Nutritional Deficiencies Common Before Weight Loss Surgery

BALTIMORE, Md -- September 14, 2015 -- Malnutrition is a known complication of weight loss surgery, but findings from a small study show many obese people may be malnourished before they undergo the procedure.

“Our results highlight the often-overlooked paradox that abundance of food and good nutrition are not one and the same,” said senior investigator Kimberley Steele, MD, Johns Hopkins University School of Medicine, Baltimore, Maryland. “Overweight and obese people can suffer from nutritional deficiencies, and those who care for them should be aware of it.”

The results, described online in the journal Obesity Surgery, fly in the face of the commonly held belief that reduced food consumption following bariatric surgery is the main driver of nutritional deficiencies. Because the surgery works by reducing the amount of food absorbed by the body, patients get vitamin supplements as part of their standard postoperative care.

However, the current findings, which reveal multiple nutritional deficiencies in more than 20% of patients preparing to undergo surgery, suggest that a nutritional workup should also be part of the pre-surgical care.

“Finding and correcting the problem before surgery would likely blunt or avert surgery-induced malnutrition in some patients,” said Dr. Steele.

For the study, the researchers performed nutritional assessments in 58 patients aged 18 to 65 years who were scheduled to undergo bariatric surgery at Johns Hopkins. They analysed blood levels of vitamins A, B12, D, and E, as well as iron, folate, and thiamine.

One in 5 patients had 3 or more deficiencies. The most prevalent were subpar levels of iron (36%) and vitamin D (71%).

By comparison, the average rate of iron deficiency in the general population is 2% for men and 9% for women. The researchers said that an estimated 42% of the general population is deficient in vitamin D, adding that vitamin D deficiency is also a common metabolic aberration of obesity. Even so, the average vitamin D level among patients in the study was well below that seen in the average adult (17 ng/mL vs 22 ng/mL in the general population).

And because nutritional deficiencies are believed to precipitate problems such as inflammation, higher infection risk and delayed wound healing, addressing them early on is particularly important in patients before they undergo surgery, the researchers said.

“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 first author Leigh Peterson, PhD, Johns Hopkins Center for Bariatric Surgery.

The investigators pointed out that a well-balanced, healthy diet should also be incorporated into the pre-surgical consult.

“While deficiencies require carefully dosed supplementation, eating nutritious, quality food should be at the core of all dietary interventions,” said Dr. Peterson.

SOURCE: Johns Hopkins Medicine
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