Applied nutritional investigationPrevalence of nutrient deficiencies in bariatric patients
Introduction
Bariatric surgery has been recognized to be the most effective long-term treatment for the morbidly obese (body mass index [BMI] ≥ 40 kg/m2), with demonstrated significant and durable weight loss, resolution or improvement of comorbidities [1], [2], and subsequent reduction in mortality [3], [4].
Bariatric procedures produce changes in the gastrointestinal anatomy and physiology. As a consequence, there is a change in the quantity and quality of diet, which may result in vitamin and mineral deficiencies [5]. Studies examining preoperative and postoperative nutritional status are few, and the reported prevalence of these deficiencies varies widely because of varying definitions of deficiency, patient populations, surgical techniques, supplement protocols, and lengths and completion of patient follow-up [5]. Furthermore, studies have shown that calcium, vitamin D, and iron deficiencies, as well as hyperparathyroidism, are prevalent among the morbidly obese before bariatric surgery [6]. Given the paucity of data exploring nutritional status among bariatric populations and the likely elevated risk for nutritional deficiencies, nutrition screening and treatment protocols appear important. These protocols will need to vary depending on the chosen bariatric procedure.
The 3 types of bariatric surgery done at our hospital are adjustable gastric banding (AGB), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG). Nutrition screening is carried out routinely before surgery, as well as 6 months, 9 months, and 1 year after surgery. The aims of this study were to determine the prevalence of nutrient deficiencies in patients who present for bariatric surgery and to assess nutritional parameters 1 year after surgery and compare these with preoperative levels.
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Materials and methods
A retrospective study was carried out on 244 consecutive patients who had undergone laparoscopic bariatric surgery by a single surgeon (J.J.) at St. George Hospital (Sydney, Australia) between February 2005 and June 2007. There were 55 AGB, 124 RYGB, and 65 SG surgeries. All patients are seen by a dietitian for routine nutrition assessment and counseling before and after surgery. The postoperative protocol involved instructing all patients to take a liquid, effervescent, or chewable
Results
Subjects' characteristics are shown in Table 1. The majority of patients (64%) were women, mostly aged 30 to 60 years (mean age, 46 ± 11 years). Nearly all patients had BMIs ≥ 35 kg/m2. In 10 patients (6 of whom underwent RYGB), BMIs were between 30 and 34.9 kg/m2, and the indication for surgery was the treatment of insulin resistance or diabetes mellitus. Percentage excess weight loss was not one of the key outcome measures in this study, so it is reported only for patients who had biochemical
Preoperative abnormalities
In patients presenting for bariatric surgery, vitamin D deficiency was the only consistent deficiency identified. More than half the patients had vitamin D deficiencies. Our findings are consistent with those of other studies, which reported vitamin D deficiencies in 60% [7] to 80% [8] of patients preoperatively. Furthermore, a quarter of the patients experienced elevated iPTH levels. Hyperparathyroidism has been observed in 25% [9] to 48% [7] in the morbidly obese.
Although an association
Conclusion
Vitamin D deficiency is common among morbidly obese patients seeking bariatric surgery. Because the prevalence of micronutrient deficiencies persists or worsens postoperatively, to ensure optimal nutrition status, routine nutrition screening, the recommendation of appropriate supplements, and monitoring adherence is imperative in this population.
Acknowledgments
We would like to thank the staff of St. George Bariatric Unit and Kelly Lambert and Karen Walton of the University of Wollongong for their invaluable support and guidance.
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