Malnutrition in Bariatric Surgery Candidates: Multiple Micronutrient Deficiencies Prior to Surgery

Abstract

Background

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.

Objectives

The aim of this study is to assess pre-operative nutritional status in our bariatric surgery candidates in a cross-sectional study.

Methods

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.

Results

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.

Conclusions

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.

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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.

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Correspondence to Leigh A. Peterson or Lawrence J. Cheskin.

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Peterson, L.A., Cheskin, L.J., Furtado, M. et al. Malnutrition in Bariatric Surgery Candidates: Multiple Micronutrient Deficiencies Prior to Surgery. OBES SURG 26, 833–838 (2016). https://doi.org/10.1007/s11695-015-1844-y

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Keywords

  • Bariatric surgery
  • Nutritional status
  • Multiple micronutrient deficiency
  • Malnutrition