Prevalence of Micronutrient Deficiency in Patients with Morbid Obesity Before Bariatric Surgery

  • Eva-Christina Krzizek
  • Johanna Maria Brix
  • Carsten Thilo Herz
  • Hans Peter Kopp
  • Gerit-Holger Schernthaner
  • Guntram Schernthaner
  • Bernhard Ludvik
Original Contributions

Abstract

Background

Postoperative micronutrient deficiency is a known side effect of bariatric surgery. In this study, we examined the prevalence of micronutrient deficiency in patients with morbid obesity (MO) preoperatively.

Methods

A total of 1732 patients with MO wishing to undergo bariatric surgery (age: 40 ± 12 years, mean BMI: 44 ± 9 kg/m2, means ± SD, 77.3% female) were analyzed in this cross-sectional examination. Iron state, vitamin B12, folic acid, 25hydroxy(OH)-vitamin D, PTH, vitamin A, and vitamin E levels were determined. Subsequently, patients underwent nutritional counseling and were substituted accordingly.

Results

A total of 63.2% (n = 1094) of the patients had a deficit in folic acid (< 5.3 ng/ml), 97.5% (n = 1689) in 25OHvitamin D (< 75 nmol/l), and 30.2% (n = 523) had a PTH elevation (> 56.9 pg/ml). A total of 5.1% (n = 88) of the patients presented with a deficit in vitamin B12 (< 188 pg/ml) and 6.2% (n = 107) in vitamin A (< 1.05 μmol/l). A total of 9.6% (n = 166) exhibited iron deficiency (ferritin < 15 μg/l). None of the patients had a deficit in vitamin E. There were no gender differences except for ferritin deficiency (women 11.8% vs. men 1.5%, p < 0.001). Patients in the highest BMI tertile had significantly more often a deficit in vitamin D (p = 0.033) and folic acid (p < 0.001). Patients in the lowest age tertile had significantly more often a deficit in folic acid (p < 0.001).

Conclusions

Our data show a high prevalence of micronutrient deficiency in patients with morbid obesity preoperatively and emphasize the importance of exact preoperative evaluation and adequate substitution as well as postoperative surveillance.

