Occurrence of hyperhomocysteinemia 1 year after gastroplasty for severe obesity

Severe obesity exposes one to an increased risk of cardiovascular mortality . Gastroplasty has been shown to induce substantial weight loss and to impr ove the atherogenic profile of severely obese subjects. However, vitamin de ficiencies after gastroplasty have been reported. Because hyperhomocysteine mia, an independent risk factor for cardiovascular disease, is influenced b y nutritional status land especially by folate intake), we hypothesized tha t a marginal folate deficiency induced by gastroplasty could promote hyperh omocysteinemia. Thus, plasma homocysteine concentrations were measured by h igh-performance liquid chromatography in 53 severely obese patients (body m ass index = 42 +/- 1), before and I yr after vertical gastroplasty. Plasma homocysteine concentrations increased, on an average, from 9.9 +/- 0.4 to 1 2.8 +/- 0.6 mu mol/L (P < 0.0001). This increase in homocysteine levels was observed in two thirds of the subjects, leading to clear-cut hyperhomocyst einemia (>15 mu mol/L) in 32%. The changes in homocysteine concentrations w ere correlated to weight loss (P < 0.001) and to decrease in plasma folate concentrations (P < 0.01). Whereas gastroplasty induced a mean 32-kg weight loss and a striking improvement in conventional risk factors, the occurren ce of iatrogenic hyperhomocysteinemia might hamper the benefit of surgery o n cardiovascular risk in most of the patients. Our results further support use of a systematic efficient folate supplementation after gastroplasty.