Department of Endocrinology, Singapore General Hospital, Singapore, Singapore.
Clinical Obesity Research, Baker Heart and Diabetes Institute, Melbourne, Australia.
Obes Surg. 2019 Jan;29(1):166-171. doi: 10.1007/s11695-018-3494-3.
Micronutrient deficiencies are highly prevalent in patients seeking metabolic-bariatric surgery (MBS), although literature remains scant in Asia. In this study, we assess the prevalence of nutritional deficiencies in patients with clinically severe obesity in Singapore and examine factors associated with the deficiencies.
This is a prospective, observational study of 577 consecutive patients scheduled to undergo MBS. Nutritional profile including renal panel, calcium, phosphate, intact parathyroid hormone (iPTH), 25-hydroxyvitamin D (25(OH)D), vitamin B12, folate, ferritin, iron studies, hemoglobin, albumin, and alkaline phosphatase were analyzed.
Mean age was 40.6 ± 10.3 years, 61.2% female, and mean BMI 42.4 ± 8.4 kg/m. 92.9% had suboptimal vitamin D levels; of which 25.6% had vitamin D insufficiency (25(OH)D < 30 mcg/L), 57.5% had vitamin D deficiency (25(OH)D < 20 mcg/L), and 9.8% had severe vitamin D deficiency (25(OH)D < 10 mcg/L). Younger age, female gender, and higher BMI were independent factors associated with lower 25(OH)D. There was an inverse relationship between iPTH and 25(OH)D, with an inflection point at 25(OH)D of approximately 20 mcg/L. Folate deficiency was present in 31% and vitamin B12 deficiency in 9.5% of the cohort. Serum ferritin levels were low in 29.3%. 25(OH)D, ferritin, serum iron, and albumin were also significantly higher in Chinese compared to Malay and Indian patients.
Vitamin D deficiency was the most common micronutrient deficiency observed in this multi-ethnic Asian cohort presenting for MBS. Ethnic differences in nutritional status were observed.
微量营养素缺乏在寻求代谢 - 减重手术（MBS）的患者中非常普遍，尽管亚洲的文献仍然很少。在这项研究中，我们评估了新加坡临床上严重肥胖患者的营养缺乏症患病率，并研究了与这些缺乏症相关的因素。
这是一项对 577 例连续接受 MBS 手术的患者进行的前瞻性观察性研究。对营养状况进行了分析，包括肾功能检查、钙、磷、完整甲状旁腺激素（iPTH）、25-羟维生素 D（25（OH）D）、维生素 B12、叶酸、铁蛋白、铁研究、血红蛋白、白蛋白和碱性磷酸酶。
平均年龄为 40.6±10.3 岁，61.2%为女性，平均 BMI 为 42.4±8.4kg/m2。92.9%的患者维生素 D 水平不足；其中 25.6%的患者维生素 D 不足（25（OH）D<30mcg/L），57.5%的患者维生素 D 缺乏（25（OH）D<20mcg/L），9.8%的患者维生素 D 严重缺乏（25（OH）D<10mcg/L）。年龄较小、女性和较高的 BMI 是与较低 25（OH）D 相关的独立因素。iPTH 与 25（OH）D 呈负相关，在 25（OH）D 约为 20mcg/L 时有一个拐点。叶酸缺乏见于 31%的患者，维生素 B12 缺乏见于 9.5%的患者。血清铁蛋白水平低的占 29.3%。25（OH）D、铁蛋白、血清铁和白蛋白在中国人中也明显高于马来人和印度人。
在这个多民族亚洲队列中，维生素 D 缺乏是接受 MBS 治疗的患者中最常见的微量营养素缺乏症。观察到营养状况存在种族差异。
