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Published in: Obesity Surgery 9/2011

01-09-2011 | Clinical Research

Nutritional Intake and Prevalence of Nutritional Deficiencies Prior to Surgery in a Spanish Morbidly Obese Population

Authors: Violeta Moizé, Ramon Deulofeu, Ferran Torres, Jesus Martinez de Osaba, Josep Vidal

Published in: Obesity Surgery | Issue 9/2011

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Abstract

Background

The prevalence of obesity in Spain is on the rise with the consequent increase in bariatric surgery. Studies in non-Mediterranean populations have shown that micronutrient deficits are present before surgery. However, there is no data on this topic in a Spanish population.

Methods

We evaluated food intake and the prevalence of nutritional deficiencies in 231 obese patient (72.3% women, 45.6 ± 9.9 years, BMI 48.2 ± 7.8 kg/m2) candidates for bariatric surgery. Forty-six normal weight individuals with similar demographic variables except BMI were included for comparison of deficiencies.

Results

In obese subjects, the mean estimated energy intake was 2,584 ± 987 kcal/day in males and 2,094 ± 669 kcal/day in females (p < 0.05). After adjusting for kilocalorie intake, carbohydrate intake was of 38.7% [CI 36.2 to 41.1] and 39.9% [CI 37.8 to 40.8] (n.s.), lipid intake was 41.9% [CI 39.6 to 44.2] and 43.0% [CI 41.7 to 44.8] (n.s.) and protein intake was 19.1% [CI 17.7 to 20.5] and 17.3% [CI 16.4 to 18.1] (n.s.) for men and women, respectively. The most prevalent deficiency was vitamin D25(OH): obese 94%, control 24%; (p < 0.0001). Above normal PTH levels were observed in 41.0% and 20.0% of obese and normal weight subjects, respectively (p < 0.0497). Increased prevalence of deficiencies in obese patients included magnesium, vitamin B6 and anaemia (p < 0.05). Other vitamin deficiencies were observed although did not reach statistical significance.

