Nutritional deficiency in South African adults scheduled for bariatric surgery

Frontiers in Endocrinology

Endocrinology

Jeanne Lubbe¹  Inge du Toit¹  Mari van de Vyver²  C. J. Greyling³  Prabash Sadhai⁴  Rutger van Gruting⁴  Ankia Coetzee⁵  Magda Conradie⁵  Marli Conradie-Smit⁵ 

[1] Department of Surgical Sciences, Division of Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa;Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa;Specialist Physician & Endocrinologist, Durbanville Mediclinic and Kuilsriver Netcare Hospital, Cape Town, South Africa;Tygerberg Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa;Tygerberg Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa;Division of Endocrinology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa;

关键词: bariatric (weight loss) surgery;    obesity;    micronutrient deficiency;    pre-bariatric aspects;    diabetes;    diabetes mellitus;    vitamin D;   

DOI  :  10.3389/fendo.2023.1120531

 received in 2022-12-10, accepted in 2023-03-20,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundGlobally, there is a rising trend in obesity, known to increase morbidity and mortality. Metabolic surgery and adequate weight loss decrease mortality but may worsen pre-existing nutrient deficiencies. Most data on pre-existing nutritional deficiencies in the population undergoing metabolic surgery is from the developed world, where an extensive micronutrient assessment is achievable. In resource-constrained environments, the cost of a comprehensive micronutrient assessment must be weighed against the prevalence of nutritional deficiencies and the potential harm if one or more nutritional deficiencies are missed.MethodsThis cross-sectional study investigated the prevalence of micronutrient and vitamin deficiencies in participants scheduled to undergo metabolic surgery in Cape Town, South Africa, a low-middle income country. 157 participants were selected and 154 reported on; who underwent a baseline evaluation from 12 July 2017 to 19 July 2020. Laboratory measurements were conducted, including vitamin B12 (Vit B12), 25-hydroxy vitamin D (25(OH)D), folate, parathyroid hormone (PTH), thyroid-stimulating hormone (TSH), thyroxine (T4), ferritin, glycated haemoglobin (HbA1c), magnesium, phosphate, albumin, iron, and calcium.ResultsParticipants were predominantly female, aged 45 years (37-51), with a preoperative BMI of 50.4 kg/m2 (44.6-56.5). A total of 64 individuals had Type 2 diabetes mellitus (T2D), with 28 undiagnosed cases at study entry (18% of study population). 25(OH)D deficiency was most prevalent (57%), followed by iron deficiency (44%), and folate deficiency (18%). Other deficiencies (vitamin B12, calcium, magnesium, phosphate) were rarely encountered and affected ≤1% of participants. Folate and 25(OH)D deficiency were related to obesity classification, with a higher prevalence in participants with a BMI ≥40 kg/m2 (p <0.01).ConclusionA higher prevalence of some micronutrient deficiencies was noted compared with data from similar populations in the developed world. The minimum baseline/preoperative nutrient evaluation in such populations should include 25(OH)D, iron studies, and folate. Additionally, screening for T2D is recommended. Future efforts should seek to collate broader patient data on a national scale and include longitudinal surveillance after surgery. This may provide a more holistic picture of the relationship between obesity, metabolic surgery and micronutrient status inform more appropriate evidence-based care.

【 授权许可】

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Copyright © 2023 Sadhai, Coetzee, Conradie-Smit, Greyling, van Gruting, du Toit, Lubbe, van de Vyver and Conradie