Skip to main content
Erschienen in: Current Treatment Options in Gastroenterology 2/2021

23.03.2021 | Nutrition and Obesity (O Pickett-Blakeley, Section Editor)

Treatment of Micronutrient Deficiencies Pre and Post Bariatric Surgery

verfasst von: Roohi Patel, MD, Monica Saumoy, MD, MS

Erschienen in: Current Treatment Options in Gastroenterology | Ausgabe 2/2021

Einloggen, um Zugang zu erhalten

Abstract

Purpose of review

The goal of this article is to review micronutrient deficiencies in patients with obesity. We will describe the absorption of micronutrients and highlight the risk factors that may exist pre- and post-surgery that contribute to the development of micronutrient deficiency states. Furthermore, we will discuss the process involved in detecting, preventing, and treating micronutrient deficiencies.

Recent findings

Pre-bariatric surgery micronutrient deficiencies are commonly due to intake of a high energy, but low micronutrient diet. Deficiencies frequently include vitamin D, folate, vitamin B12, and iron. Post-bariatric surgery micronutrient deficiencies are commonly related to altered absorption in the setting of non-compliance with or intolerance of recommended diets, and frequently include abovementioned deficiencies as well as vitamin A, copper, and zinc deficiencies. All patients should have routine daily supplementation as well as close monitoring for the development of deficiency post-surgery.

