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

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.

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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.

    CAS  Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google 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.

    Article  PubMed  Google Scholar 

  4. 4.

    Schweiger C, Weiss R, Berry E, et al. Nutritional deficiencies in bariatricsurgerycandidates. Obes Surg. 2010;20:193–7.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google Scholar 

  10. 10.

    Toh SY, Zarshenas N, Jorgensen J. Prevalence of nutient deficiencies in bariatric patients. Nutrition. 2009;25(11–12):1150–6.

    CAS  Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    CAS  Article  PubMed  Google 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.

    Article  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Holick MF. Vitamin D deficiency. NEJM. 2007;357:266–81.

    CAS  Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    CAS  PubMed  Google 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.

    Article  PubMed  Google 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.

    CAS  Article  PubMed  Google 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.

    Article  Google 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.

    Article  PubMed  Google 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.

    Article  Google Scholar 

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Acknowledgements

The authors thank all patients who participated in this study and medical staff in Rudolfstiftung hospital who helped with the data collection.

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Correspondence to Eva-Christina Krzizek.

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Conflict of Interest

Dr. Krzizek: no conflict of interest.

Dr. Brix: no conflict of interest.

Dr. Herz: no conflict of interest.

Dr. Kopp: no conflict of interest.

Prof. Schernthaner: no conflict of interest.

Prof. Schernthaner: no conflict of interest.

Prof. Ludvik: no conflict of interest.

All procedures performed were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments [15], and the Good Clinical Practice guidelines. Informed consent was obtained from all individual participants included in the study.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in the study.

Statement of Human Rights

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

Appendix

Appendix

Table 1 Reference values for micronutrients
Table 2 Baseline characteristics women vs. men
Table 3 Deficits of the respective parameters according to tertiles of body mass index
Table 4 Deficits of the respective parameters according to tertiles of age

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Krzizek, EC., Brix, J.M., Herz, C.T. et al. Prevalence of Micronutrient Deficiency in Patients with Morbid Obesity Before Bariatric Surgery. OBES SURG 28, 643–648 (2018). https://doi.org/10.1007/s11695-017-2902-4

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Keywords

  • Morbid obesity
  • Micronutrients