title: Malnutrition in Bariatric Surgery Candidates: Multiple Micronutrient Deficiencies Prior to Surgery.
abstract: BACKGROUND
  Over 78 million American adults have obesity. Bariatric surgery is the leading means of durable weight loss. Nutritional deficiencies are commonly treated post-operatively but are often undiagnosed pre-operatively. Malnutrition is correlated with adverse surgical outcomes.
  
  
  OBJECTIVE
  The aim of this study is to assess pre-operative nutritional status in our bariatric surgery candidates in a cross-sectional study.
  
  
  METHODS
  We recruited 58 bariatric candidates approved to undergo the Roux-en Y gastric bypass. Nutritional status was determined for vitamins A, B12, D, E-α, and E-β/γ as well as thiamine, folate, and iron. We used clinical as well as frank deficiency cut-offs based on the Institute of Medicine and the World Health Organization guidelines.
  
  
  RESULTS
  This cohort was largely female (77.6%) and white (63.8%). Median age was 42.2 years. Median body mass index (BMI) was 46.3 kg/m(2). Multiple comorbidities (MCM) were present in 41.4%, 54.0% hypertension, 42.0% diabetic, 34.0% sleep apnea. Men had more comorbidities, 69.2 % with MCM. Folate and iron saturation varied significantly by sex. Vitamins A, D, E-α, and thiamine significantly varied by race. Vitamin D negatively correlated with BMI (p = 0.003) and age (p = 0.030). Vitamin A negatively correlated with age (p = 0.001) and number of comorbidities (p = 0.003). These pre-operative bariatric candidates had significant malnutrition, particularly in vitamin D (92.9%) and iron (36.2 to 56.9 %). Multiple micronutrient deficiency (MMND) was more common in blacks (50.0 versus 39.7% overall). Number of comorbidities did not correlate with MMND.
  
  
  CONCLUSIONS
  Malnutrition in one or multiple micronutrients is pervasive in this pre-operative bariatric cohort. The effect of pre-operative supplementation, especially vitamin D and iron, should be explored.
authors: The Johns Hopkins Center for Bariatric Surgery, 4940 Eastern Avenue, Baltimore, MD, 21224, USA. leighpeterson@jhmi.edu.
authors: Leigh A
authors: http://orcid.org/0000-0002-1475-2778
authors: LA
authors: Peterson
authors: The Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA. cheskin@jhu.edu.|The Johns Hopkins Weight Management Center, The Global Obesity Prevention Center at Johns Hopkins, Baltimore, MD, 21205, USA. cheskin@jhu.edu.|The Johns Hopkins Bloomberg School of Public Health, 550 N Broadway, Baltimore, MD, 21205, USA. cheskin@jhu.edu.
authors: Lawrence J
authors: LJ
authors: Cheskin
authors: The Johns Hopkins Bayview Department of Clinical Nutrition, American University of Antigua School of Medicine, 4940 Eastern Avenue, Baltimore, MD, 21224, USA.
authors: Margaret
authors: M
authors: Furtado
authors: , PO Box 572, Jonesborough, TN, 37659, USA.
authors: Konstantinos
authors: K
authors: Papas
authors: The Johns Hopkins Center for Bariatric Surgery, 4940 Eastern Avenue, Baltimore, MD, 21224, USA.
authors: Michael A
authors: MA
authors: Schweitzer
authors: The Johns Hopkins Center for Bariatric Surgery, 4940 Eastern Avenue, Baltimore, MD, 21224, USA.
authors: Thomas H
authors: TH
authors: Magnuson
authors: The Johns Hopkins Center for Bariatric Surgery, 4940 Eastern Avenue, Baltimore, MD, 21224, USA.
authors: Kimberley E
authors: KE
authors: Steele
mesh_terms: D000328:Adult; D000368:Aged; D050110:Bariatric Surgery; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000175:diagnosis*; D008875:Middle Aged; D009752:Nutritional Status; D009767:Obesity, Morbid / Q000150:complications*; D057234:Preoperative Period; D011446:Prospective Studies; D044469:Racial Groups; D012737:Sex Factors; D014481:United States; D055815:Young Adult
keywords: Bariatric surgery; Malnutrition; Multiple micronutrient deficiency; Nutritional status