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

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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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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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Authors and Affiliations

  1. Department of Medicine I, Rudolfstiftung Hospital, Juchgasse 25, 1030, Vienna, Austria

    Eva-Christina Krzizek, Johanna Maria Brix, Hans Peter Kopp, Guntram Schernthaner & Bernhard Ludvik

  2. Karl Landsteiner Institute of obesity and metabolic diseases, Vienna, Austria

    Eva-Christina Krzizek, Johanna Maria Brix, Hans Peter Kopp & Bernhard Ludvik

  3. Department of Medicine III, Medical University Vienna, Vienna, Austria

    Carsten Thilo Herz

  4. Department of Medicine II, Div. Angiology, Medical University of Vienna, Vienna, Austria

    Gerit-Holger Schernthaner

Authors
  1. Eva-Christina Krzizek
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  2. Johanna Maria Brix
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  3. Carsten Thilo Herz
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  4. Hans Peter Kopp
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  5. Gerit-Holger Schernthaner
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  6. Guntram Schernthaner
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  7. Bernhard Ludvik
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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
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Table 2 Baseline characteristics women vs. men
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Table 3 Deficits of the respective parameters according to tertiles of body mass index
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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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