Beriberi seen after teen gastric bypass

The nutritional disorder, beriberi - caused by lack of vitamin B1 in the diet - can appear in teens who have undergone gastric bypass surgery for severe obesity.

Dr. Thomas H. Inge from Cincinnati Children's Hospital Medical Center and colleagues report three such cases in the Journal of Pediatrics.

The hallmark of beriberi is peripheral nerve damage, and other symptoms can include fatigue, sleep disturbances, and anorexia. It used to be common in populations that relied on rice as the dietary staple, because polished rice loses its thiamine (or vitamin B1) content.

Beriberi can also arise because of poor absorption of nutrients, as happens with gastric bypass. "The key to successful treatment of this problem lies in prompt recognition and thiamine supplementation," Inge's team emphasizes.

The fact that all three adolescents in the report responded to supplemental thiamine confirmed the diagnosis of beriberi in these individuals.

While beriberi has been described in adults after gastric bypass, these are the first reported cases of it occurring in younger patients, Inge told Reuters Health.

It is not clear in the current cases whether thiamine deficiency developed despite adequate intake or because of poor compliance with prescribed vitamin supplements.

"Recognizing that adolescents are prone to risk taking behaviors, and struggle with autonomy issues, there will be difficulty maintaining medical compliance (including dietary, vitamin and mineral intake) postoperatively," Inge said. "This places them at somewhat higher risk."

Gastric bypass for adolescents should involve a multi-member team of health professionals who are experts on pediatric issues, "to minimize the likelihood of postoperative nutritional complications," he added.

Based on these cases, Inge said he now starts adolescent patients who are scheduled for gastric bypass on a daily multivitamin several months prior to surgery, and he adds a separate vitamin B complex supplement after surgery.

Moreover, he believes that it "may be wise" to augment thiamine for teens who've had gastric bypass to more than the usually recommended daily intake of 1.5 milligrams, to further reduce the chance of beriberi.

SOURCE: Journal of Pediatrics, August 2004.