Conclusions

Nutritional deficiencies are commonly found in the Spanish obese population undergoing bariatric surgery and are significantly more prevalent than in normal weight individuals.
Literature
1.
go back to reference Salas-Salvadó J, Rubio MA, Barbany M, et al. Spanish Society for the Study of Obesity (SEEDO) 2007. Consensus for the evaluation of overweight and obesity and the establishment of therapeutic intervention criteria. Med Clin (Barc). 2007;128(5):184–9.CrossRef Salas-Salvadó J, Rubio MA, Barbany M, et al. Spanish Society for the Study of Obesity (SEEDO) 2007. Consensus for the evaluation of overweight and obesity and the establishment of therapeutic intervention criteria. Med Clin (Barc). 2007;128(5):184–9.CrossRef
2.
go back to reference No authors listed. Guidelines for clinical practice for bariatric surgery. Recommendations of the Spanish Society of Obesity Surgery (SECO). Salamanca Statement. Cirugia Española. 2004;75(5):312–314. No authors listed. Guidelines for clinical practice for bariatric surgery. Recommendations of the Spanish Society of Obesity Surgery (SECO). Salamanca Statement. Cirugia Española. 2004;75(5):312–314.
3.
go back to reference Fried M, Hainer V, Basdevant A, et al. Inter-disciplinary European guidelines on surgery of severe obesity. Int J Obes. 2007;31(4):569–77. Fried M, Hainer V, Basdevant A, et al. Inter-disciplinary European guidelines on surgery of severe obesity. Int J Obes. 2007;31(4):569–77.
4.
go back to reference Sjöström L, Lindroos AK, Peltonen M, et al. Swedish obese subjects study scientific group. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93.PubMedCrossRef Sjöström L, Lindroos AK, Peltonen M, et al. Swedish obese subjects study scientific group. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93.PubMedCrossRef
5.
go back to reference Bloomberg RD, Fleishman A, Nalle JE, et al. Nutritional deficiencies following bariatric surgery: what have we learned? Obes Surg. 2005;15:145–54.PubMedCrossRef Bloomberg RD, Fleishman A, Nalle JE, et al. Nutritional deficiencies following bariatric surgery: what have we learned? Obes Surg. 2005;15:145–54.PubMedCrossRef
6.
go back to reference Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142(7):547–59.PubMed Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142(7):547–59.PubMed
7.
go back to reference Flancbaum L, Belsley S, Drake V, et al. Preoperative nutritional status of patients undergoing roux-en-y gastric bypass for morbid obesity. J Gastrointest Surg. 2006;10(7):1033–7.PubMedCrossRef Flancbaum L, Belsley S, Drake V, et al. Preoperative nutritional status of patients undergoing roux-en-y gastric bypass for morbid obesity. J Gastrointest Surg. 2006;10(7):1033–7.PubMedCrossRef
8.
go back to reference Carrodeguas L, Kaidar-Person O, Szomstein S, et al. Preoperative thiamine deficiency in obese population undergoing laparoscopic bariatric surgery. Surg Obes Relat Dis. 2005;1(6):517–22.PubMedCrossRef Carrodeguas L, Kaidar-Person O, Szomstein S, et al. Preoperative thiamine deficiency in obese population undergoing laparoscopic bariatric surgery. Surg Obes Relat Dis. 2005;1(6):517–22.PubMedCrossRef
9.
go back to reference Nelson ML, Bolduc LM, Toder ME, et al. Correction of preoperative vitamin D deficiency after roux-en-y gastric bypass surgery. Surg Obes Relat Dis. 2007;3(4):434–7.PubMedCrossRef Nelson ML, Bolduc LM, Toder ME, et al. Correction of preoperative vitamin D deficiency after roux-en-y gastric bypass surgery. Surg Obes Relat Dis. 2007;3(4):434–7.PubMedCrossRef
10.
go back to reference Kaidar-Person O, Person B, Szomstein S, et al. Nutritional deficiencies in morbidly obese patients: a new form of malnutrition? Part A: vitamins. Obes Surg. 2008;18(7):870–6.PubMedCrossRef Kaidar-Person O, Person B, Szomstein S, et al. Nutritional deficiencies in morbidly obese patients: a new form of malnutrition? Part A: vitamins. Obes Surg. 2008;18(7):870–6.PubMedCrossRef
11.