Summary

It is important to understand a patient’s unique risk factors for developing a micronutrient deficiency, and to perform a complete nutritional evaluation to further assess, intervene on, and monitor a patient’s nutritional status throughout their pre- and post-operative course. Treatment of these deficiencies will require a multidisciplinary and multimodal approach involving risk factor modification and supplementation that depends on the severity and duration of the identified deficiency.
Literatur
1.
Zurück zum Zitat Schwartz MW, Seeley RJ, Zeltser LM, Drewnowski A, Ravussin E, Redman LM, et al. Obesity pathogenesis: an Endocrine Society scientific statement. Endocr Rev. 2017;38(4):267–96.CrossRef Schwartz MW, Seeley RJ, Zeltser LM, Drewnowski A, Ravussin E, Redman LM, et al. Obesity pathogenesis: an Endocrine Society scientific statement. Endocr Rev. 2017;38(4):267–96.CrossRef
2.
Zurück zum Zitat Hruby A, Hu FB. The epidemiology of obesity: a big picture. Pharmacoeconomics. 2015;33(7):673–89.CrossRef Hruby A, Hu FB. The epidemiology of obesity: a big picture. Pharmacoeconomics. 2015;33(7):673–89.CrossRef
3.
Zurück zum Zitat Strohmayer E, Via MA, Yanagisawa R. Metabolic management following bariatric surgery. Mt Sinai J Med. 2010;77(5):431–45.CrossRef Strohmayer E, Via MA, Yanagisawa R. Metabolic management following bariatric surgery. Mt Sinai J Med. 2010;77(5):431–45.CrossRef
4.
Zurück zum Zitat Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity and severe obesity among adults: United States, 2017-2018. NCHS Data Brief. 2020 Feb;(360):1-8. Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity and severe obesity among adults: United States, 2017-2018. NCHS Data Brief. 2020 Feb;(360):1-8.
5.
Zurück zum Zitat Kang JH, Le QA. Effectiveness of bariatric surgical procedures: a systematic review and network meta-analysis of randomized controlled trials. Medicine (Baltimore). 2017;96(46):e8632.CrossRef Kang JH, Le QA. Effectiveness of bariatric surgical procedures: a systematic review and network meta-analysis of randomized controlled trials. Medicine (Baltimore). 2017;96(46):e8632.CrossRef
6.
Zurück zum Zitat Acosta A, Streett S, Kroh MD, Cheskin LJ, Saunders KH, Kurian M, et al. White Paper AGA: POWER - practice guide on obesity and weight management, education, and resources. Clin Gastroenterol Hepatol. 2017;15(5):631–49 e10. Acosta A, Streett S, Kroh MD, Cheskin LJ, Saunders KH, Kurian M, et al. White Paper AGA: POWER - practice guide on obesity and weight management, education, and resources. Clin Gastroenterol Hepatol. 2017;15(5):631–49 e10.
7.
Zurück zum Zitat Karmali S, Johnson Stoklossa C, Sharma A, Stadnyk J, Christiansen S, Cottreau D, et al. Bariatric surgery: a primer. Can Fam Physician. 2010;56(9):873–9.PubMedPubMedCentral Karmali S, Johnson Stoklossa C, Sharma A, Stadnyk J, Christiansen S, Cottreau D, et al. Bariatric surgery: a primer. Can Fam Physician. 2010;56(9):873–9.PubMedPubMedCentral
8.
Zurück zum Zitat Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.CrossRef Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.CrossRef
9.
Zurück zum Zitat Kushner RF, Lawrence V, Kumar S. Practical manual of clinical obesity. Chichester: John Wiley & Sons; 2013.CrossRef Kushner RF, Lawrence V, Kumar S. Practical manual of clinical obesity. Chichester: John Wiley & Sons; 2013.CrossRef
10.
Zurück zum Zitat Wolfe BM, Kvach E, Eckel RH. Treatment of obesity: weight loss and bariatric surgery. Circ Res. 2016;118(11):1844–55.CrossRef Wolfe BM, Kvach E, Eckel RH. Treatment of obesity: weight loss and bariatric surgery. Circ Res. 2016;118(11):1844–55.CrossRef
11.
Zurück zum Zitat Gudzune KA, Huizinga MM, Chang HY, Asamoah V, Gadgil M, Clark JM. Screening and diagnosis of micronutrient deficiencies before and after bariatric surgery. Obes Surg. 2013;23(10):1581–9.CrossRef Gudzune KA, Huizinga MM, Chang HY, Asamoah V, Gadgil M, Clark JM. Screening and diagnosis of micronutrient deficiencies before and after bariatric surgery. Obes Surg. 2013;23(10):1581–9.CrossRef
