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Obes Surg. 2016 Apr;26(4):833-8. doi: 10.1007/s11695-015-1844-y.

Malnutrition in Bariatric Surgery Candidates: Multiple Micronutrient Deficiencies Prior to Surgery.

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The Johns Hopkins Center for Bariatric Surgery, 4940 Eastern Avenue, Baltimore, MD, 21224, USA.
The Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
The Johns Hopkins Weight Management Center, The Global Obesity Prevention Center at Johns Hopkins, Baltimore, MD, 21205, USA.
The Johns Hopkins Bloomberg School of Public Health, 550 N Broadway, Baltimore, MD, 21205, USA.
The Johns Hopkins Bayview Department of Clinical Nutrition, American University of Antigua School of Medicine, 4940 Eastern Avenue, Baltimore, MD, 21224, USA.
, PO Box 572, Jonesborough, TN, 37659, USA.
The Johns Hopkins Center for Bariatric Surgery, 4940 Eastern Avenue, Baltimore, MD, 21224, USA.



Over 78 million American adults have obesity. Bariatric surgery is the leading means of durable weight loss. Nutritional deficiencies are commonly treated post-operatively but are often undiagnosed pre-operatively. Malnutrition is correlated with adverse surgical outcomes.


The aim of this study is to assess pre-operative nutritional status in our bariatric surgery candidates in a cross-sectional study.


We recruited 58 bariatric candidates approved to undergo the Roux-en Y gastric bypass. Nutritional status was determined for vitamins A, B12, D, E-α, and E-β/γ as well as thiamine, folate, and iron. We used clinical as well as frank deficiency cut-offs based on the Institute of Medicine and the World Health Organization guidelines.


This cohort was largely female (77.6%) and white (63.8%). Median age was 42.2 years. Median body mass index (BMI) was 46.3 kg/m(2). Multiple comorbidities (MCM) were present in 41.4%, 54.0% hypertension, 42.0% diabetic, 34.0% sleep apnea. Men had more comorbidities, 69.2 % with MCM. Folate and iron saturation varied significantly by sex. Vitamins A, D, E-α, and thiamine significantly varied by race. Vitamin D negatively correlated with BMI (p = 0.003) and age (p = 0.030). Vitamin A negatively correlated with age (p = 0.001) and number of comorbidities (p = 0.003). These pre-operative bariatric candidates had significant malnutrition, particularly in vitamin D (92.9%) and iron (36.2 to 56.9 %). Multiple micronutrient deficiency (MMND) was more common in blacks (50.0 versus 39.7% overall). Number of comorbidities did not correlate with MMND.


Malnutrition in one or multiple micronutrients is pervasive in this pre-operative bariatric cohort. The effect of pre-operative supplementation, especially vitamin D and iron, should be explored.


Bariatric surgery; Malnutrition; Multiple micronutrient deficiency; Nutritional status

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