go back to reference Kaidar-Person O, Person B, Szomstein S, et al. Nutritional deficiencies in morbidly obese patients: a new form of malnutrition? Part B: minerals. Obes Surg. 2008;18(8):1028–34.PubMedCrossRef Kaidar-Person O, Person B, Szomstein S, et al. Nutritional deficiencies in morbidly obese patients: a new form of malnutrition? Part B: minerals. Obes Surg. 2008;18(8):1028–34.PubMedCrossRef
12.
go back to reference Ernst B, Thurnheer M, Schmid SM, et al. Evidence for the necessity to systematically assess micronutrient status prior to bariatric surgery. Obes Surg. 2009;19(1):66–73.PubMedCrossRef Ernst B, Thurnheer M, Schmid SM, et al. Evidence for the necessity to systematically assess micronutrient status prior to bariatric surgery. Obes Surg. 2009;19(1):66–73.PubMedCrossRef
13.
go back to reference Toh SY, Zarshenas N, Jorgensen J. Prevalence of nutrient deficiencies in bariatric patients. Nutrition. 2009;25(11–12):1150–6.PubMedCrossRef Toh SY, Zarshenas N, Jorgensen J. Prevalence of nutrient deficiencies in bariatric patients. Nutrition. 2009;25(11–12):1150–6.PubMedCrossRef
14.
go back to reference Porta A, Begua M. Graphical documentation for nutritional evaluation: foods and their cooking. Barcelona: Laboratorios Lifescan; 2002. Porta A, Begua M. Graphical documentation for nutritional evaluation: foods and their cooking. Barcelona: Laboratorios Lifescan; 2002.
15.
go back to reference Institute of Medicine of the National Academies. Food and nutrition board. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. Washington, D.C: The National Academies Press; 2005. Institute of Medicine of the National Academies. Food and nutrition board. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. Washington, D.C: The National Academies Press; 2005.
16.
go back to reference Harris JA, Benedict FG. A biometric study of basal metabolism in man. Publication No79 of the Carnegie Institution of Washington, 1919. Harris JA, Benedict FG. A biometric study of basal metabolism in man. Publication No79 of the Carnegie Institution of Washington, 1919.
17.
go back to reference Pietiläinen KH, Korkeila M, Bogl LH, et al. Inaccuracies in food and physical activity diaries of obese subjects: complementary evidence from doubly labelled water and co-twin assessments. Int J Obes. 2010;34(3):437–45.CrossRef Pietiläinen KH, Korkeila M, Bogl LH, et al. Inaccuracies in food and physical activity diaries of obese subjects: complementary evidence from doubly labelled water and co-twin assessments. Int J Obes. 2010;34(3):437–45.CrossRef
18.
go back to reference FAO/WHO/UNU (1985). Report of a Joint Expert Consultation. Energy and protein requirements. Geneva: WHO; Tech Rep Series 1985. No 724. FAO/WHO/UNU (1985). Report of a Joint Expert Consultation. Energy and protein requirements. Geneva: WHO; Tech Rep Series 1985. No 724.
19.
go back to reference Beutler E, Waalen J. The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration? Blood. 2006;107(5):1747–50.PubMedCrossRef Beutler E, Waalen J. The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration? Blood. 2006;107(5):1747–50.PubMedCrossRef
20.
go back to reference Valdés J, Grau M, Subirana I, et al. Secular trends in energy intake and diet quality in a Mediterranean population. Ann Nutr Metab. 2009;54(3):177–83.PubMedCrossRef Valdés J, Grau M, Subirana I, et al. Secular trends in energy intake and diet quality in a Mediterranean population. Ann Nutr Metab. 2009;54(3):177–83.PubMedCrossRef
21.
go back to reference No authors listed. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: executive summary. Expert panel on the identification, evaluation, and treatment of overweight in Adults. Am J Clin Nutr. 1998;68(4):899–917. No authors listed. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: executive summary. Expert panel on the identification, evaluation, and treatment of overweight in Adults. Am J Clin Nutr. 1998;68(4):899–917.
22.