12.
Zurück zum Zitat Lupoli R, Lembo E, Saldalamacchia G, Avola CK, Angrisani L, Capaldo B. Bariatric surgery and long-term nutritional issues. World J Diabetes. 2017;8(11):464–74.CrossRef Lupoli R, Lembo E, Saldalamacchia G, Avola CK, Angrisani L, Capaldo B. Bariatric surgery and long-term nutritional issues. World J Diabetes. 2017;8(11):464–74.CrossRef
13.
Zurück zum Zitat Miras AD, le Roux CW. Mechanisms underlying weight loss after bariatric surgery. Nat Rev Gastroenterol Hepatol. 2013;10(10):575–84.CrossRef Miras AD, le Roux CW. Mechanisms underlying weight loss after bariatric surgery. Nat Rev Gastroenterol Hepatol. 2013;10(10):575–84.CrossRef
14.
Zurück zum Zitat Oussaada SM, van Galen KA, Cooiman MI, Kleinendorst L, Hazebroek EJ, van Haelst MM, et al. The pathogenesis of obesity. Metabolism. 2019;92:26–36.CrossRef Oussaada SM, van Galen KA, Cooiman MI, Kleinendorst L, Hazebroek EJ, van Haelst MM, et al. The pathogenesis of obesity. Metabolism. 2019;92:26–36.CrossRef
15.
Zurück zum Zitat Patel JJ, Mundi MS, Hurt RT, Wolfe B, Martindale RG. Micronutrient deficiencies after bariatric surgery: an emphasis on vitamins and trace minerals [formula: see text]. Nutr Clin Pract. 2017;32(4):471–80.CrossRef Patel JJ, Mundi MS, Hurt RT, Wolfe B, Martindale RG. Micronutrient deficiencies after bariatric surgery: an emphasis on vitamins and trace minerals [formula: see text]. Nutr Clin Pract. 2017;32(4):471–80.CrossRef
16.
Zurück zum Zitat Jameson JL. Harrison’s principles of internal medicine. New York: McGraw-Hill Education; 2018. Jameson JL. Harrison’s principles of internal medicine. New York: McGraw-Hill Education; 2018.
17.
Zurück zum Zitat World Health Organization., Food and Agriculture Organization of the United Nations. Vitamin and mineral requirements in human nutrition. 2nd ed. Geneva Rome: World Health Organization ; FAO; 2004. xix, 341 p. p. World Health Organization., Food and Agriculture Organization of the United Nations. Vitamin and mineral requirements in human nutrition. 2nd ed. Geneva Rome: World Health Organization ; FAO; 2004. xix, 341 p. p.
18.
Zurück zum Zitat Institute of Medicine (U.S.). Food and Nutrition Board. Dietary reference intakes: a risk assessment model for establishing upper intake levels for nutrients. Washington, D.C.: National Academy Press; 1998. x, 71 p. p. Institute of Medicine (U.S.). Food and Nutrition Board. Dietary reference intakes: a risk assessment model for establishing upper intake levels for nutrients. Washington, D.C.: National Academy Press; 1998. x, 71 p. p.
19.
Zurück zum Zitat In: Ross AC, Taylor CL, Yaktine AL, Del Valle HB, editors. Dietary reference intakes for calcium and vitamin D. The National Academies Collection: Reports funded by National Institutes of Health. Washington (DC)2011. In: Ross AC, Taylor CL, Yaktine AL, Del Valle HB, editors. Dietary reference intakes for calcium and vitamin D. The National Academies Collection: Reports funded by National Institutes of Health. Washington (DC)2011.
20.
Zurück zum Zitat Parrott J, Frank L, Rabena R, Craggs-Dino L, Isom KA, Greiman L. American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient 2016 update: micronutrients. Surg Obes Relat Dis. 2017;13(5):727–41.CrossRef Parrott J, Frank L, Rabena R, Craggs-Dino L, Isom KA, Greiman L. American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient 2016 update: micronutrients. Surg Obes Relat Dis. 2017;13(5):727–41.CrossRef
21.
Zurück zum Zitat Raj P. Bariatric surgical practice guide. New York: Springer Berlin Heidelberg; 2016. pages cm p Raj P. Bariatric surgical practice guide. New York: Springer Berlin Heidelberg; 2016. pages cm p
22.
Zurück zum Zitat Kiela PR, Ghishan FK. Physiology of intestinal absorption and secretion. Best Pract Res Clin Gastroenterol. 2016;30(2):145–59.CrossRef Kiela PR, Ghishan FK. Physiology of intestinal absorption and secretion. Best Pract Res Clin Gastroenterol. 2016;30(2):145–59.CrossRef
