develop a micronutrient deficiency. The major macronutrient deficiency after bariatric surgery is protein malnutrition. Deficiencies in micronutrients, which include trace elements, essential minerals, and water-soluble and fat-soluble vitamins, are common before bariatric surgery and often persist postoperatively, despite universal recommendations on multivitamin and mineral supplements. Other disorders, including small intestinal bacterial overgrowth, can promote micronutrient deficiencies, especially in patients with diabetes mellitus. Recognition of the clinical presentations of micronutrient deficiencies is important, both to enable early intervention and to minimize long-term adverse effects. A major clinical concern is the relationship between vitamin D deficiency and the development of metabolic bone diseases, such as osteoporosis or osteomalacia; metabolic bone diseases may explain the increased risk of hip fracture in patients after RYGB. Further studies are required to determine the optimal levels of nutrient supplementation and whether postoperative laboratory monitoring effectively detects nutrient deficiencies. In the absence of such data, clinicians should inquire about and treat symptoms that suggest nutrient deficiencies.
The rising prevalences of morbid obesity and type 2 diabetes mellitus have increased the number of patients undergoing bariatric surgery
Bariatric surgical approaches, including gastric bypass, the adjustable gastric band, vertical sleeve gastrectomy, the duodenal switch, and biliopancreatic diversion, can cause or exacerbate nutrient deficiencies
Standardized approaches to micronutrient supplementation and clinical and laboratory screening for micronutrient deficiencies after bariatric surgery are required
Vitamin D deficiency, a major clinical concern after bariatric procedures, must be aggressively treated with sufficient supplementation to prevent the development of metabolic bone diseases
Whether currently suggested laboratory blood tests that are intended to screen for micronutrient deficiencies identify all clinically relevant nutrient deficiencies is unclear
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Ginter, E. & Simko, V. Diabetes type 2 pandemic in 21st century. Bratisl. Lek. Listy 111, 134–137 (2010).
Hedley, A. A. et al. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002. JAMA 291, 2847–2850 (2004).
Flegal, K. M., Carroll, M. D., Ogden, C. L. & Johnson, C. L. Prevalence and trends in obesity among US adults, 1999–2000. JAMA 288, 1723–1727 (2002).
Flegal, K. M., Carroll, M. D., Kit, B. K. & Ogden, C. L. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA 307, 491–497 (2012).
Wilkinson, J. R., Berghmans, L., Imbert, F., Ledésert, B. & Ochoa, A. Health indicators in the European regions: expanding regional comparisons to the new countries of the European Union–ISARE III. Public Health 123, 490–495 (2009).
[No authors listed] Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ. Tech. Rep. Ser. 894, 1–253 (2000).
[No authors listed] Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults—the evidence report. National Institutes of Health. Obes. Res. 6 (Suppl. 2), 51S–209S (1998).
Proietto, J. Why is treating obesity so difficult? Justification for the role of bariatric surgery. Med. J. Aust. 195, 144–146 (2011).
Lebovitz, H. E. Type 2 diabetes mellitus—current therapies and the emergence of surgical options. Nat.Rev. Endocrinol. 7, 408–419 (2011).
Sjöström, L. et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N. Engl. J. Med. 357, 741–752 (2007).
Adams, T. D. et al. Long-term mortality after gastric bypass surgery. N. Engl. J. Med. 357, 753–761 (2007).
Adams, T. D. et al. Health outcomes of gastric bypass patients compared to nonsurgical, nonintervened severely obese. Obesity (Silver Spring) 18, 121–130 (2010).
Buchwald, H. & Oien, D. M. Metabolic/bariatric surgery worldwide 2008. Obes. Surg. 19, 1605–1611 (2009).
Bradley, E. L. 3rd, Isaacs, J. T., Mazo, J. D., Hersh, T. & Chey, W. Y. Pathophysiology and significance of malabsorption after Roux-en-Y reconstruction. Surgery 81, 684–691 (1977).
Clements, R. H. et al. Incidence of vitamin deficiency after laparoscopic Roux-en-Y gastric bypass in a university hospital setting. Am. Surg. 72, 1196–1202 (2006).
Aasheim, E. T. et al. Vitamin status after bariatric surgery: a randomized study of gastric bypass and duodenal switch. Am. J. Clin. Nutr. 90, 15–22 (2009).
