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Obesity Surgery

, Volume 18, Issue 7, pp 870–876 | Cite as

Nutritional Deficiencies in Morbidly Obese Patients: A New Form of Malnutrition?

Part A: Vitamins
  • Orit Kaidar-Person
  • Benjamin Person
  • Samuel Szomstein
  • Raul J. RosenthalEmail author
Review

Abstract

It is a common belief that clinical vitamin or mineral deficiencies are rare in Western countries because of the low cost and unlimited diversity of food supply. However, many people consume food that is either unhealthy or of poor nutritional value that lacks proteins, vitamins, minerals, and fiber. In this, article we reviewed the literature and highlighted the vitamin deficiencies in obese patients before bariatric surgery. Deficiency of dietary minerals is described in the accompanying manuscript. The prevalence of vitamin deficiencies in the morbidly obese population prior to bariatric surgery is higher and more significant than previously believed.

Keywords

Vitamins Nutrient Morbid obesity Deficiency 

Notes

References

  1. 1.
    Russell RM. Vitamin and trace mineral deficiency and excess. In: Kasper DL, Fauci AS, Longo DL, Braunwald E, Hauser SL, Jameson JL, editors. Harrison’s principles of internal medicine. Vol 1. 16th ed. McGraw-Hill: Medical Publishing Division; 2005. p. 403.Google Scholar
  2. 2.
    Glanz K, Basil M, Maibach E, Goldberg J, Snyder D. Why Americans eat what they do: taste, nutrition, cost, convenience, and weight control concerns as influences on food consumption. J Am Diet Assoc. 1998;98(10):1118–26.PubMedCrossRefGoogle Scholar
  3. 3.
    Agte V, Tarwadi K, Mengale S, Hinge A, Chiplonkar S. Vitamin profile of cooked foods: how healthy is the practice of ready-to-eat foods? Int J Food Sci Nutr. 2002;53(3):197–208.PubMedCrossRefGoogle Scholar
  4. 4.
    Kant AK, Graubard BI, Kumanyika SK. Trends in black-white differentials in dietary intakes of U.S. adults, 1971–2002. Am J Prev Med. 2007;32(4):264–72.PubMedCrossRefGoogle Scholar
  5. 5.
    Frazao E, Allshouse J. Strategies for intervention: commentary and debate. Symposium: sugar and fat—from genes to culture. American Society for Nutritional Sciences. J Nutr. 2000;133:844–7.Google Scholar
  6. 6.
    Nielsen SJ, Popkin BM. Patterns and trends in food portion sizes, 1977–1998. JAMA. 2003;289:450–3.PubMedCrossRefGoogle Scholar
  7. 7.
    Shahar D, Shai I, Vardi H, Shahar A, Fraser D. Diet and eating habits in high and low socioeconomic groups. Nutrition. 2005;21:559–66.PubMedCrossRefGoogle Scholar
  8. 8.
    Bourre JM. Effects of nutrients (in food) on the structure and function of the nervous system: update on dietary requirements for brain. Part 1: micronutrients. J Nutr Health Aging. 2006;10(5):377–85.PubMedGoogle Scholar
  9. 9.
    Bourre JM. Effects of nutrients (in food) on the structure and function of the nervous system: update on dietary requirements for brain. Part 2 : macronutrients. J Nutr Health Aging. 2006;10(5):386–99.PubMedGoogle Scholar
  10. 10.
    Bendich A. The potential for dietary supplements to reduce premenstrual syndrome (PMS) symptoms. J Am Coll Nutr. 2000;19(1):3–12.PubMedGoogle Scholar
  11. 11.
