Malnutrition in Bariatric Surgery Candidates: Multiple Micronutrient Deficiencies Prior to Surgery
- 1.3k Downloads
Over 78 million American adults have obesity. Bariatric surgery is the leading means of durable weight loss. Nutritional deficiencies are commonly treated post-operatively but are often undiagnosed pre-operatively. Malnutrition is correlated with adverse surgical outcomes.
The aim of this study is to assess pre-operative nutritional status in our bariatric surgery candidates in a cross-sectional study.
We recruited 58 bariatric candidates approved to undergo the Roux-en Y gastric bypass. Nutritional status was determined for vitamins A, B12, D, E-α, and E-β/γ as well as thiamine, folate, and iron. We used clinical as well as frank deficiency cut-offs based on the Institute of Medicine and the World Health Organization guidelines.
This cohort was largely female (77.6 %) and white (63.8 %). Median age was 42.2 years. Median body mass index (BMI) was 46.3 kg/m2. Multiple comorbidities (MCM) were present in 41.4 %, 54.0 % hypertension, 42.0 % diabetic, 34.0 % sleep apnea. Men had more comorbidities, 69.2 % with MCM. Folate and iron saturation varied significantly by sex. Vitamins A, D, E-α, and thiamine significantly varied by race. Vitamin D negatively correlated with BMI (p = 0.003) and age (p = 0.030). Vitamin A negatively correlated with age (p = 0.001) and number of comorbidities (p = 0.003). These pre-operative bariatric candidates had significant malnutrition, particularly in vitamin D (92.9 %) and iron (36.2 to 56.9 %). Multiple micronutrient deficiency (MMND) was more common in blacks (50.0 versus 39.7 % overall). Number of comorbidities did not correlate with MMND.
Malnutrition in one or multiple micronutrients is pervasive in this pre-operative bariatric cohort. The effect of pre-operative supplementation, especially vitamin D and iron, should be explored.
KeywordsBariatric surgery Nutritional status Multiple micronutrient deficiency Malnutrition
Conflicts of Interest Disclosure Statement
The authors declare that they have no competing interests.
Statement of Informed Consent
Informed consent was obtained from all individual participants included in the study.
Statement of Human and Animal Rights
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- 5.Mechanick JI, Kushner RF, Sugerman HJ, et al. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Obesity (Silver Spring). 2009;17(1):S1–70.CrossRefGoogle Scholar
- 23.Saneei P, Salehi-Abargouei A, Esmaillzadeh A. Serum 25-hydroxy vitamin D levels in relation to body mass index: a systematic review and meta-analysis. Obes Rev 2013Google Scholar
- 26.Centers for Disease Control and Prevention. FastStats—Anemia. http://www.cdc.gov/nchs/fastats/anemia.htm . 7-14-2014. 12-22-2014.
- 27.Institute of Medicine Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: National Academy Press; 2010.Google Scholar