Bajardi, G., Latteri, M., Ricevuto, G., Mastrandrea, G. & Florena, M. Biliopancreatic diversion: early complications. Obes. Surg. 2, 177–180 (1992).
de Luis, D. A. et al. Clinical results and nutritional consequences of biliopancreatic diversion: three years of follow-up. Ann. Nutr. Metab. 53, 234–239 (2008).
Hamoui, N., Chock, B., Anthone, G. J. & Crookes, P. F. Revision of the duodenal switch: indications, technique, and outcomes. J. Am. Coll. Surg. 204, 603–608 (2007).
Aasheim, E. T., Hofsø, D., Hjelmesaeth, J. & Sandbu, R. Peripheral neuropathy and severe malnutrition following duodenal switch. Obes. Surg. 18, 1640–1643 (2008).
Balsa, J. A. et al. Copper and zinc serum levels after derivative bariatric surgery: differences between Roux-en-Y gastric bypass and biliopancreatic diversion. Obes. Surg. 21, 744–750 (2011).
Huerta, S. et al. Vitamin A deficiency in a newborn resulting from maternal hypovitaminosis A after biliopancreatic diversion for the treatment of morbid obesity. Am. J. Clin. Nutr. 76, 426–429 (2002).
Martin, L. et al. Gastric bypass surgery as maternal risk factor for neural tube defects. Lancet 1, 640–641 (1988).
Heber, D. et al. Endocrine and nutritional management of the post-bariatric surgery patient: an Endocrine Society clinical practice guideline. J. Clin. Endocrinol. Metab. 95, 4823–4843 (2010).
Skroubis, G. et al. Comparison of nutritional deficiencies after Roux-en-Y gastric bypass and after biliopancreatic diversion with Roux-en-Y gastric bypass. Obes. Surg. 12, 551–558 (2002).
Marceau, S. et al. Biliopancreatic diversion, with distal gastrectomy, 250 cm and 50 cm limbs: long-term results. Obes. Surg. 5, 302–307 (1995).
Nanni, G. et al. Biliopancreatic diversion: clinical experience. Obes. Surg. 7, 26–29 (1997).
Dolan, K. et al. A clinical and nutritional comparison of biliopancreatic diversion with and without duodenal switch. Ann. Surg. 240, 51–56 (2004).
Ramírez Prada, D., Delgado, G., Hidalgo Patiño, C. A., Pérez-Navero, J. & Gil Campos, M. Using of WHO guidelines for the management of severe malnutrition to cases of marasmus and kwashiorkor in a Colombia children's hospital. Nutr. Hosp. 26, 977–983 (2011).
Gehring, N., Imoberdorf, R., Wegmann, M., Rühlin, M. & Ballmer, P. E. Serum albumin—a qualified parameter to determine the nutritional status? Swiss Med. Wkly 136, 664–669 (2006).
Bal, B., Koch, T. R., Finelli, F. C. & Sarr, M. G. Managing medical and surgical disorders after divided Roux-en-Y gastric bypass surgery. Nat. Rev. Gastroenterol. Hepatol. 7, 320–334 (2010).
Butterworth, R. F. in Modern Nutrition in Health and Disease 10th edn Ch. 23 (eds Shils, M. E., Shike, M., Ross, A. C., Caballero, B. & Cousins, R. J.) 426–433 (Lippincott Williams & Wilkins, Baltimore, 2006).
Lakhani, S. V. et al. Small intestinal bacterial overgrowth and thiamine deficiency after Roux-en-Y gastric bypass surgery in obese patients. Nutr. Res. 28, 293–298 (2008).
Galvin, R. et al. EFNS guidelines for diagnosis, therapy and prevention of Wernicke encephalopathy. Eur. J. Neurol. 17, 1408–1418 (2010).
WHO. Thiamine deficiency and its prevention and control in major emergencies [online], (1999).
Gangolf, M. et al. Thiamine status in humans and content of phosphorylated thiamine derivatives in biopsies and cultured cells. PLoS ONE 5, e13616 (2010).
Herve, C., Beyne, P., Lettéron, P. & Delacoux, E. Comparison of erythrocyte transketolase activity with thiamine and thiamine phosphate ester levels in chronic alcoholic patients. Clin. Chim. Acta 234, 91–100 (1995).
Thomson, A. D. & Marshall, E. J. The treatment of patients at risk of developing Wernicke's encephalopathy in the community. Alcohol Alcohol. 41, 159–167 (2006).
