Krzizek Eva-Christina, Brix Johanna Maria, Herz Carsten Thilo, Kopp Hans Peter, Schernthaner Gerit-Holger, Schernthaner Guntram, Ludvik Bernhard
Department of Medicine I, Rudolfstiftung Hospital, Juchgasse 25, 1030, Vienna, Austria.
Karl Landsteiner Institute of obesity and metabolic diseases, Vienna, Austria.
Obes Surg. 2018 Mar;28(3):643-648. doi: 10.1007/s11695-017-2902-4.
Postoperative micronutrient deficiency is a known side effect of bariatric surgery. In this study, we examined the prevalence of micronutrient deficiency in patients with morbid obesity (MO) preoperatively.
A total of 1732 patients with MO wishing to undergo bariatric surgery (age: 40 ± 12 years, mean BMI: 44 ± 9 kg/m, means ± SD, 77.3% female) were analyzed in this cross-sectional examination. Iron state, vitamin B12, folic acid, 25hydroxy(OH)-vitamin D, PTH, vitamin A, and vitamin E levels were determined. Subsequently, patients underwent nutritional counseling and were substituted accordingly.
A total of 63.2% (n = 1094) of the patients had a deficit in folic acid (< 5.3 ng/ml), 97.5% (n = 1689) in 25OHvitamin D (< 75 nmol/l), and 30.2% (n = 523) had a PTH elevation (> 56.9 pg/ml). A total of 5.1% (n = 88) of the patients presented with a deficit in vitamin B12 (< 188 pg/ml) and 6.2% (n = 107) in vitamin A (< 1.05 μmol/l). A total of 9.6% (n = 166) exhibited iron deficiency (ferritin < 15 μg/l). None of the patients had a deficit in vitamin E. There were no gender differences except for ferritin deficiency (women 11.8% vs. men 1.5%, p < 0.001). Patients in the highest BMI tertile had significantly more often a deficit in vitamin D (p = 0.033) and folic acid (p < 0.001). Patients in the lowest age tertile had significantly more often a deficit in folic acid (p < 0.001).
Our data show a high prevalence of micronutrient deficiency in patients with morbid obesity preoperatively and emphasize the importance of exact preoperative evaluation and adequate substitution as well as postoperative surveillance.
术后微量营养素缺乏是减肥手术已知的副作用。在本研究中，我们术前检查了病态肥胖（MO）患者微量营养素缺乏的患病率。
在本次横断面检查中，对总共1732例希望接受减肥手术的MO患者（年龄：40±12岁，平均BMI：44±9kg/m²，均值±标准差，77.3%为女性）进行了分析。测定了铁状态、维生素B12、叶酸、25-羟基（OH）-维生素D、甲状旁腺激素（PTH）、维生素A和维生素E水平。随后，患者接受了营养咨询并相应地进行了补充。
总共63.2%（n=1094）的患者叶酸缺乏（<5.3ng/ml），97.5%（n=1689）的患者25OH维生素D缺乏（<75nmol/l），30.2%（n=523）的患者PTH升高（>56.9pg/ml）。总共5.1%（n=88）的患者维生素B12缺乏（<188pg/ml），6.2%（n=107）的患者维生素A缺乏（<1.05μmol/l）。总共9.6%（n=166）的患者表现出缺铁（铁蛋白<15μg/l）。没有患者维生素E缺乏。除铁蛋白缺乏外（女性11.8% vs.男性1.5%，p<0.001），没有性别差异。BMI最高三分位数的患者维生素D缺乏（p=0.033）和叶酸缺乏（p<0.001）的情况明显更常见。年龄最低三分位数的患者叶酸缺乏的情况明显更常见（p<0.001）。
我们的数据显示病态肥胖患者术前微量营养素缺乏的患病率很高，并强调了术前准确评估、充分补充以及术后监测的重要性。
