Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ASCO Annual Meeting 2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

2024 ASCO Annual Meeting

Keep up to date with all the top stories and latest evidence with our hub page, including official congress videos and expert takeaways.
ADVANCED SEARCH
Log in
Top
Obesity Surgery
Published in: Obesity Surgery 8/2018

01-08-2018 | Original Contributions

Prevalence of Micronutrient Deficiencies Prior to Bariatric Surgery: Tehran Obesity Treatment Study (TOTS)

Authors: Golaleh Asghari, Alireza Khalaj, Maryam Ghadimi, Maryam Mahdavi, Hossein Farhadnejad, Majid Valizadeh, Fereidoun Azizi, Maryam Barzin, Farhad Hosseinpanah

Published in: Obesity Surgery | Issue 8/2018

Login to get access

Abstract

Background

Micronutrient deficiencies are major concerns after bariatric surgery, although these conditions often go undiagnosed pre-surgery.

Objective

To assess pre-surgery micronutrient status of an Iranian population of morbidly obese candidates of bariatric surgery in a cross-sectional study.

Methods

A cross-sectional analysis of 2008 candidates for bariatric surgery, aged 15–65 years, with either body mass index (BMI) ≥ 40 kg/m2 or 30 < BMI < 35 kg/m2 with a medical comorbidity was conducted. In order to determine the micronutrient status of participants, blood samples were collected to assess serum concentrations of vitamins (B12 and D), minerals (copper, calcium, phosphate, and zinc), and iron profiles (total iron binding capacity, iron concentration, ferritin, and iron saturation), according to standard protocol.

Results

The mean age and BMI of patients (79.3% female) were 37.8 years and 44.8 kg/m2, respectively. Deficiencies were found for 25(OH) D (53.6%), vitamin B12 (34.4%), serum iron (10.2%), and low levels of hemoglobin (16.6%). The prevalence of other deficiencies were all below 10%. Body mass index had a negative correlation with iron, calcium, vitamin B12, and 25(OH) D and was positively correlated with copper.