Surges, R., Beck, S., Niesen, W. D., Weiller, C. & Rijntjes, M. Sudden bilateral blindness in Wernicke's encephalopathy: case report and review of the literature. J. Neurol. Sci. 260, 261–264 (2007).
Gibson, R. S. Principles of Nutritional Assessment 2nd edn (Oxford University Press, New York, 2005).
Combs, G. F. Jr. The Vitamins. Fundamental Aspects in Nutrition and Health (Elsevier, San Diego, 2008).
Bassan, M. et al. A case for immediate-release niacin. Heart Lung 41, 95–98 (2012).
Stover, P. J. Physiology of folate and vitamin B12 in health and disease. Nutr. Rev. 62, S3–S12 (2004).
Camilo, E. et al. Folate synthesized by bacteria in the human upper small intestine is assimilated by the host. Gastroenterology 110, 991–998 (1996).
American College of Obstetricians and Gynecologists. ACOG Committee Opinion number 315, September 2005. Obesity in pregnancy. Obstet. Gynecol. 106, 671–675 (2005).
Karmon, A. & Sheiner, E. Pregnancy after bariatric surgery: a comprehensive review. Arch. Gynecol. Obstet. 277, 381–388 (2008).
Moriwaki, K., Kanno, Y., Nakamoto, H., Okada, H. & Suzuki, H. Vitamin B6 deficiency in elderly patients on chronic peritoneal dialysis. Adv. Perit. Dial. 16, 308–312 (2000).
Herrmann, W. & Obeid, R. Causes and early diagnosis of vitamin B12 deficiency. Dtsch Arztebl Int. 105, 680–685 (2008).
Dalcanale, L. et al. Long-term nutritional outcome after gastric bypass. Obes. Surg. 20, 181–187 (2010).
Levine, M., Padayatty, S. J. & Espey, M. G. Vitamin C: a concentration-function approach yields pharmacology and therapeutic discoveries. Adv. Nutr. 2, 78–88 (2011).
Gropper, S. S., Smith, J. L. & Groff, J. L. Advanced Nutrition and Human Metabolism 4th edn (Thomson/Wadsworth, Belmont, 2004).
Zempleni, J., Hassan, Y. I. & Wijeratne, S. S. Biotin and biotinidase deficiency. Expert Rev. Endocrinol. Metab. 3, 715–724 (2008).
Greenway, F. L. et al. Loss of taste responds to high-dose biotin treatment. J. Am. Coll. Nutr. 30, 178–181 (2011).
Bean, W. B., Hodges, R. E. & Daum, K. Pantothenic acid deficiency induced in human subjects. J. Clin. Invest. 34, 1073–1084 (1955).
Hatizifotis, M., Dolan, K., Newbury, L. & Fielding, G. Symptomatic vitamin A deficiency following biliopancreatic diversion. Obes. Surg. 13, 655–657 (2003).
Eckert, M. J. et al. Incidence of low vitamin A levels and ocular symptoms after Roux-en-Y gastric bypass. Surg. Obes. Relat. Dis. 6, 653–657 (2010).
Strauss, E. W. Electron microscopic study of intestinal fat absorption in vitro from mixed micelles containing linolenic acid, monoolein, and bile salt. J. Lipid. Res. 7, 307–323 (1966).
Bell, T. D., Demay, M. B. & Burnett-Bowie, S. A. The biology and pathology of vitamin D control in bone. J. Cell Biochem. 111, 7–13 (2010).
Johnson, J. M. et al. Effects of gastric bypass procedures on bone mineral density, calcium, parathyroid hormone, and vitamin D. J. Gastrointest. Surg. 9, 1106–1110 (2005).
Johnson, J. M. et al. The long-term effects of gastric bypass of vitamin D metabolism. Ann. Surg. 243, 701–704 (2006).
El-Kadre, L. J., Rocha, P. R., de Almeida Tinoco, A. C., Tinoco, R. C. Calcium metabolism in pre- and postmenopausal morbidly obese women at baseline and after laparoscopic Roux-en-Y gastric bypass. Obes. Surg. 14, 1062–1066 (2004).
Eliel, L. P., Chanes, R. & Hawrylko, J. Influence of parathyroid activity on ion exchange in various tissues. Trans. Am. Clin. Climatol. Assoc. 74, 130–138 (1962).
