Obesity and thiamine; Is thiamine the main accused secret in pre-and post-bariatric surgery, and is thiamine screening needed?
Authors: Ahmed Amr , Brakat Aml M , Alaa Neveen 
Published: September 2022

Now, the treatment of obesity is the basic regimen for obesity-associated type 2 diabetes and its complications, and many drug discoveries target type 2 diabetes depending on the treatment of obesity. Obesity has emerged as a significant global health issue that increases the risk of many fatal and incapacitating conditions, including type 2 diabetes mellitus and cardiac diseases (1). Last year's bariatric surgery is growing dramatically, and the types of surgery are evolving with different methods and medical research (2).The role of nutrition and vitamins in pre-and post-bariatric surgery is needed to look at scientists in Micronutrition. Thiamine, generally known as vitamin B1, is crucial. There is no endogenous synthesis. However, some types of bacteria in the colon can make a small amount of thiamine. (3) Excessive drinking of soft drinks by teenagers is risky for obesity and minerals and nutritional elements deficiency like thiamine was studied by Akihisa Okumura et.al. (4)Thiamine (Vit B1) is a necessary component that acts as a cofactor for many enzymes; many are in the mitochondria. Other thiamine-dependent enzymes are involved in energy metabolism and nucleic acid production, while others are antioxidants. The brain is dependent on mitochondrial ATP generation, so it is vulnerable to thiamine deficiency. This is especially noticeable during rapid growth periods (such as pregnancy and childhood) when thiamine deficiency is frequently associated with malnutrition or genetic abnormalities. Thiamine deficiency can result in a variety of illnesses, ranging from minor neurological and mental symptoms such as confusion, memory loss, sleep difficulties, and other health issues to more serious diseases. Thiamine deficiency may be inherited, and it is a serious problem that can lead to death. Given the importance of thiamine-dependent enzymes in glucose utilization, thiamine deficiency may cause brain tissue damage by reducing brain energy utilization. (5)Thiamine has a role in immunity as its role in the treatment of sepsis and plays a role in glucose metabolism and lactic production as its deficiency is present in 20-70% of sepsis cases and decreases of most important cytokine-like interleukin 6 at sepsis. (6)The role of interleukin 6 in obesity is studied by studies on the production of IL-6 by adipocytes and adipose-tissue macrophages, as well as higher IL-6 levels in obese patients. Numerous physiological or pathologic variables, including hormones, cytokines, food, exercise, stress, hypoxia, and others, control the release of IL-6. Adipose tissue-derived IL-6 may affect metabolism via several pathways, including adipose tissue-specific gene expression, triglyceride release, downregulation of lipoprotein lipase, insulin sensitivity, and others. Understanding these systems better could help with obesity prevention and treatment. (7)Regarding the role of interleukin 6 in obesity and insulin resistance, despite extensive research using conditional animal models, the effects of TNF and IL-6 signaling on obesity-related insulin resistance still provide inconsistent results, Since TNF and IL-6 are also produced by cells in the tumor microenvironment, they not only affect systemic insulin sensitivity in obesity but also advance cancer. In keeping with this, cancer patients' blood TNF and IL-6 levels are raised. A link between cancer incidence and body mass index is present for the majority of cancer types (8) IL-6 is increased in diabetes (9), obesity (10), and various cancers. (11)Thiamine deficiency in obese patients may occur pre-and post-bariatric surgery as Evidence reveals that obesity may also be a disease of malnutrition, although it has generally been thought of as a disease of excess nutrition. Particularly, 15.5-29% of obese patients considering bariatric surgery had thiamin insufficiency. (12)A nutritional side effect of stomach surgery called beriberi is brought on by thiamine, or vitamin B1, deficiency. Reduced red blood cell oxygen delivery, cardiac dysfunction, poor neurotransmission, and neuronal death are all consequences of thiamine deficiency (13), and also deficiency of thiamine in adolescents' post-bariatric surgery in a study by Jillian et.al. (14)In a survey of Australia and New Zealand bariatric clinicians, Most thiamine deficiency patients appear clinically with dysphagia, and vomiting but 32% of respondents reported symptoms of Wernicke-Korsakoff syndrome and neuropathy. (15)In the end, the screening of thiamine needs attention pre-and post-bariatric surgery to avoid complications before and after as Wernicke's encephalopathy and mood disorders or neurological complications as is thiamine deficiency is a forgotten disease and need health education by health doctors, nutritionists, and surgeons so we need more attention and highlight it in clinical management.