Conclusion

Micronutrient deficiencies, including vitamin D, vitamin B12, and iron, are commonly found among morbidly obese subjects who are potential candidates of bariatric surgery.
Literature
1.
Wang YC, McPherson K, Marsh T, et al. Health and economic burden of the projected obesity trends in the USA and the UK. Lancet. 2011;378(9793):815–25.CrossRefPubMed
2.
Swinburn BA, Sacks G, Hall KD, et al. The global obesity pandemic: shaped by global drivers and local environments. Lancet. 2011;378(9793):804–14.CrossRefPubMed
3.
Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the global burden of disease study 2013. Lancet. 2014;384(9945):766–81.CrossRefPubMedPubMedCentral
4.
Popkin BM, Gordon-Larsen P. The nutrition transition: worldwide obesity dynamics and their determinants. Int J Obes Relat Metab Disord. 2004;28(Suppl 3):S2–9.CrossRefPubMed
5.
Jafari-Adli S, Jouyandeh Z, Qorbani M, et al. Prevalence of obesity and overweight in adults and children in Iran; a systematic review. J Diabetes Metab Disord. 2014;13(1):121.CrossRefPubMedPubMedCentral
6.
Ikramuddin S, Korner J, Lee WJ, et al. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the diabetes surgery study randomized clinical trial. JAMA. 2013;309(21):2240–9.CrossRefPubMedPubMedCentral
7.
8.
Bloomberg RD, Fleishman A, Nalle JE, et al. Nutritional deficiencies following bariatric surgery: what have we learned? Obes Surg. 2005;15(2):145–54.CrossRefPubMed
9.
Moize V, Deulofeu R, Torres F, et al. Nutritional intake and prevalence of nutritional deficiencies prior to surgery in a Spanish morbidly obese population. Obes Surg. 2011;21(9):1382–8.CrossRefPubMed
10.
Peterson LA, Cheskin LJ, Furtado M, et al. Malnutrition in bariatric surgery candidates: multiple micronutrient deficiencies prior to surgery. Obes Surg. 2016;26(4):833–8.CrossRefPubMed
11.
Lefebvre P, Letois F, Sultan A, et al. Nutrient deficiencies in patients with obesity considering bariatric surgery: a cross-sectional study. Surg Obes Relat Dis. 2014;10(3):540–6.CrossRefPubMed
12.
Wolf E, Utech M, Stehle P, et al. Preoperative micronutrient status in morbidly obese patients before undergoing bariatric surgery: results of a cross-sectional study. Surg Obes Relat Dis. 2015;11(5):1157–63.CrossRefPubMed
13.
de Lima KV, Costa MJ, Goncalves Mda C, et al. Micronutrient deficiencies in the pre-bariatric surgery. Arquivos brasileiros de cirurgia digestiva: ABCD. Braz Arch Dig Surg. 2013;26(Suppl 1):63–6.
14.
Garcia OP, Long KZ, Rosado JL. Impact of micronutrient deficiencies on obesity. Nutr Rev. 2009;67(10):559–72.CrossRefPubMed
15.
Aasheim ET, Hofso D, Hjelmesaeth J, et al. Vitamin status in morbidly obese patients: a cross-sectional study. Am J Clin Nutr. 2008;87(2):362–9.CrossRefPubMed
16.
Barzin M, Hosseinpanah F. Bariatric surgery for morbid obesity: Tehran obesity treatment study (TOTS) rationale and study design. JMIR Res Protoc. 2016;5(1):e8.CrossRefPubMedPubMedCentral
17.
Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Surg Obes Relat Dis. 2013;9(2):159–91.CrossRefPubMed
18.
National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) finalreport. Circulation. 2002;106(25):3143–421.
19.
James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507–20.CrossRefPubMed
20.
American Diabetes Association.Executive summary: Standards of medical care in diabetes -- 2012.Diabetes Care. 2012;35 Suppl 1:S4–S10.
21.
Pereira-Santos M, Costa PR, Assis AM, et al. Obesity and vitamin D deficiency: a systematic review and meta-analysis. Obes Rev. 2015;16(4):341–9.CrossRefPubMed
22.
Alemzadeh R, Kichler J, Babar G, et al. Hypovitaminosis D in obese children and adolescents: relationship with adiposity, insulin sensitivity, ethnicity, and season. Metabolism. 2008;57(2):183–91.CrossRefPubMed
23.
Earthman CP, Beckman LM, Masodkar K, et al. The link between obesity and low circulating 25-hydroxyvitamin D concentrations: considerations and implications. Int J Obes. 2012;36(3):387–96.CrossRef
24.
Grace C, Vincent R, Aylwin SJ. High prevalence of vitamin D insufficiency in a United Kingdom urban morbidly obese population: implications for testing and treatment. Surg Obes Relat Dis. 2014;10(2):355–60.CrossRefPubMed
25.
Goldner WS, Stoner JA, Thompson J, et al. Prevalence of vitamin D insufficiency and deficiency in morbidly obese patients: a comparison with non-obese controls. Obes Surg. 2008;18(2):145–50.CrossRefPubMed
26.
Pinhas-Hamiel O, Newfield RS, Koren I, et al. Greater prevalence of iron deficiency in overweight and obese children and adolescents. Int J Obes Related Metab Disord. 2003;27(3):416–8.CrossRef
27.
Ewang-Emukowhate M, Harrington DJ, Botha A, et al. Vitamin K and other markers of micronutrient status in morbidly obese patients before bariatric surgery. Int J Clin Pract. 2015;69(6):638–42.CrossRefPubMed
28.
Schweiger C, Weiss R, Berry E, et al. Nutritional deficiencies in bariatric surgery candidates. Obes Surg. 2010;20(2):193–7.CrossRefPubMed