Youssef, Y. et al. Risk of secondary hyperparathyroidism after laparoscopic gastric bypass surgery in obese women. Surg. Endosc. 21, 1393–1396 (2007).
Fleischer, J. et al. The decline in hip bone density after gastric bypass surgery is associated with extent of weight loss. J. Clin. Endocrinol. Metab. 93, 3735–3740 (2008).
Aarts, E. O., Janssen, I. M. & Berends, F. J. The gastric sleeve: losing weight as fast as micronutrients? Obes. Surg. 21, 207–211 (2011).
Nogués, X. et al. Bone mass loss after sleeve gastrectomy: a prospective comparative study with gastric bypass [Spanish]. Cir. Esp. 88, 103–109 (2010).
Gehrer, S., Kern, B., Peters, T., Christoffel-Courtin, C. & Peterli, R. Fewer nutrient deficiencies after laparoscopic sleeve gastrectomy (LSG) than after laparoscopic Roux-Y-gastric bypass (LRYGB)—a prospective study. Obes. Surg. 20, 447–453 (2010).
Al-Shoha, A., Qiu, S., Palnitkar, S. & Rao, D. S. Osteomalacia with bone marrow fibrosis due to severe vitamin D deficiency after a gastrointestinal bypass operation for severe obesity. Endocr. Pract. 15, 528–533 (2009).
Berarducci, A., Haines, K. & Murr, M. M. Incidence of bone loss, falls, and fractures after Roux-en-Y gastric bypass for morbid obesity. Appl. Nurs. Res. 22, 35–41 (2009).
Dawson-Hughes, B. et al. Estimates of optimal vitamin D status. Osteoporos. Int. 16, 713–716 (2005).
Khandalavala, B. N., Hibma, P. P. & Fang, X. Prevalence and persistence of vitamin D deficiency in biliopancreatic diversion patients: a retrospective study. Obes. Surg. 20, 881–884 (2010).
Balsa, J. A. et al. Chronic increase of bone turnover markers after biliopancreatic diversion is related to secondary hyperparathyroidism and weight loss. Relation with bone mineral density. Obes. Surg. 20, 468–473 (2010).
Nadler, E. P., Youn, H. A., Ren, C. J. & Fielding, G. A. An update on 73 US obese pediatric patients treated with laparoscopic adjustable gastric banding: comorbidity resolution and compliance data. J. Pediatr. Surg. 43, 141–146 (2008).
Patel, V., Rink, C., Khanna, S. & Sen, C. K. .Tocotrienols: the lesser known form of natural vitamin E. Indian J. Exp. Biol. 49, 732–738 (2011).
Bieri, J. G. & Evarts, R. P. γ-Tocopherol: metabolism, biological activity and significance in human vitamin E nutrition. Am. J. Clin. Nutr. 27, 980–986 (1974).
Bendich, A. & Machlin, L. J. Safety of oral intake of vitamin E. Am. J. Clin. Nutr. 48, 612–619 (1988).
Shearer, M. J., McBurney, A. & Barkhan, P. Studies on the absorption and metabolism of phylloquinone (vitamin K1) in man. Vitam. Horm. 32, 513–542 (1974).
Finegold, S. M. Intestinal bacteria. The role they play in normal physiology, pathologic physiology, and infection. Calif. Med. 110, 455–459 (1969).
Eerdekens, A. et al. Maternal bariatric surgery: adverse outcomes in neonates. Eur. J. Pediatr. 169, 191–196 (2010).
Cable, C. T. et al. Prevalence of anemia after Roux-en-Y gastric bypass surgery: what is the right number? Surg. Obes. Relat. Dis. 7, 134–139 (2011).
Hakeam, H. A., O'Reagan, P. J., Salem, A. M., Bamehria, F. Y. & Eldali, A. M. Impact of laparoscopic sleeve gastrectomy on iron indices: 1 year follow-up. Obes. Surg. 19, 1491–1496 (2009).
Boza, C. et al. Laparoscopic adjustable gastric banding (LAGB): surgical results and 5-year follow-up. Surg. Endosc. 25, 292–297 (2011).
Ruz, M. et al. Iron absorption and iron status are reduced after Roux-en-Y gastric bypass. Am. J. Clin. Nutr. 90, 527–532 (2009).
