The aim of this study was to investigate the effects of bariatric surgery on homocysteine serum levels with respect to cognitive functioning and level of depression.
Materials and Methods:
Fasting homocysteine, vitamin B12, and folate levels were measured in 99 patients; 48 bariatric surgery candidates and 51 postbariatric patients with a mean excess weight loss of at least 40%. Cognitive performance in all subjects was evaluated by a computerized test battery. Depression was assessed using the depression module of the Patient Health Questionnaire.
Results:
We found a significant relationship between gender, folate, and affiliation and the pre/postgroup and homocysteine levels. Postoperative patients' homocysteine levels were significantly higher compared with preoperative levels. Regarding cognitive functioning, bivariate correlations suggested a link between homocysteine and verbal learning/short-term memory, measured with the Auditory Verbal Learning Test as a trend, not reaching significance. Multivariate analysis showed that it was not homocysteine but affiliation to the pre- or postoperative group that was significantly associated with the level of depression. Applying the Auditory Verbal Learning Test as a dependent variable, male gender and younger age were associated with better task performance, but homocysteine was not.
Conclusions:
Our results do not support a relevant pathophysiological role of homocysteine levels in cognitive performance early after bariatric surgery.
Get full access to this article
View all access options for this article.
References
1.
SturmR. Increases in morbid obesity in the USA: 2000–2005. Public Health, 2007; 121:492–496.
2.
CourcoulasAP, YanovskiSZ, BondsD, EggermanTL, HorlickM, StatenMA, et al.Long-term outcomes of bariatric surgery: a National Institutes of Health symposium. JAMA Surg, 2014; 149:1323–1329.
le RouxCW, AylwinSJ, BatterhamRL, BorgCM, CoyleF, PrasadV, et al.Gut hormone profiles following bariatric surgery favor an anorectic state, facilitate weight loss, and improve metabolic parameters. Ann Surg, 2006; 243:108–114.
5.
TohSY, ZarshenasN, JorgensenJ. Prevalence of nutrient deficiencies in bariatric patients. Nutrition, 2009; 25:1150–1156.
6.
BehrnsKE, SmithCD, SarrMG. Prospective evaluation of gastric acid secretion and cobalamin absorption following gastric bypass for clinically severe obesity. Digest Dis Sci, 1994; 39:315–320.
7.
MoizeV, GeliebterA, GluckME, YahavE, LorenceM, ColarussoT, et al.Obese patients have inadequate protein intake related to protein intolerance up to 1 year following Roux-en-Y gastric bypass. Obes Surg, 2003; 13:23–28.
8.
MarcuardS, SinarD, SwansonM, SilvermanJ, LevineJ. Absence of luminal intrinsic factor after gastric bypass surgery for morbid obesity. Digest Dis Sci, 1989; 34:1238–1242.
9.
AillsL, BlankenshipJ, BuffingtonC, FurtadoM, ParrottJ. ASMBS allied health nutritional guidelines for the surgical weight loss patient. Surg Obes Relat Dis, 2008; 4:S73–S108.
10.
Alvarez-LeiteJI. Nutrient deficiencies secondary to bariatric surgery. Curr Opin Clin Nutr Metab Care, 2004; 7:569–575.
11.
MaronBA, LoscalzoJ. The treatment of hyperhomocysteinemia. Annu Rev Med, 2009; 60:39.
12.
AloscoML, GaliotoR, SpitznagelMB, StrainG, DevlinM, CohenR, et al.Cognitive function after bariatric surgery: evidence for improvement 3 years after surgery. Am J Surg, 2014; 207:870–876.
13.
GunstadJ, StrainG, DevlinMJ, WingR, CohenRA, PaulRH, et al.Improved memory function 12 weeks after bariatric surgery. Surg Obes Relat Dis, 2011; 7:465–472.
14.
AloscoML, SpitznagelMB, StrainG, DevlinM, CohenR, PaulR, et al.Improved memory function two years after bariatric surgery. Obesity, 2014; 22:32–38.
