Integrated health original article Preoperative micronutrient status in morbidly obese patients before undergoing bariatric surgery: results of a cross-sectional study

Background: Reliable information on micronutrient status before bariatric surgery is needed to optimize preoperative nutritional status and postoperative nutritional therapy. Objective: To investigate the pro-/vitamin and mineral status and its association with nutrient intake in morbidly obese patients seeking bariatric surgery Setting: Klinikum Vest, Recklinghausen, Germany. Methods: The cross-sectional study investigated retinol, ascorbic acid, tocopherol, and β-carotene (high-pressure liquid chromatography), 25-hydroxycholecalciferol (enzyme-linked immunosorbent assay), and calcium, phosphate, and magnesium (photometry) in serum/plasma in 43 patients (body mass index: 52.6 10.5 kg/m 2 ) before sleeve gastrectomy. Albumin, parathyroid hormone, and alkaline phosphatase were analyzed. Data were compared with accepted cutoff values. Dietary intake was estimated by 3-day food records, and nutrient intake was compared with recommended values. Results: One third of participants had ascorbic acid concentrations o28 nmol/L. All patients had β-carotene levels r.9 mmol/L, although retinol was below the cutoff value (o.7 mmol/L) in only 5%. Tocopherol/cholesterol-ratio was always 42.8 mmol/mmol. Of the patients, 84% had 25hydroxycholecalciferol levels below 50 nmol/L. Parathyroid hormone was elevated in 23% (46.5 pmol/L). Calcium, magnesium, and alkaline phosphatase were always, and phosphate was mostly (98%) above cutoff values. Intake of retinol (23%), ascorbic acid (55.8%), vitamin D (90.7%), tocopherol (48.8%), and β-carotene (o2.0 mg/d; 37.2%) were often below recommendations. Correlations between serum/plasma concentrations and nutritional intake and associations between low concentrations and inadequate intake were not observed. Conclusions: Many morbidly obese patients in Germany suffer from deficiencies in multiple micronutrients, particularly vitamin D, ascorbic acid, and β-carotene before sleeve gastrectomy. Measurement of preoperative micronutrient status will help supplement patients before, and optimize nutritional therapy after, surgery. (Surg Obes Relat Dis 2015;11:1157–1163.) r 2015 American Society for Metabolic and Bariatric Surgery. All rights reserved.