Obesity Surgery

, Volume 29, Issue 1, pp 166–171 | Cite as

Nutritional Deficiencies in Severe Obesity: a Multiethnic Asian Cohort

  • Phong Ching LeeEmail author
  • Sonali Ganguly
  • John B. Dixon
  • Hong Chang Tan
  • Chin Hong Lim
  • Kwang Wei Tham
Original Contributions



Micronutrient deficiencies are highly prevalent in patients seeking metabolic-bariatric surgery (MBS), although literature remains scant in Asia. In this study, we assess the prevalence of nutritional deficiencies in patients with clinically severe obesity in Singapore and examine factors associated with the deficiencies.


This is a prospective, observational study of 577 consecutive patients scheduled to undergo MBS. Nutritional profile including renal panel, calcium, phosphate, intact parathyroid hormone (iPTH), 25-hydroxyvitamin D (25(OH)D), vitamin B12, folate, ferritin, iron studies, hemoglobin, albumin, and alkaline phosphatase were analyzed.


Mean age was 40.6 ± 10.3 years, 61.2% female, and mean BMI 42.4 ± 8.4 kg/m2. 92.9% had suboptimal vitamin D levels; of which 25.6% had vitamin D insufficiency (25(OH)D < 30 mcg/L), 57.5% had vitamin D deficiency (25(OH)D < 20 mcg/L), and 9.8% had severe vitamin D deficiency (25(OH)D < 10 mcg/L). Younger age, female gender, and higher BMI were independent factors associated with lower 25(OH)D. There was an inverse relationship between iPTH and 25(OH)D, with an inflection point at 25(OH)D of approximately 20 mcg/L.

Folate deficiency was present in 31% and vitamin B12 deficiency in 9.5% of the cohort. Serum ferritin levels were low in 29.3%. 25(OH)D, ferritin, serum iron, and albumin were also significantly higher in Chinese compared to Malay and Indian patients.


Vitamin D deficiency was the most common micronutrient deficiency observed in this multi-ethnic Asian cohort presenting for MBS. Ethnic differences in nutritional status were observed.


Nutritional deficiencies Obesity Bariatric surgery Vitamin D deficiency Parathyroid hormone 



We would like to thank Vieon Wu Aini and Jasmine Chua for data collection and maintenance of the database and Drs S Pasupathy, Chan WH, Alvin Eng, and Eugene Lim who performed the surgeries and cared for the patients.

Compliance with Ethical Standards

Competing Interests

The authors declare that they have no competing interests.

Ethical Approval Statement

This article does not contain any studies with human participants or animals performed by any of the authors. For this type of study formal consent is not required.

Informed Consent Statement

Does not apply.

Supplementary material

11695_2018_3494_MOESM1_ESM.docx (120 kb)
ESM 1 (DOCX 120 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of EndocrinologySingapore General HospitalSingaporeSingapore
  2. 2.Clinical Obesity ResearchBaker Heart and Diabetes InstituteMelbourneAustralia
  3. 3.Department of Upper Gastrointestinal and Bariatric SurgerySingapore General HospitalSingaporeSingapore

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