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Nutrient deficiencies prior to bariatric surgery

Roust, Lori R.; DiBaise, John K.

Current Opinion in Clinical Nutrition & Metabolic Care: March 2017 - Volume 20 - Issue 2 - p 138–144
doi: 10.1097/MCO.0000000000000352
NUTRITION AND THE INTENSIVE CARE UNIT: Edited by Peter Weijs and Stephen A. McClave

Purpose of review The purpose of this review is to provide an update of recent additions to our understanding of the prevalence of nutrient deficiencies and the potential role of preoperative weight loss in contributing to these deficiencies in obese individuals planning to undergo bariatric surgery.

Recent findings Recent reports that have included bariatric surgery candidates from sites around the world have shown consistent deficiencies in a variety of nutrients. Although protein–energy malnutrition is uncommon preoperatively, micronutrient deficiencies occur commonly with multiple deficiencies often present in the same individual. No difference in the prevalence of deficiency between men and women is apparent, and a standard profile of susceptibility to deficiency has not been identified. In the only studies that have evaluated dietary intake of total energy, macronutrients and micronutrients preoperatively, despite an excess of calories ingested, micronutrient intake tends to be lower than recommended.

Summary A high prevalence of micronutrient deficiencies, especially vitamin D, folate, B12 and iron, is present in obese individuals being considered for bariatric surgery. Despite high-caloric intake, the deficiencies present appear to be related to the poor quality of the diet and low micronutrient intake. These findings strengthen prior recommendations of routine preoperative nutritional screening. Because a standard profile of susceptibility to deficiency has not been identified, extensive nutritional screening, including micronutrient testing, should be considered in all patients in the preoperative setting. Finally, we recommend early supplementation of vitamins and minerals based on laboratory assessment and incorporation of a program to optimize eating behaviors prior to surgery.

aDivisions of Endocrinology

bGastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA

Correspondence to John K. DiBaise, MD, Professor of Medicine, Gastroenterology and Hepatology, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA. Tel: +1 480 301 6990; fax: +1 480 301 6737; e-mail:

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