Micronutrient Screening Before Obesity SurgeryThursday, January 29, 2009
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.