    Dimopoulos N, Piperi C, Salonicioti A, Psarra V, Gazi F, Nounopoulos C, et al. Association of cognitive impairment with plasma levels of folate, vitamin B12 and homocysteine in the elderly. In Vivo. 2006;20(6B):895–9.PubMedGoogle Scholar
  12. 12.
    Reynolds E. Vitamin B12, folic acid, and the nervous system. Lancet Neurol. 2006;5(11):949–60.PubMedCrossRefGoogle Scholar
  13. 13.
    Konofal E, Lecendreux M, Arnulf I, Mouren MC. Iron deficiency in children with attention-deficit/hyperactivity disorder. Arch Pediatr Adolesc Med. 2004;158(12):1113–5.PubMedCrossRefGoogle Scholar
  14. 14.
    Lonsdale D, et al. Crime and Violence: A hypothetical explanation of its relationship with high calorie malnutrition. J Adv Med. 1994;7(3):171–80.Google Scholar
  15. 15.
    Lopes L, Faintuch J, Kahwage S, de Assis A. A cluster of polyneuropathy and Wernicke–Korsakoff syndrome in a bariatric unit. Obes Surg. 2002;12:328–34.CrossRefGoogle Scholar
  16. 16.
    Seehra H, MacDrmontt N, Lascelles R, et al. Lesson of the week: Wernicke’s encephalopathy after vertical banded gastroplasty for morbid obesity. BMJ. 1996;312:434.PubMedGoogle Scholar
  17. 17.
    Singh S, Kumar A. Wernicke encephalopathy after obesity surgery: a systematic review. Neurology. 2007 13;68(11):807–11.CrossRefGoogle Scholar
  18. 18.
    Tanphaichitr V. Thiamine. In: Shils ME, Olson JA, Shike M, editors. Modern nutrition in heath and disease. Vol. 21. 9th ed. Baltimore: William & Wilkins, 1999. p. 381–89.Google Scholar
  19. 19.
    Lonsdale D. A review of the biochemistry, metabolism and clinical benefits of thiamin(e) and its derivatives. Evid-Based Complement Altern Med. 2006;3(1):49–59.CrossRefGoogle Scholar
  20. 20.
    Davis RE, Icke GC. Clinical chemistry of thiamin. Adv Clin Chem. 1983;23:93–140.PubMedCrossRefGoogle Scholar
  21. 21.
    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. 2005;1(6):517–22.PubMedCrossRefGoogle Scholar
  22. 22.
    Flancbaum L, Belsley S, Drake V, Colarusso T, Tayler E. Preoperative nutritional status of patients undergoing Roux-en-Y gastric bypass for morbid obesity. J Gastrointest Surg. 2006;10(7):1033–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Cravens DD, Nashelsky J, Oh RC. How do we evaluate a marginally low B12 level? J Fam Pract. 2007;56(1):62–3.PubMedGoogle Scholar
  24. 24.
    Hvas AM, Nexo E. Diagnosis and treatment of vitamin B12 deficiency—an update. Haematologica. 2006;91(11):1506–12.PubMedGoogle Scholar
  25. 25.
    Oh R, Brown DL. Vitamin B12 deficiency. Am Fam Phys. 2003;1;67(5):979–86.Google Scholar
  26. 26.
    Nygard O, Nordrehaug JE, Refsum H, Ueland PM, Farstad M, Vollset SE. Plasma homocysteine levels and mortality in patients with coronary artery disease. N Engl J Med. 1997;337:230–6.PubMedCrossRefGoogle Scholar
  27. 27.
    Pinhas-Hamiel O, Doron-Panush N, Reichman B, Nitzan-Kaluski D, Shalitin S, Geva-Lerner L. Obese children and adolescents: a risk group for low vitamin B12 concentration. Arch Pediatr Adolesc Med. 2006;160(9):933–6.PubMedCrossRefGoogle Scholar
  28. 28.
    Madan AK, Orth WS, Tichansky DS, Ternovits CA. Vitamin and trace mineral levels after laparoscopic gastric bypass. Obes Surg. 2006;16(5):603–6.PubMedCrossRefGoogle Scholar
  29. 29.
