Results from a recent study entitled “Malnutrition in Bariatric Surgery Candidates: Multiple Micronutrient Deficiencies Prior to Surgery,” published in the journal Obesity Surgery revealed that malnutrition in one or multiple micronutrients is common in obese patients before undergoing bariatric surgery. The discovery suggests that addressing malnourishment in patients prior to the surgery could lead to better outcomes post-procedure.
“Our results highlight the often-overlooked paradox that abundance of food and good nutrition are not one and the same,” said in a news release senior investigator Kimberley Steele, M.D., Ph.D., associate professor of surgery at the Johns Hopkins University School of Medicine. “Overweight and obese people can suffer from nutritional deficiencies, and those who care for them should be aware of it.”
More than 78 million American adults have obesity (body mass index (BMI)≥35 kg/m2 ), costing an estimated $147 billion annually due to medical care alone. Currently, sustained long-term weight loss is most successfully obtained through the use of weight loss surgery. Nutritional deficiencies after surgery are commonly treated, particularly following malabsorptive procedures like the Roux-en Y gastric bypass. If deficiencies are present prior to surgery, it stands to reason that remedying them prior to surgery could be beneficial and certainly easier than after a malabsorptive procedure. Furthermore, malnutrition has been linked to adverse surgical outcomes in many studies.
The study conducted by a team of researchers at Johns Hopkins assessed the baseline nutritional status of obese patients who were approved and scheduled to undergo Roux-en Y gastric bypass. The study aim was to determine the prevalence of micronutrient deficiencies prior to surgery.
“Finding and correcting the problem before surgery would likely blunt or avert surgery-induced malnutrition in some patients,” Dr. Steele concluded.
Researchers conducted nutritional evaluations 58 patients, aged between 18 and 65 years, scheduled to undergo bariatric surgery at Johns Hopkins. The researchers examined blood levels of vitamins B12, A, D and E, as well as folate, iron, and thiamine. Results revealed that one in five patients had three or more nutritional deficiencies. Of these, the most prevalent were subpar levels of iron (36%) — and vitamin D (71%).
By contrast, in the general population the average rate of iron deficiency is 9% for women and 2% for men. The researchers noted that an estimated 42% of the general population is deficient in vitamin D, adding that vitamin D deficiency is also a common metabolic irregularity of obesity. The results also showed that the average vitamin D level among patients in the study was below the one observed in the average adult — 17 nanograms per milliliter of blood, in comparison to 22 in the general population.
According to the researchers, because nutritional deficiencies — particularly vitamin D — are thought to precipitate complications such as higher infection risk, inflammation, and delayed wound healing, focusing on resolving them early on is particularly relevant in patients prior they undergo surgery.
“Correcting malnutrition is not only easier before surgery, but it may also play a role in reducing surgical complications in the short term and improving overall health in the long run,” said study first author Leigh Peterson, Ph.D., M.H.S., a nutritionist and postdoctoral research fellow at the Johns Hopkins Center for Bariatric Surgery.
The team highlighted the need of incorporating a healthy and well-balanced diet in presurgical consultations with patients.
“While deficiencies require carefully dosed supplementation, eating nutritious, quality food should be at the core of all dietary interventions,” Peterson said.
Researchers agree that further studies should be carried out to determine whether these deficiencies increase the risk of adverse surgical outcomes. The effect of pre-operative supplementation, especially vitamin D and iron, should also be explored in order to optimize health management strategies for weight loss surgery patients.