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Micronutrient Screening Before Obesity Surgery



Obesity surgery is now widely recognized as the only effective treatment for severe obesity – given both the remarkable health and economic outcomes, numbers are likely to continue increasing exponentially world wide.

However, as I have often blogged before, obesity surgery is not just about the surgery. Indeed, nutritional management of these patients after surgery requires careful life-long monitoring and supplementation to avoid nutritional deficiencies. This problem is often exacerbated by the fact that many patients start out with severe deficiencies even before surgery.

Thus, in a new paper just out in Obesity Surgery by Barbara Ernst and colleagues from the Interdisciplinary Obesity Center, Kantonsspital St. Gallen, Rorschach, Switzerland, micronutrient deficiencies are alarmingly prevalent in patients seeking bariatric surgery.

In their systematic assessment of micronutrient status in 232 morbidly obese subjects prior to bariatric surgery, 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 B12.

In addition, 25.4% showed severe vitamin D deficiency, which was accompanied by secondary hyperparathyroidism in 36.6% cases.

Overall, around 50% of patients had at least one of the most prevalent deficiencies, i.e., vitamin B12, zinc or severe vitamin D deficiency.

In a sub-sample, 32.6% showed selenium, 5.6% vitamin B3, 2.2% vitamin B6, and 2.2% vitamin E deficiencies.

On a positive note, there were no cases of copper, vitamin B1, or vitamin A deficiencies.

These findings are very much in line with our own anecdotal observations of a surprisingly poor nutritional status in patients presenting at our centre.

The authors recommend, and I concur, that systematic screening and correction of nutritional deficiencies prior to surgery should be routine practice in candidates for bariatric surgery.

I believe that these deficiencies are generally common in severely obese individuals, irrespective of whether or not they plan to undergo surgery and would therefore recommend that screening and substitution of micronutrients would be beneficial in ALL patients presenting with severe obesity.

AMS
Edmonton, Alberta

5 Comments

  1. Dr. Sharma, thanks for sharing great research on obesity on your website. Your concern for your patients and the difficulties and challenges is evident. Thanks for your positive work in this area.

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  2. Arya,
    Thanks for pointing me to this important paper and for your comments. As you point out we recommend that patients follow a vitamin and mineral supplementation post surgery. This paper argues that supplementation should begin even before surgery. We are currently analyzing samples from baseline through to 2 and 5 yr post surgery in post-gastric bypass patients. It may be that long-term comprehensive nutritional screening will be especially important in these patients even when they are compliant with their vitamin and mineral regimen.

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  3. I know of a woman who has apparently developed MS as a complication of obesity surgery. She says it was a specialist in her state who diagnosed her. Plus she has regained considerable wt. I only know her online, but it’s not a good situation.

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  4. Obesity is the second leading cause of death. Though bariatric surgery is recommended it is to taken as the last resort. Patients should know all about the process, its outcome and precautions to be taken. Systematic screening and correction of nutritional deficiencies prior to surgery should be made a routine practice in candidates for bariatric surgery. Surgery won’t make any one slim, healthy habits and lifestyle modification will only show the results. Some great info you have here http://www.empowereddoctor.com/weight-loss4

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  5. My doctors (both the bariatric surgeon and, later, my primary care physician) have been very vigilant about tracking my nutritional status and advising daily supplementation. I have had deficient levels of Iron and Vitamin D; the others have been maintained through supplements.

    I’m a little concerned at how glibly doctors recommend bariatric surgery. It is a great treatment for obesity, but it also causes many long term issues which patients should carefully consider before having the surgery. It’s not a magic bullet. You do have to be very conscientious about nutrition. I’m a diabetic vegetarian–trying to balance my need for protein, low glycemic-index carbs, etc. can get so crazy that I often feel like I have a brand new eating disorder, thanks to the surgery. And it’s entirely too easy to gain the weight back if you’re not careful.

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