    Tucker KL, Mahnken B, Wilson PW, Jacques P, Selhub J. Folic acid fortification of the food supply. Potential benefits and risks for the elderly population. JAMA. 1996;276:1879–85.PubMedCrossRefGoogle Scholar
  30. 30.
    Giovannucci E, Rimm EB, Ascherio A, Stampfer MJ, Colditz GA, Willett WC. Alcohol, low-methionine-low-folate diets, and risk of colon cancer in men. J Natl Cancer Inst. 1995;15;87(4):265–73.PubMedCrossRefGoogle Scholar
  31. 31.
    Rohan TE, Jain MG, Howe GR, Miller AB. Dietary folate consumption and breast cancer risk. J Natl Cancer Ins.t 2000;2;92(3):266–9.PubMedCrossRefGoogle Scholar
  32. 32.
    USDA. National Nutrient Database for Standard Reference: http://www.ars.usda.gov/Services/docs.htm?docid=9673. Last accessed: May 30, 2007.
  33. 33.
    Whittaker P, Tufaro PR, Rader JI. Iron and folate in fortified cereals. J Am Coll Nutr. 2001;20(3):247–54.PubMedGoogle Scholar
  34. 34.
    Hey H, Stokholm KH, Lund B, Lund B, Sorensen OH. Vitamin D deficiency in obese patients and changes in circulating vitamin D metabolites following jejunoileal bypass. Int J Obes. 1982;6(5):473–9.PubMedGoogle Scholar
  35. 35.
    Andersen T, McNair P, Fogh-Andersen N, Nielsen TT, Hyldstrup L, Transbol I. Increased parathyroid hormone as a consequence of changed complex binding of plasma calcium in morbid obesity. Metabolism. 1986;35(2):147–51.PubMedCrossRefGoogle Scholar
  36. 36.
    Buffington C, Walker B, Cowan GS Jr, Scruggs D. Vitamin D deficiency in the morbidly obese. Obes Surg. 1993 Nov;3(4):421–4.PubMedCrossRefGoogle Scholar
  37. 37.
    Hamoui N, Anthone G, Crookes PF. Calcium metabolism in the morbidly obese. Obes Surg. 2004;14(1):9–12.PubMedCrossRefGoogle Scholar
  38. 38.
    Carlin AM, Rao DS, Meslemani AM, Genaw JA, Parikh NJ, Levy S, et al. Prevalence of vitamin D depletion among morbidly obese patients seeking gastric bypass surgery. Surg Obes Relat Dis. 2006;2(2):98–103.PubMedCrossRefGoogle Scholar
  39. 39.
    Carlin AM, Rao DS, Yager KM, Genaw JA, Parikh NJ, Szymanski W. Effect of gastric bypass surgery on vitamin D nutritional status. Surg Obes Relat Dis. 2006;2(6):638–42.PubMedCrossRefGoogle Scholar
  40. 40.
    Yanoff LB, Parikh SJ, Spitalnik A, Denkinger B, Sebring NG, Slaughter P, et al. The prevalence of hypovitaminosis D and secondary hyperparathyroidism in obese Black Americans. Clin Endocrinol (Oxf). 2006;64(5):523–9.CrossRefGoogle Scholar
  41. 41.
    Abbasi AA, Amin M, Smiertka JK, Grunberger G, MacPherson B, Hares M, et al. Abnormalities of vitamin D and calcium metabolism after surgical treatment of morbid obesity: a study of 136 patients. Endocr Pract. 2007;13(2):131–6.PubMedGoogle Scholar
  42. 42.
    Ybarra J, Sanchez-Hernandez J, Perez A. Hypovitaminosis D and morbid obesity. Nurs Clin North Am. 2007;42(1):19–27.PubMedCrossRefGoogle Scholar
  43. 43.
    Morinobu T, Murata T, Takaya R, Tamai H. Nutritional status of beta-carotene, alpha-tocopherol and retinol in obese children. Int J Vitam Nutr Res. 2002;72(3):119–23.PubMedCrossRefGoogle Scholar
  44. 44.
    Strauss RS. Comparison of serum concentrations of alpha-tocopherol and beta-carotene in a cross-sectional sample of obese and nonobese children (NHANES III). National Health and Nutrition Examination Survey. J Pediatr. 1999;134(2):160–5.PubMedCrossRefGoogle Scholar