Keywords

Morbid obesity Micronutrients 

References

  1. 1.
    Stein J, Stier C, Raab H, et al. Review article: the nutritional and pharmacological consequences of obesity surgery. Aliment Pharmacol Ther. 2014;40:582–609.CrossRefPubMedGoogle Scholar
  2. 2.
    Gudzune KA, Huizinga MM, Chang H-Y, et al. Screening and diagnosis of micronutrient deficiencies before and after bariatric surgery. Obes Surg. 2013;23(10):1581–9.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Flancbaum L, Belsley S, Drake V, et al. Preoperative nutritional status of patients undergoing roux-en-Y gastric bypass for morbid obesity. J Gastrointest Surg. 2006;10:1033–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Schweiger C, Weiss R, Berry E, et al. Nutritional deficiencies in bariatricsurgerycandidates. Obes Surg. 2010;20:193–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Peterson LA, Cheskin LJ, Furtado M, et al. Malnutrition in bariatric surgery candidates: multiple micronutrient deficiencies prior to surgery. Obes Surg. 2016;26:833–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Sanchez A, Rojas P, Basfi-fer K, et al. Micronutrient deficiencies in morbidly obese women prior to bariatric surgery. Obes Surg. 2016;26:361–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Arshad M, Jaberian S, Pazouki A, et al. Iron deficiency anemia and megaloblastic anemia in obese patients. Rom J Intern Med. 2017;55(1):3–7.PubMedGoogle Scholar
  8. 8.
    Gobato RC, Seixas Chaves DF, Chaim EA. Micrunutrient and physiological parameters before and 6 months after RYGB. Surg Obes Relat Dis. 2014;10(5):944–51.CrossRefPubMedGoogle Scholar
  9. 9.
    Lefebvre P, Letois F, Sultan A, et al. Nutrient deficiencies in patients with obesity considering bariatric surgery: a cross-sectional study. Surg Obes Relat Dis. 2014;10(3):540–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Toh SY, Zarshenas N, Jorgensen J. Prevalence of nutient deficiencies in bariatric patients. Nutrition. 2009;25(11–12):1150–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Ernst B, Thurnheer M, Schmid SM, et al. Evidence for the necessity to systematically assess micronutrient status prior to bariatric surgery. Obes Surg. 2009;19(1):66–73.CrossRefPubMedGoogle Scholar
  12. 12.
    Pereira MA, Kartashov AI, Ebbeling CB, et al. Fast-food habits, weight gain, and insulin resistance (the CARDIA study): 15-year prospective analysis. Lancet. 2005;365:36–42.CrossRefPubMedGoogle Scholar
  13. 13.
    Epstein LH, Gordy CC, Raynor HA, et al. Increasing fruit and vegetable intake and decreasing fat and sugar intake in families at risk for childhood obesity. Obes Res. 2001;9(3):171–8.CrossRefGoogle Scholar
  14. 14.
    Ali SM, Lindström M. Socioeconomic, psychosocial, behavioural, and psychological determinants of BMI among young women: differing patterns for underweight and overweight/obesity. Eur J Pub Health. 2005;16(3):324–30.CrossRefGoogle Scholar
  15. 15.
    World Medical Association Declaration of Helsinki. Recommendations guiding physicians in biomedical research involving human subjects. Helsinki, Finland. 1964; amended in Tokyo, Japan. 1975; Venice, Italy. 1983; Hong Kong 1989; Somerset West, South Africa. 1996; Edinburgh, Scotland. 2000; Washington, USA., 2002; Tokyo, Japan 2004. Available at http://www.wma.net/en/60about/70history/01declarationHelsinki/index.html. Accessed 25 Feb 2017.
  16. 16.
    Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142(7):547–59.CrossRefPubMedGoogle Scholar
  17. 17.
    Luger M, Kruschitz R, Kienbacher C, et al. Prevalence of liver fibrosis and its association with non-invasive fibrosis and metabolic markers in morbidly obese patients with vitamin D deficiency. Obes Surg. 2016;26(10):2425–32.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Holick MF. Vitamin D deficiency. NEJM. 2007;357:266–81.CrossRefPubMedGoogle Scholar
  19. 19.
    Williams Jr RD, Housman JM, Odum M, et al. Energy drink use linked to high-sugar beverage intake and BMI among teens. Am J Health Behav. 2017;41(3):259–65.CrossRefPubMedGoogle Scholar
  20. 20.
    Wortsman J, Matsuoka JY, Chen TC, et al. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr. 2000;72:690–3.PubMedGoogle Scholar
  21. 21.
    Dagan SS, Zelber-Sagi S, Webb M, et al. Nutritional status prior to laparoscopic sleeve gastrectomy surgery. Obes Surg. 2016;26(9):2119–26.CrossRefPubMedGoogle Scholar
  22. 22.
    Milunsky A, Jick H, Jick SS, et al. Multivitamin/folic acid supplementation in early pregnancy reduces the prevalence of neural tube defects. JAMA. 1989;262(20):2847–52.CrossRefPubMedGoogle Scholar
  23. 23.
    Lee WB, Hamilton SM, Harris JP, et al. Ocular complications of hypovitaminosis a after bariatric surgery. Ophtalmology. 2005;112(6):1031–4.CrossRefGoogle Scholar
  24. 24.
    Cañete A, Cano E, Muñoz-Chápuli R, et al. Role of vitamin a/retinoic acid in regulation of embryonic and adult hematopoiesis. Nutrients. 2017;20:9(2).Google Scholar
  25. 25.
    Parrott J, Frank L, Rabena R, et al. American Society for Metabolic and Bariatric Surgery integrated health nutritional guidelines for the surgical weight loss patient 2016 update: micronutrients. Surg Obes Relat Dis. 2017;13(5):727–41.CrossRefPubMedGoogle Scholar
  26. 26.
    Walmala SP, Wolk A, Orth-Gomes K. Determinants of obesity in relation to socioeconomic status among middle-aged Swedish women. Prev Med. 1997;26:734–44.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of Medicine IRudolfstiftung HospitalViennaAustria
  2. 2.Karl Landsteiner Institute of obesity and metabolic diseasesViennaAustria
  3. 3.Department of Medicine IIIMedical University ViennaViennaAustria
  4. 4.Department of Medicine II, Div. AngiologyMedical University of ViennaViennaAustria

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