15.
MillerLA, CrosbyRD, GaliotoR, StrainG, DevlinMJ, WingR, et al.Bariatric surgery patients exhibit improved memory function 12 months postoperatively. Obes Surg, 2013; 23:1527–1535.
16.
Borson-ChazotF, HartheC, TeboulF, LabrousseF, GaumeC, GuadagninoL, et al.Occurrence of hyperhomocysteinemia 1 year after gastroplasty for severe obesity. J Clin Endocrinol Metab, 1999; 84:541–545.
17.
HumphreyLL, FuR, RogersK, FreemanM, HelfandM. Homocysteine level and coronary heart disease incidence: a systematic review and meta-analysis. Mayo Clinic Proceedings. 2008; 83:1203–1212.
18.
Den HeijerM, LewingtonS, ClarkeR. Homocysteine, MTHFR and risk of venous thrombosis: a meta‐analysis of published epidemiological studies. J Thromb Haemost, 2005; 3:292–299.
19.
JinL, CaldwellRB, Li-MastersT, CaldwellRW. Homocysteine induces endothelial dysfunction via inhibition of arginine transport. J Physiol Pharmacol, 2007; 58:191.
20.
YangJ, HuX, ZhangQ, CaoH, WangJ, LiuB. Homocysteine level and risk of fracture: a meta-analysis and systematic review. Bone, 2012; 51:376–382.
21.
WaldDS, KasturiratneA, SimmondsM. Serum homocysteine and dementia: meta-analysis of eight cohort studies including 8669 participants. Alzheimers Dement, 2011; 7:412–417.
22.
RavagliaG, FortiP, MaioliF, MartelliM, ServadeiL, BrunettiN, et al.Homocysteine and folate as risk factors for dementia and Alzheimer disease. Am J Clin Nutr, 2005; 82:636–643.
23.
Van DamF, Van GoolWA. Hyperhomocysteinemia and Alzheimer's disease: a systematic review. Arch Gerontol Geriatr, 2009; 48:425–430.
24.
TeunissenCE, BlomA, Van BoxtelM, BosmaH, de BruijnC, JollesJ, et al.Homocysteine: a marker for cognitive performance? A longitudinal follow-up study. J Nutr Health Aging, 2002; 7:153–159.
25.
SalaI, Belén Sánchez-SaudinósM, Molina-PorcelL, LázaroE, GichI, ClarimónJ, et al.Homocysteine and cognitive impairment. Dement Geriatr Cogn Disord, 2008; 26:506–512.
26.
WilhelmJ, BayerleinK, HillemacherT, ReulbachU, FrielingH, KromolanB, et al.Short-term cognition deficits during early alcohol withdrawal are associated with elevated plasma homocysteine levels in patients with alcoholism. J Neural Transm, 2006; 113:357–363.
27.
SheuWH-H, WuHS, WangCW, WanCJ, LeeWJ. Elevated plasma homocysteine concentrations six months after gastroplasty in morbidly obese subjects. Intern Med, 2001; 40:584–588.
28.
DixonJ, DixonME, O'BrienP. Elevated homocysteine levels with weight loss after Lap-Band® surgery: higher folate and vitamin B 12 levels required to maintain homocysteine level. Int J Obes Relat Metab Disord, 2001; 25:219–227.
29.
DixonJB. Elevated homocysteine with weight loss. Obes Surg, 2001; 11:537–538.
30.
BleichS, BandelowB, JavaheripourK, MüllerA, DegnerD, WilhelmJ, et al.Hyperhomocysteinemia as a new risk factor for brain shrinkage in patients with alcoholism. Neurosci Lett, 2003; 335:179–182.
31.
BleichS, DegnerD, BandelowB, von AhsenN, RütherE, KornhuberJ. Plasma homocysteine is a predictor of alcohol withdrawal seizures. Neuroreport, 2000; 11:2749–2752.