go back to reference Ortega RM, López Sobaler AM, Aranceta J, et al. Are there any nutritional deficiencies in the Mediterranean diet? Arch Latinoam Nutr. 2004;54(2 Suppl 1):87–91.PubMed Ortega RM, López Sobaler AM, Aranceta J, et al. Are there any nutritional deficiencies in the Mediterranean diet? Arch Latinoam Nutr. 2004;54(2 Suppl 1):87–91.PubMed
23.
go back to reference Serra-Majem L, Ribas-Barba L, Salvador G, et al. Trends in energy and nutrient intake and risk of inadequate intakes in Catalonia, Spain (1992–2003). Public Health Nutr. 2007;10(11A):1354–67.PubMed Serra-Majem L, Ribas-Barba L, Salvador G, et al. Trends in energy and nutrient intake and risk of inadequate intakes in Catalonia, Spain (1992–2003). Public Health Nutr. 2007;10(11A):1354–67.PubMed
24.
go back to reference Beunza JJ, Toledo E, Hu FB, et al. Adherence to the Mediterranean diet, long-term weight change, and incident overweight or obesity: the Seguimiento Universidad de Navarra (SUN) cohort. Am J Clin Nutr. 2010;92(6):1484–9 Beunza JJ, Toledo E, Hu FB, et al. Adherence to the Mediterranean diet, long-term weight change, and incident overweight or obesity: the Seguimiento Universidad de Navarra (SUN) cohort. Am J Clin Nutr. 2010;92(6):1484–9
25.
go back to reference Bach-Faig A, Fuentes-Bol C, Ramos D, et al. The Mediterranean diet in Spain: adherence trends during the past two decades using the Mediterranean adequacy index. Public Health Nutr. 2010;29:1–7. Bach-Faig A, Fuentes-Bol C, Ramos D, et al. The Mediterranean diet in Spain: adherence trends during the past two decades using the Mediterranean adequacy index. Public Health Nutr. 2010;29:1–7.
26.
go back to reference Schoeller DA, Bandini LG, Dietz WH. Inaccuracies in self-reported intake identified by comparison with the doubly labelled water method. J Physiol Pharmacol. 1990;68(7):941–9.CrossRef Schoeller DA, Bandini LG, Dietz WH. Inaccuracies in self-reported intake identified by comparison with the doubly labelled water method. J Physiol Pharmacol. 1990;68(7):941–9.CrossRef
27.
go back to reference Trabulsi J, Troiano RP, Subar AF, et al. Precision of the doubly labeled water method in a large-scale application: evaluation of a streamlined-dosing protocol in the observing protein and energy nutrition (OPEN) study. Eur J Clin Nutr. 2003;57(11):1370–7.PubMedCrossRef Trabulsi J, Troiano RP, Subar AF, et al. Precision of the doubly labeled water method in a large-scale application: evaluation of a streamlined-dosing protocol in the observing protein and energy nutrition (OPEN) study. Eur J Clin Nutr. 2003;57(11):1370–7.PubMedCrossRef
28.
go back to reference Saura-Calixto F, Goñi I. Definition of the Mediterranean diet based on bioactive compounds. Crit Rev Food Sci Nutr. 2009;49(2):145–52.PubMedCrossRef Saura-Calixto F, Goñi I. Definition of the Mediterranean diet based on bioactive compounds. Crit Rev Food Sci Nutr. 2009;49(2):145–52.PubMedCrossRef
30.
go back to reference Gemmel K, Santry HP, Prachand VN, et al. Vitamin D deficiency in preoperative bariatric surgery patients. Surg Obes Relat Dis. 2009;5(1):54–9.PubMedCrossRef Gemmel K, Santry HP, Prachand VN, et al. Vitamin D deficiency in preoperative bariatric surgery patients. Surg Obes Relat Dis. 2009;5(1):54–9.PubMedCrossRef
31.
go back to reference Gehrer S, Kern B, Peters T, et al. Fewer nutrient deficiencies after laparoscopic sleeve gastrectomy (LSG) than after laparoscopic Roux-Y-gastric bypass (LRYGB)—a prospective study. Obes Surg. 2010;20(4):447–53.PubMedCrossRef Gehrer S, Kern B, Peters T, et al. Fewer nutrient deficiencies after laparoscopic sleeve gastrectomy (LSG) than after laparoscopic Roux-Y-gastric bypass (LRYGB)—a prospective study. Obes Surg. 2010;20(4):447–53.PubMedCrossRef
32.
go back to reference Ybarra J, Sánchez-Hernández J, Pérez A. Hypovitaminosis D and morbid obesity. Nurs Clin North Am. 2007;42(1):19–27.PubMedCrossRef Ybarra J, Sánchez-Hernández J, Pérez A. Hypovitaminosis D and morbid obesity. Nurs Clin North Am. 2007;42(1):19–27.PubMedCrossRef
33.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
