title: Preoperative micronutrient status in morbidly obese patients before undergoing bariatric surgery: results of a cross-sectional study.
abstract: BACKGROUND
  Reliable information on micronutrient status before bariatric surgery is needed to optimize preoperative nutritional status and postoperative nutritional therapy.
  
  
  OBJECTIVE
  To investigate the pro-/vitamin and mineral status and its association with nutrient intake in morbidly obese patients seeking bariatric surgery
  
  
  METHODS
  Klinikum Vest, Recklinghausen, Germany.
  
  
  METHODS
  The cross-sectional study investigated retinol, ascorbic acid, tocopherol, and β-carotene (high-pressure liquid chromatography), 25-hydroxycholecalciferol (enzyme-linked immunosorbent assay), and calcium, phosphate, and magnesium (photometry) in serum/plasma in 43 patients (body mass index: 52.6±10.5 kg/m(2)) before sleeve gastrectomy. Albumin, parathyroid hormone, and alkaline phosphatase were analyzed. Data were compared with accepted cutoff values. Dietary intake was estimated by 3-day food records, and nutrient intake was compared with recommended values.
  
  
  RESULTS
  One third of participants had ascorbic acid concentrations<28 nmol/L. All patients had β-carotene levels≤.9 µmol/L, although retinol was below the cutoff value (<.7 µmol/L) in only 5%. Tocopherol/cholesterol-ratio was always>2.8 µmol/mmol. Of the patients, 84% had 25-hydroxycholecalciferol levels below 50 nmol/L. Parathyroid hormone was elevated in 23% (>6.5 pmol/L). Calcium, magnesium, and alkaline phosphatase were always, and phosphate was mostly (98%) above cutoff values. Intake of retinol (23%), ascorbic acid (55.8%), vitamin D (90.7%), tocopherol (48.8%), and β-carotene (<2.0 mg/d; 37.2%) were often below recommendations. Correlations between serum/plasma concentrations and nutritional intake and associations between low concentrations and inadequate intake were not observed.
  
  
  CONCLUSIONS
  Many morbidly obese patients in Germany suffer from deficiencies in multiple micronutrients, particularly vitamin D, ascorbic acid, and β-carotene before sleeve gastrectomy. Measurement of preoperative micronutrient status will help supplement patients before, and optimize nutritional therapy after, surgery.
authors.affiliation: Department of General and Visceral Surgery, Klinikum Vest, Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Germany; Department of Nutrition and Food Sciences, Nutritional Physiology, University of Bonn, Bonn, Germany.
authors.forename: Eva
authors.initials: E
authors.lastname: Wolf
authors.affiliation: Department of General and Visceral Surgery, Klinikum Vest, Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Utech
authors.affiliation: Department of Nutrition and Food Sciences, Nutritional Physiology, University of Bonn, Bonn, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Stehle
authors.affiliation: Department of General and Visceral Surgery, Klinikum Vest, Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Büsing
authors.affiliation: Department of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany.
authors.forename: Birgit
authors.initials: B
authors.lastname: Stoffel-Wagner
authors.affiliation: Department of Nutrition and Food Sciences, Nutritional Physiology, University of Bonn, Bonn, Germany; Faculty of Food, Nutrition and Hospitality Sciences, Hochschule Niederrhein, University of Applied Sciences, Mönchengladbach, Germany. Electronic address: Sabine.Ellinger@hs-niederrhein.de.
authors.forename: Sabine
authors.initials: S
authors.lastname: Ellinger
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects / Q000379:methods*; D015992:Body Mass Index; D002851:Chromatography, High Pressure Liquid; D003430:Cross-Sectional Studies; D003677:Deficiency Diseases / Q000175:diagnosis* / Q000453:epidemiology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D008297:Male; D018977:Micronutrients / Q000097:blood* / Q000172:deficiency; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D009767:Obesity, Morbid / Q000097:blood* / Q000453:epidemiology / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D018977:Micronutrients
keywords: Bariatric surgery; Dietary intake; Micronutrients; Nutritional deficiencies; Nutritional recommendations; Obesity; Preoperative nutritional assessment