Evidence for the necessity to systematically assess micronutrient status prior to bariatric surgery.
BACKGROUND
Bariatric surgery has been proven the most effective treatment of morbid obesity, but micronutrient deficiency following bariatric surgery is a major concern. Increasing evidence points to a generally poor micronutrient status in obese subjects.


METHODS
We assessed micronutrient status in 232 morbidly obese subjects (BMI > or = 35 kg/m(2)) prior to bariatric surgery. Serum albumin, calcium, phosphate, magnesium, ferritin, hemoglobin, zinc, folate, vitamin B(12), 25-OH vitamin D(3), and intact parathormone (iPTH) were determined. In a sub-sample of 89 subjects, we additionally assessed copper, selenium, vitamin B(1), B(3), B(6), A, and E levels.


RESULTS
Deficiencies were found in 12.5% of the subjects for albumin, 8.0% for phosphate, 4.7% for magnesium, 6.9% for ferritin, 6.9% for hemoglobin, 24.6% for zinc, 3.4% for folate, and 18.1% for vitamin B(12). In addition, 25.4% showed a severe 25-OH vitamin D(3) deficiency, which was accompanied by a secondary hyperparathyroidism in 36.6% cases. Prevalence of albumin deficiency (p < 0.007) and of anemia (p < 0.003; in women only) significantly increased with BMI. Of note, 48.7% of the subjects showed at least one of the most prevalent deficiencies, i.e., vitamin B(12), zinc and severe 25-OH vitamin D(3) deficiency. In the sub-sample, 32.6% showed a selenium, 5.6% a vitamin B(3), 2.2% a vitamin B(6), and 2.2% a vitamin E deficiency. Copper, vitamin B(1), and vitamin A deficiency was found in none of the subjects.


CONCLUSIONS
Data indicate a high prevalence of micronutrient deficiencies in morbidly obese subjects. Based on these results, we strongly recommend a systematic assessment of the micronutrient status in all candidates for bariatric surgery.
Ernst
Barbara
B
Interdisciplinary Obesity Center, Kantonsspital St. Gallen, CH-9400, Rorschach, Switzerland.
Thurnheer
Martin
M
Schmid
Sebastian M
SM
Schultes
Bernd
B
D000328:Adult; D050110:Bariatric Surgery; D015992:Body Mass Index; D015331:Cohort Studies; D003677:Deficiency Diseases / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D018977:Micronutrients; D008875:Middle Aged; D020380:Needs Assessment; D009752:Nutritional Status; D009767:Obesity, Morbid / Q000150:complications* / Q000378:metabolism / Q000601:surgery; D015995:Prevalence; D012307:Risk Factors
D018977:Micronutrients