29.
Gobato RC, Seixas Chaves DF, Chaim EA. Micronutrient and physiologic parameters before and 6 months after RYGB. Surg Obes Relat Dis. 2014;10(5):944–51.CrossRefPubMed
30.
Sanchez A, Rojas P, Basfi-Fer K, et al. Micronutrient deficiencies in morbidly obese women prior to bariatric surgery. Obes Surg. 2016;26(2):361–8.CrossRefPubMed
31.
de Luis DA, Pacheco D, Izaola O, et al. Micronutrient status in morbidly obese women before bariatric surgery. Surg Obes Relat Dis. 2013;9(2):323–7.CrossRefPubMed
32.
van Rutte PW, Aarts EO, Smulders JF, et al. Nutrient deficiencies before and after sleeve gastrectomy. Obes Surg. 2014;24(10):1639–46.CrossRefPubMed
33.
Toh SY, Zarshenas N, Jorgensen J. Prevalence of nutrient deficiencies in bariatric patients. Nutrition. 2009;25(11–12):1150–6.CrossRefPubMed
34.
Dagan SS, Zelber-Sagi S, Webb M, et al. Nutritional status prior to laparoscopic sleeve gastrectomy surgery. Obes Surg. 2016;26(9):2119–26.CrossRef
35.
Wortsman J, Matsuoka LY, Chen TC, et al. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr. 2000;72(3):690–3.CrossRefPubMed
36.
Ernst B, Thurnheer M, Schmid SM, et al. Seasonal variation in the deficiency of 25-hydroxyvitamin D(3) in mildly to extremely obese subjects. Obes Surg. 2009;19(2):180–3.CrossRefPubMed
37.
Packianathan IC, Sheikh M, Feben S, et al. The eating disorder inventory in a UK National Health Service Obesity Clinic and its response to modest weight loss. Eat Behav. 2002;3(3):275–84.CrossRefPubMed
38.
Asim Syed IA, Abbas Naqvi SH. Proton pump inhibitors use; beware of side-effects. JPMA J Pak Med Assoc. 2016;66(10):1314–8.PubMed
39.
Khubchandani SR, Kulkarni S, Teckchandani S, et al. Ultrastructure of the H. pylori microbe in individuals having macrocytosis and B12 deficiency. Ultrastruct Pathol. 2011;35(5):204–8.CrossRefPubMed
40.
Parrott J, Frank L, Rabena R, et al. American Society for Metabolic and Bariatric Surgery integrated health nutritional guidelines for the surgical weight loss patient 2016 update: micronutrients. Surg Obes Relat Dis. 2017;13(5):727–41.CrossRefPubMed
41.
Arshad M, Jaberian S, Pazouki A, et al. Iron deficiency anemia and megaloblastic anemia in obese patients. Rom J Intern Med. 2017;55(1):3–7.CrossRefPubMed
42.
Salgado Jr W, Modotti C, Nonino CB, et al. Anemia and iron deficiency before and after bariatric surgery. Surg Obes Relat Dis. 2014;10(1):49–54.CrossRefPubMed
43.
Cepeda-Lopez AC, Aeberli I, Zimmermann MB. Does obesity increase risk for iron deficiency? A review of the literature and the potential mechanisms. Int J Vitam Nutr Res. 2010;80(4–5):263–70.CrossRefPubMed
44.
Coad J, Conlon C. Iron deficiency in women: assessment, causes and consequences. Curr Opin Clin Nutr Metab Care. 2011;14(6):625–34.CrossRefPubMed
45.
Ghayour-Mobarhan M, Taylor A, New SA, et al. Determinants of serum copper, zinc and selenium in healthy subjects. Ann Clin Biochem. 2005;42(Pt 5):364–75.CrossRefPubMed
46.
de Luis DA, Pacheco D, Izaola O, et al. Zinc and copper serum levels of morbidly obese patients before and after biliopancreatic diversion: 4 years of follow-up. J Gastrointest Surg. 2011;15(12):2178–81.CrossRefPubMed
47.
Ozturk P, Kurutas E, Ataseven A, et al. BMI and levels of zinc, copper in hair, serum and urine of Turkish male patients with androgenetic alopecia. J Trace Elem Med Biol. 2014;28(3):266–70.CrossRefPubMed
48.
Olusi S, Al-Awadhi A, Abiaka C, et al. Serum copper levels and not zinc are positively associated with serum leptin concentrations in the healthy adult population. Biol Trace Elem Res. 2003;91(2):137–44.CrossRefPubMed
Metadata
Title
Prevalence of Micronutrient Deficiencies Prior to Bariatric Surgery: Tehran Obesity Treatment Study (TOTS)
Authors
Golaleh Asghari
Alireza Khalaj
Maryam Ghadimi
Maryam Mahdavi
Hossein Farhadnejad
Majid Valizadeh
Fereidoun Azizi
Maryam Barzin
Farhad Hosseinpanah
Publication date
01-08-2018
Publisher
Springer US
Published in
Obesity Surgery / Issue 8/2018
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-018-3187-y

Other articles of this Issue 8/2018

Obesity Surgery 8/2018 Go to the issue

Original Contributions

Contrasting Views of the Post-bariatric Surgery Experience between Patients and their Practitioners: a Qualitative Study

Original Contributions

A 4-Week Preoperative Ketogenic Micronutrient-Enriched Diet Is Effective in Reducing Body Weight, Left Hepatic Lobe Volume, and Micronutrient Deficiencies in Patients Undergoing Bariatric Surgery: a Prospective Pilot Study

Original Contributions

Preoperative Detection of Sarcopenic Obesity Helps to Predict the Occurrence of Gastric Leak After Sleeve Gastrectomy

Original Contributions

Attrition after Acceptance onto a Publicly Funded Bariatric Surgery Program

Original Contributions

Short-Term Results of Revisional Single-Anastomosis Gastric Bypass After Sleeve Gastrectomy for Weight Regain

Review Article

Understanding Pathophysiological Concepts Leading to Obstructive Apnea