34.
go back to reference Rueda S, Fernández-Fernández C, Romero F, et al. Vitamin D, PTH, and the metabolic syndrome in severely obese subjects. Obes Surg. 2008;18(2):151–4.PubMedCrossRef Rueda S, Fernández-Fernández C, Romero F, et al. Vitamin D, PTH, and the metabolic syndrome in severely obese subjects. Obes Surg. 2008;18(2):151–4.PubMedCrossRef
35.
go back to reference Calatayud M, Jódar E, Sánchez R, et al. Prevalence of deficient and insufficient vitamin D levels in a young healthy population. Endocrinol Nutr. 2009;56(4):164–9.PubMedCrossRef Calatayud M, Jódar E, Sánchez R, et al. Prevalence of deficient and insufficient vitamin D levels in a young healthy population. Endocrinol Nutr. 2009;56(4):164–9.PubMedCrossRef
36.
go back to reference Liel Y, Ulmer E, Shary J, et al. Low circulating vitamin D in obesity. Calcif Tissue Int. 1988;43:199–201.PubMedCrossRef Liel Y, Ulmer E, Shary J, et al. Low circulating vitamin D in obesity. Calcif Tissue Int. 1988;43:199–201.PubMedCrossRef
37.
go back to reference Anast CS, Winnacker JL, Forte LR, et al. Impaired release of parathyroid hormone in magnesium deficiency. J Clin Endocrinol Metab. 1976;42(4):707–17.PubMedCrossRef Anast CS, Winnacker JL, Forte LR, et al. Impaired release of parathyroid hormone in magnesium deficiency. J Clin Endocrinol Metab. 1976;42(4):707–17.PubMedCrossRef
38.
go back to reference Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med. 1999;340(6):448–54.PubMedCrossRef Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med. 1999;340(6):448–54.PubMedCrossRef
39.
go back to reference Basora M, Deulofeu R, Salazar F, et al. Improved preoperative iron status assessment by soluble transferrin receptor in elderly patients undergoing knee and hip replacement. Clin Lab Haematol. 2006;28(6):370–5.PubMedCrossRef Basora M, Deulofeu R, Salazar F, et al. Improved preoperative iron status assessment by soluble transferrin receptor in elderly patients undergoing knee and hip replacement. Clin Lab Haematol. 2006;28(6):370–5.PubMedCrossRef
40.
go back to reference Mast AE, Blinder MA, Gronowski AM, et al. Clinical utility of the soluble transferrin receptor and comparison with serum ferritin in several populations. Clin Chem. 1998;44(1):45–5.PubMed Mast AE, Blinder MA, Gronowski AM, et al. Clinical utility of the soluble transferrin receptor and comparison with serum ferritin in several populations. Clin Chem. 1998;44(1):45–5.PubMed
41.
go back to reference Shenkin A. Serum prealbumin: is it a marker of nutritional status or of risk of malnutrition? Clin Chem. 2006;52(12):2177–9.PubMedCrossRef Shenkin A. Serum prealbumin: is it a marker of nutritional status or of risk of malnutrition? Clin Chem. 2006;52(12):2177–9.PubMedCrossRef
42.
go back to reference Devoto G, Gallo F, Marchello C, et al. Prealbumin serum concentrations as a useful tool in the assessment of malnutrition in hospitalized patients. Clin Chem. 2006;52(12):2281–5.PubMedCrossRef Devoto G, Gallo F, Marchello C, et al. Prealbumin serum concentrations as a useful tool in the assessment of malnutrition in hospitalized patients. Clin Chem. 2006;52(12):2281–5.PubMedCrossRef
43.
go back to reference Coupaye M, Puchaux K, Bogard C, et al. Nutritional consequences of adjustable gastric banding and gastric bypass: a 1-year prospective study. Obes Surg. 2009;19(1):56–65.PubMedCrossRef Coupaye M, Puchaux K, Bogard C, et al. Nutritional consequences of adjustable gastric banding and gastric bypass: a 1-year prospective study. Obes Surg. 2009;19(1):56–65.PubMedCrossRef
Metadata
Title
Nutritional Intake and Prevalence of Nutritional Deficiencies Prior to Surgery in a Spanish Morbidly Obese Population
Authors
Violeta Moizé
Ramon Deulofeu
Ferran Torres
Jesus Martinez de Osaba
Josep Vidal
Publication date
01-09-2011
Publisher
Springer-Verlag
Published in
Obesity Surgery / Issue 9/2011
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-011-0360-y

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