title: Evidence for the necessity to systematically assess micronutrient status prior to bariatric surgery.
abstract: 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.
authors.affiliation: Interdisciplinary Obesity Center, Kantonsspital St. Gallen, CH-9400, Rorschach, Switzerland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Ernst
authors.forename: Martin
authors.initials: M
authors.lastname: Thurnheer
authors.forename: Sebastian M
authors.initials: SM
authors.lastname: Schmid
authors.forename: Bernd
authors.initials: B
authors.lastname: Schultes
mesh_terms: 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
chemical_list: D018977:Micronutrients