Avgerinos, D. V., Llaguna, O. H., Seigerman, M., Lefkowitz, A. J. & Leitman, I. M. Incidence and risk factors for the development of anemia following gastric bypass surgery. World J. Gastroenterol. 16, 1867–1870 (2010).
Turnberg, L. A. Excessive oral iron therapy causing haemochromatosis. Br. Med. J. 1, 1360 (1965).
[No authors listed] Dietary Supplement Fact Sheet: Calcium. Office of Dietary Supplements National Institutes of Health [online], (2011).
Whelton, M. J., Kehayoglou, A. K., Agnew, J. E., Turnberg, L. A. & Sherlock, S. 47Calcium absorption in parenchymatous and biliary liver disease. Gut 12, 978–983 (1971).
Grant, A. M. et al. Oral vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people (Randomised Evaluation of Calcium Or vitamin D, RECORD): a randomised placebo-controlled trial. Lancet 365, 1621–1628 (2005).
Martin, N. H. & Perkins, D. J. The calcium binding of human serum albumin in health and disease. Biochem. J. 54, 642–645 (1953).
Chikunguwo, S. et al. Influence of obesity and surgical weight loss on thyroid hormone levels. Surg. Obes. Relat. Dis. 3, 631–635 (2007).
Raftopoulos, Y. et al. Improvement of hypothyroidism after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes. Surg. 14, 509–513 (2004).
Rink, L. & Gabriel, P. Zinc and the immune system. Proc. Nutr. Soc. 59, 541–552 (2000).
Powell, S. R. The antioxidant properties of zinc. J. Nutr. 130 (Suppl. 5S), 1447S–1454S (2000).
Sallé, A. et al. Zinc deficiency: a frequent and underestimated complication after bariatric surgery. Obes. Surg. 20, 1660–1670 (2010).
Lippard, S. J. & Berg, J. M. Principles of Bioinorganic Chemistry (University Science Books, Mill Valley, 1994).
Decker, H. & Terwilliger, N. Cops and robbers: putative evolution of copper oxygen-binding proteins. J. Exp. Biol. 203, 1777–1782 (2000).
Nose, Y. et al. Ctr1 is an apical copper transporter in mammalian intestinal epithelial cells in vivo that is controlled at the level of protein stability. J. Biol. Chem. 285, 32385–32392 (2010).
Zimnicka, A. M., Ivy, K. & Kaplan, J. H. Acquisition of dietary copper: a role for anion transporters in intestinal apical copper uptake. Am. J. Physiol. Cell Physiol. 300, C588–C599 (2011).
Todd, L. M., Godber, I. M. & Gunn, I. R. Iatrogenic copper deficiency causing anaemia and neutropenia. Ann. Clin. Biochem. 41, 414–416 (2004).
Fuhrman, M. P., Herrmann, V., Masidonski, P. & Eby, C. Pancytopenia after removal of copper from total parenteral nutrition. JPEN J. Parenter. Enteral Nutr. 24, 361–366 (2000).
Kumar, N. Copper deficiency myelopathy (human swayback). Mayo Clinic Proc. 81, 1371–1384 (2006).
Kumar, N., Ahlskog, J. E. & Gross, J. B. Jr. Acquired hypocupremia after gastric surgery. Clin. Gastroenterol. Hepatol. 2, 1074–1079 (2004).
Kelkar, P., Chang, S. & Muley, S. A. Response to oral supplementation in copper deficiency myeloneuropathy. J. Clin. Neuromuscul. Dis. 10, 1–3 (2008).
Juhasz-Pocsine, K., Rudnicki, S. A., Archer, R. L. & Harik, S. I. Neurologic complications of gastric bypass surgery for morbid obesity. Neurology 68, 1843–1850 (2007).
Naismith, R. T., Shepherd, J. B., Weihl, C. C., Tutlam, N. T. & Cross, A. H. Acute and bilateral blindness due to optic neuropathy associated with copper deficiency. Arch. Neurol. 66, 1025–1027 (2009).
Wei, H. L. et al. Analysis of glutathione peroxidase 1 gene polymorphism and Keshan disease in Heilongjiang Province, China. Genet. Mol. Res. 10, 2996–3001 (2011).
Boldery, R., Fielding, G., Rafter, T., Pascoe, A. L. & Scalia, G. M. Nutritional deficiency of selenium secondary to weight loss (bariatric) surgery associated with life-threatening cardiomyopathy. Heart Lung Circ. 16, 123–126 (2007).