  45. 45.
    Neuhouser ML, Rock CL, Eldridge AL, Kristal AR, Patterson RE, Cooper DA, et al. Serum concentrations of retinol, alpha-tocopherol and the carotenoids are influenced by diet, race and obesity in a sample of healthy adolescents. J Nutr. 2001;131(8):2184–91.PubMedGoogle Scholar
  46. 46.
    Wallstrom P, Wirfalt E, Lahmann PH, Gullberg B, Janzon L, Berglund G. Serum concentrations of beta-carotene and alpha-tocopherol are associated with diet, smoking, and general and central adiposity. Am J Clin Nutr. 2001;73(4):777–85.PubMedGoogle Scholar
  47. 47.
    Kimmons JE, Blanck HM, Tohill BC, Zhang J, Khan LK. Associations between body mass index and the prevalence of low micronutrient levels among US adults. MedGenMed. 2006;19;8(4):59.PubMedGoogle Scholar
  48. 48.
    Hak AE, Ma J, Powell CB, et al. Prospective study of plasma parotenoids and tocopherols in relation to risk of ischemic stroke. Stroke. 2004;35:1584–8.PubMedCrossRefGoogle Scholar
  49. 49.
    Facchini FS, Humphreys MH, DoNascimento CA, Abbasi F, Reaven GM. Relation between insulin resistance and plasma concentrations of lipid hydroperoxides, carotenoids, and tocopherols. Am J Clin Nutr. 2000;72:776–9.PubMedGoogle Scholar
  50. 50.
    Ziegler RG. Vegetables, fruits, and carotenoids and the risk of cancer. Am J Clin Nutr. 1991;53 Suppl 1:251–9S.PubMedGoogle Scholar
  51. 51.
    Mares-Perlman JA, Millen AE, Ficek TL, Hankinson SE. The body of evidence to support a protective role for lutein and zeaxanthin in delaying chronic disease. Overview. J Nutr. 2002;132:518–24S.PubMedGoogle Scholar
  52. 52.
    Levine M, Rumsey SC, Wang Y, Park JB, Daruwala R. Vitamin C. In: Stipanuk MH, editor. Biochemical and physiological aspects of human nutrition. Philadelphia: WB Saunders; 2000. p. 541–67.Google Scholar
  53. 53.
    Prockop DJ, Kivirikko KI. Collagens: molecular biology, diseases, and potentials for therapy. Annu Rev Biochem. 1995;64:403–34.PubMedCrossRefGoogle Scholar
  54. 54.
    Rebouche CJ. Ascorbic acid and carnitine biosynthesis. Am J Clin Nutr. 1991;54:1147–52S.PubMedGoogle Scholar
  55. 55.
    Kaufman S. Dopamine-beta-hydroxylase. J Psychiatr Res. 1974;11:303–16.PubMedCrossRefGoogle Scholar
  56. 56.
    Englard S, Seifter S. The biochemical functions of ascorbic acid. Annu Rev Nutr. 1986;6:365–406.PubMedCrossRefGoogle Scholar
  57. 57.
    Bhat V, Weiner WJ. Parkinson’s disease. Diagnosis and the initiation of therapy. Minerva Med. 2005;96(3):145–54.PubMedGoogle Scholar
  58. 58.
    Block G. Ascorbic acid, blood pressure, and the American diet. Ann N Y Acad Sci. 2002;959:180–7.PubMedCrossRefGoogle Scholar
  59. 59.
    Wilson JX. Regulation of vitamin C transport. Annu Rev Nutr. 2005;25:105–25.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media B.V. 2007

Authors and Affiliations

  • Orit Kaidar-Person
    • 1
    • 2
  • Benjamin Person
    • 2
  • Samuel Szomstein
    • 1
  • Raul J. Rosenthal
    • 1
    Email author
  1. 1.The Bariatric Institute and Section of Minimal Invasive SurgeryCleveland Clinic FloridaWestonUSA
  2. 2.Department of Colorectal SurgeryCleveland Clinic FloridaWestonUSA

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