23.
Zurück zum Zitat Sabliov CM, Chen H, Yada RY. Nanotechnology and functional foods: effective delivery of bioactive ingredients. Chichester: Wiley Blackwell; 2015.CrossRef Sabliov CM, Chen H, Yada RY. Nanotechnology and functional foods: effective delivery of bioactive ingredients. Chichester: Wiley Blackwell; 2015.CrossRef
24.
Zurück zum Zitat Hallberg L, Brune M, Rossander L. The role of vitamin C in iron absorption. Int J Vitam Nutr Res Suppl. 1989;30:103–8.PubMed Hallberg L, Brune M, Rossander L. The role of vitamin C in iron absorption. Int J Vitam Nutr Res Suppl. 1989;30:103–8.PubMed
25.
Zurück zum Zitat Roust LR, DiBaise JK. Nutrient deficiencies prior to bariatric surgery. Curr Opin Clin Nutr Metab Care. 2017;20(2):138–44.CrossRef Roust LR, DiBaise JK. Nutrient deficiencies prior to bariatric surgery. Curr Opin Clin Nutr Metab Care. 2017;20(2):138–44.CrossRef
26.
Zurück zum Zitat Frame-Peterson LA, Megill RD, Carobrese S, Schweitzer M. Nutrient deficiencies are common prior to bariatric surgery. Nutr Clin Pract. 2017;32(4):463–9.CrossRef Frame-Peterson LA, Megill RD, Carobrese S, Schweitzer M. Nutrient deficiencies are common prior to bariatric surgery. Nutr Clin Pract. 2017;32(4):463–9.CrossRef
27.
Zurück zum Zitat Peterson LA, Cheskin LJ, Furtado M, Papas K, Schweitzer MA, Magnuson TH, et al. Malnutrition in bariatric surgery candidates: multiple micronutrient deficiencies prior to surgery. Obes Surg. 2016;26(4):833–8.CrossRef Peterson LA, Cheskin LJ, Furtado M, Papas K, Schweitzer MA, Magnuson TH, et al. Malnutrition in bariatric surgery candidates: multiple micronutrient deficiencies prior to surgery. Obes Surg. 2016;26(4):833–8.CrossRef
28.
Zurück zum Zitat Bird JK,Murphy RA, Ciappio ED,McBurneyMI. Risk of Deficiency in Multiple Concurrent Micronutrients in Children and Adults in the United States Nutrients. 2017 Jun 24;9(7):655. Bird JK,Murphy RA, Ciappio ED,McBurneyMI. Risk of Deficiency in Multiple Concurrent Micronutrients in Children and Adults in the United States Nutrients. 2017 Jun 24;9(7):655.
29.
Zurück zum Zitat Lefebvre P, Letois F, Sultan A, Nocca D, Mura T, Galtier F. Nutrient deficiencies in patients with obesity considering bariatric surgery: a cross-sectional study. Surg Obes Relat Dis. 2014;10(3):540–6.CrossRef Lefebvre P, Letois F, Sultan A, Nocca D, Mura T, Galtier F. Nutrient deficiencies in patients with obesity considering bariatric surgery: a cross-sectional study. Surg Obes Relat Dis. 2014;10(3):540–6.CrossRef
30.
Zurück zum Zitat Valentino D, Sriram K, Shankar P. Update on micronutrients in bariatric surgery. Curr Opin Clin Nutr Metab Care. 2011;14(6):635–41.CrossRef Valentino D, Sriram K, Shankar P. Update on micronutrients in bariatric surgery. Curr Opin Clin Nutr Metab Care. 2011;14(6):635–41.CrossRef
31.
Zurück zum Zitat Gletsu-Miller N, Wright BN. Mineral malnutrition following bariatric surgery. Adv Nutr. 2013;4(5):506–17.CrossRef Gletsu-Miller N, Wright BN. Mineral malnutrition following bariatric surgery. Adv Nutr. 2013;4(5):506–17.CrossRef
32.
Zurück zum Zitat Kazemi A, Frazier T, Cave M. Micronutrient-related neurologic complications following bariatric surgery. Curr Gastroenterol Rep. 2010;12(4):288–95.CrossRef Kazemi A, Frazier T, Cave M. Micronutrient-related neurologic complications following bariatric surgery. Curr Gastroenterol Rep. 2010;12(4):288–95.CrossRef
33.
Zurück zum Zitat Osland E, Powlesland H, Guthrie T, Lewis CA, Memon MA. Micronutrient management following bariatric surgery: the role of the dietitian in the postoperative period. Ann Transl Med. 2020;8(Suppl 1):S9.CrossRef Osland E, Powlesland H, Guthrie T, Lewis CA, Memon MA. Micronutrient management following bariatric surgery: the role of the dietitian in the postoperative period. Ann Transl Med. 2020;8(Suppl 1):S9.CrossRef
34.