32.
WilhelmJ, FrielingH, Von AhsenN, HillemacherT, KornhuberJ, BleichS. Apolipoprotein E polymorphism, homocysteine serum levels and hippocampal volume in patients with alcoholism: an investigation of a gene–environment interaction. Pharmacogenomics J, 2008; 8:117–121.
33.
FrielingH, RöschkeB, KornhuberJ, WilhelmJ, RömerK, GrussB, et al.Cognitive impairment and its association with homocysteine plasma levels in females with eating disorders—findings from the HEaD-study. J Neural Transm, 2005; 112:1591–1598.
34.
LangenbergS, SchulzeM, BartschM, Gruner-LabitzkeK, PekC, KöhlerH, et al.Physical activity is unrelated to cognitive performance in pre-bariatric surgery patients. J Psychosomat Res, 2015; 79:165–170.
35.
BartschM, LangenbergS, Gruner-LabitzkeK, SchulzeM, KöhlerH, CrosbyRD, et al.Physical activity, decision-making abilities, and eating disturbances in pre-and postbariatric surgery patients. Obes Surg, 2016; 26:1–10.
VeroneseN, FacchiniS, StubbsB, LuchiniC, SolmiM, ManzatoE, et al.Weight loss is associated with improvements in cognitive function among overweight and obese people: a systematic review and meta-analysis. Neurosci Biobehav Rev, 2017; 72:87–94.
38.
ThiaraG, CigliobiancoM, MuravskyA, PaoliRA, MansurR, HawaR, et al.Evidence for neurocognitive improvement after bariatric surgery: a systematic review. Psychosomatics, 2017; 58:217–227.
39.
BecharaA, DamasioAR, DamasioH, AndersonSW. Insensitivity to future consequences following damage to human prefrontal cortex. Cognition, 1994; 50:7–15.
40.
BerchDB, KrikorianR, HuhaEM. The Corsi block-tapping task: methodological and theoretical considerations. Brain Cogn, 1998; 38:317–338.
41.
ReyA. L'examen Clinique en Psychologie. Paris: Presses universitaires de France, 196.
42.
LezakMD. Neuropsychological Assessment, 2nd ed. New York: Oxford University Press, 1983:xvi, 768 p.
43.
PowellJB, CripeLI, DodrillCB. Assessment of brain impairment with the Rey Auditory Verbal Learning Test: a comparison with other neuropsychological measures. Arch Clin Neuropsychol, 1991; 6:241–249.
44.
LuppinoFS, de WitLM, BouvyPF, StijnenT, CuijpersP, PenninxBW, et al.Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry, 2010; 67:220–229.
45.
KroenkeK, SpitzerRL, WilliamsJB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med, 2001; 16:606–13.
46.
GilbodyS, RichardsD, BrealeyS, HewittC. Screening for depression in medical settings with the Patient Health Questionnaire (PHQ): a diagnostic meta-analysis. J Gen Intern Med, 2007; 22:1596–1602.
47.
LedouxS, CoupayeM, BogardC, ClericiC, MsikaS. Determinants of hyperhomocysteinemia after gastric bypass surgery in obese subjects. Obes Surg, 2011; 21:78–86.
WaldDS, BishopL, WaldNJ, LawM, HennessyE, WeirD, et al.Randomized trial of folic acid supplementation and serum homocysteine levels. Arch Intern Med, 2001; 161:695–700.
50.
HeeseP, LinnebankM, SemmlerA, MuschlerMA, HeberleinA, FrielingH, et al.Alterations of homocysteine serum levels during alcohol withdrawal are influenced by folate and riboflavin: results from the German Investigation on Neurobiology in Alcoholism (GINA). Alcohol Alcohol, 2012; 47:497–500.
51.
Trialists' CollaborationHL. Dose-dependent effects of folic acid on blood concentrations of homocysteine: a meta-analysis of the randomized trials. Am J Clin Nutr, 2005; 82:806–812.