Jeejeebhoy, K. N., Chu, R. C., Marliss, E. B., Greenberg, G. R. & Bruce-Robertson, A. Chromium deficiency, glucose intolerance, and neuropathy reversed by chromium supplementation, in a patient receiving long-term total parenteral nutrition. Am. J. Clin. Nutr. 30, 531–538 (1977).
Emsley, J. Nature's Building Blocks: An A–Z Guide to the Elements 249–253 (Oxford University Press, Oxford, 2001).
Gong, H. & Amemiya, T. Corneal changes in manganese-deficient rats. Cornea 18, 472–482 (1999).
Carrodeguas, L., Kaidar-Person, O., Szomstein, S., Antozzi, P. & Rosenthal, R. Preoperative thiamine deficiency in obese population undergoing laparoscopic bariatric surgery. Surg. Obes. Relat. Dis. 1, 517–522 (2005).
Ernst, B., Thurnheer, M., Schmid, S. M. & Schultes, B. Evidence for the necessity to systematically assess micronutrient status prior to bariatric surgery. Obes. Surg. 19, 66–73 (2009).
Buffington, C., Walker, B., Cowan, G. S. Jr & Scruggs, D. Vitamin D deficiency in the morbidly obese. Obes. Surg. 3, 421–424 (1993).
Moizé, V., Deulofeu, R., Torres, F., de Osaba, J. M. & Vidal, J. Nutritional intake and prevalence of nutritional deficiencies prior to surgery in a Spanish morbidly obese population. Obes. Surg. 21, 1382–1388 (2011).
Ducloux, R. et al. Vitamin D deficiency before bariatric surgery: should supplement intake be routinely prescribed? Obes. Surg. 21, 556–560 (2011).
Pinhas-Hamiel, O. et al. Obese children and adolescents: a risk group for low vitamin B12 concentration. Arch. Pediatr. Adolesc. Med. 160, 933–936 (2006).
de Luis, D. A. et al. Zinc and copper serum levels of morbidly obese patients before and after biliopancreatic diversion: 4 years of follow-up. J. Gastrointest. Surg. 15, 2178–2181 (2011).
Tanumihardjo, S. A. et al. Poverty, obesity, and malnutrition: an international perspective recognizing the paradox. J. Amer. Diet Assoc. 107, 1966–1972 (2007).
Sechi, G., Serra, A., Pirastru, M. I., Sotgui, S. & Rosati, G. Wernicke's encephalopathy in a woman on slimming diet. Neurology 58, 1697–1698 (2002).
Sechi, G. Dietary supplements and the risk of Wernicke's encephalopathy. Clin. Pharmacol. Ther. 88, 164 (2010).
Bures, J. et al. Small intestinal bacterial overgrowth syndrome. World J. Gastroenterol. 16, 2978–2990 (2010).
Ojetti, V. et al. Small bowel bacterial overgrowth and type 1 diabetes. Eur. Rev. Med. Pharmacol. Sci. 13, 419–423 (2009).
Begum, A., Drebes, J., Perbandt, M., Wrenger, C. & Betzel, C. Purification, crystallization and preliminary X-ray diffraction analysis of the thiaminase type II from Staphylococcus aureus. Acta Crystallogr. Sect. F Struct. Biol. Cryst. Commun. 67 (Pt 1), 51–53 (2011).
Toms, A. V., Haas, A. L., Park, J. H., Begley, T. P. & Ealick, S. E. Structural characterization of the regulatory proteins TenA and TenI from Bacillus subtilis and identification of TenA as a thiaminase II. Biochemistry 44, 2319–2329 (2005).
Neale, G., Gompertz, D., Schönsby, H., Tabaqchali, S. & Booth, C. C. The metabolic and nutritional consequences of bacterial overgrowth in the small intestine. Am. J. Clin. Nutr. 25, 1409–1417 (1972).
Alston, T. A. & Abeles, R. H. Enzymatic conversion of the antibiotic metronidazole to an analog of thiamine. Arch. Biochem. Biophys. 257, 357–362 (1987).
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Bal, B., Finelli, F., Shope, T. et al. Nutritional deficiencies after bariatric surgery. Nat Rev Endocrinol 8, 544–556 (2012). https://doi.org/10.1038/nrendo.2012.48
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