Eva Wolf1, Markus Utech2, Peter Stehle3, Martin Büsing2, Birgit Stoffel-Wagner4, Sabine Ellinger5. 1. Department of General and Visceral Surgery, Klinikum Vest, Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Germany; Department of Nutrition and Food Sciences, Nutritional Physiology, University of Bonn, Bonn, Germany. 2. Department of General and Visceral Surgery, Klinikum Vest, Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Germany. 3. Department of Nutrition and Food Sciences, Nutritional Physiology, University of Bonn, Bonn, Germany. 4. Department of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany. 5. Department of Nutrition and Food Sciences, Nutritional Physiology, University of Bonn, Bonn, Germany; Faculty of Food, Nutrition and Hospitality Sciences, Hochschule Niederrhein, University of Applied Sciences, Mönchengladbach, Germany. Electronic address: Sabine.Ellinger@hs-niederrhein.de.
Abstract
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<28 nmol/L. All patients had β-carotene levels≤.9 µmol/L, although retinol was below the cutoff value (<.7 µmol/L) in only 5%. Tocopherol/cholesterol-ratio was always>2.8 µmol/mmol. Of the patients, 84% had 25-hydroxycholecalciferol levels below 50 nmol/L. Parathyroid hormone was elevated in 23% (>6.5 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 (<2.0 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.
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 obesepatients 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<28 nmol/L. All patients had β-carotene levels≤.9 µmol/L, although retinol was below the cutoff value (<.7 µmol/L) in only 5%. Tocopherol/cholesterol-ratio was always>2.8 µmol/mmol. Of the patients, 84% had 25-hydroxycholecalciferol levels below 50 nmol/L. Parathyroid hormone was elevated in 23% (>6.5 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 (<2.0 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 obesepatients 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.