Zurück zum Zitat Bal BS, Finelli FC, Shope TR, Koch TR. Nutritional deficiencies after bariatric surgery. Nat Rev Endocrinol. 2012;8(9):544–56.CrossRef Bal BS, Finelli FC, Shope TR, Koch TR. Nutritional deficiencies after bariatric surgery. Nat Rev Endocrinol. 2012;8(9):544–56.CrossRef
35.
Zurück zum Zitat Shankar P, Boylan M, Sriram K. Micronutrient deficiencies after bariatric surgery. Nutrition. 2010;26(11–12):1031–7.CrossRef Shankar P, Boylan M, Sriram K. Micronutrient deficiencies after bariatric surgery. Nutrition. 2010;26(11–12):1031–7.CrossRef
36.
Zurück zum Zitat Bettini S, Belligoli A, Fabris R, Busetto L. Diet approach before and after bariatric surgery. Rev Endocr Metab Disord. 2020;21(3):297–306.CrossRef Bettini S, Belligoli A, Fabris R, Busetto L. Diet approach before and after bariatric surgery. Rev Endocr Metab Disord. 2020;21(3):297–306.CrossRef
37.
Zurück zum Zitat Richardson WS, Plaisance AM, Periou L, Buquoi J, Tillery D. Long-term management of patients after weight loss surgery. Ochsner J. 2009;9(3):154–9.PubMedPubMedCentral Richardson WS, Plaisance AM, Periou L, Buquoi J, Tillery D. Long-term management of patients after weight loss surgery. Ochsner J. 2009;9(3):154–9.PubMedPubMedCentral
38.
Zurück zum Zitat Mechanick JI, Kushner RF. Lifestyle medicine: a manual for clinical practice. Springer International Publishing Switzerland 2016. Mechanick JI, Kushner RF. Lifestyle medicine: a manual for clinical practice. Springer International Publishing Switzerland 2016.
39.
Zurück zum Zitat Thibault R, Huber O, Azagury DE, Pichard C. Twelve key nutritional issues in bariatric surgery. Clin Nutr. 2016;35(1):12–7.CrossRef Thibault R, Huber O, Azagury DE, Pichard C. Twelve key nutritional issues in bariatric surgery. Clin Nutr. 2016;35(1):12–7.CrossRef
40.
Zurück zum Zitat Sherf Dagan S, Goldenshluger A, Globus I, Schweiger C, Kessler Y, Kowen Sandbank G, et al. Nutritional recommendations for adult bariatric surgery patients: clinical practice. Adv Nutr. 2017;8(2):382–94.CrossRef Sherf Dagan S, Goldenshluger A, Globus I, Schweiger C, Kessler Y, Kowen Sandbank G, et al. Nutritional recommendations for adult bariatric surgery patients: clinical practice. Adv Nutr. 2017;8(2):382–94.CrossRef
41.
Zurück zum Zitat Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring). 2013;21(Suppl 1):S1–27.CrossRef Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring). 2013;21(Suppl 1):S1–27.CrossRef
42.
Zurück zum Zitat Lewis CA, de Jersey S, Hopkins G, Hickman I, Osland E. Does bariatric surgery cause vitamin A, B1, C or E deficiency? A systematic review. Obes Surg. 2018;28(11):3640–57.CrossRef Lewis CA, de Jersey S, Hopkins G, Hickman I, Osland E. Does bariatric surgery cause vitamin A, B1, C or E deficiency? A systematic review. Obes Surg. 2018;28(11):3640–57.CrossRef
43.
Zurück zum Zitat Duncan A, Talwar D, McMillan DC, Stefanowicz F, O'Reilly DS. Quantitative data on the magnitude of the systemic inflammatory response and its effect on micronutrient status based on plasma measurements. Am J Clin Nutr. 2012;95(1):64–71.CrossRef Duncan A, Talwar D, McMillan DC, Stefanowicz F, O'Reilly DS. Quantitative data on the magnitude of the systemic inflammatory response and its effect on micronutrient status based on plasma measurements. Am J Clin Nutr. 2012;95(1):64–71.CrossRef
Metadaten
Titel
Treatment of Micronutrient Deficiencies Pre and Post Bariatric Surgery
verfasst von
Roohi Patel, MD
Monica Saumoy, MD, MS
Publikationsdatum
23.03.2021
Verlag
Springer US
Erschienen in
Current Treatment Options in Gastroenterology / Ausgabe 2/2021
Print ISSN: 1092-8472
Elektronische ISSN: 1534-309X
DOI
https://doi.org/10.1007/s11938-020-00328-5

Weitere Artikel der Ausgabe 2/2021

Current Treatment Options in Gastroenterology 2/2021 Zur Ausgabe

Colon (JC Anderson, Section Editor)

Occult Small Bowel Bleeding

Liver (J Bajaj, Section Editor)

Metabolomics in Advanced Liver Disease

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.