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Lewis CA, Osland EJ, de Jersey S, Hopkins G, Seymour M, Webb L, Chatfield MD, Hickman IJ. Monitoring for micronutrient deficiency after bariatric surgery-what is the risk? Eur J Clin Nutr 2023; 77:1071-1083. [PMID: 37550536 PMCID: PMC10630125 DOI: 10.1038/s41430-023-01318-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 07/15/2023] [Accepted: 07/19/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Bariatric surgery may increase the risk of micronutrient deficiencies; however, confounders including preoperative deficiency, supplementation and inflammation are rarely considered. OBJECTIVE To examine the impact of bariatric surgeries, supplementation and inflammation on micronutrient deficiency. SETTING Two public hospitals, Australia. METHODS Participants were recruited to an observational study monitoring biochemical micronutrient outcomes, supplementation dose, inflammation and glycaemic control, pre-operatively and at 1-3, 6 and 12 months after gastric bypass (GB; Roux-en-Y Gastric Bypass and Single Anastomosis Gastric Bypass; N = 66) or sleeve gastrectomy (SG; N = 144). Participant retention at 12 months was 81%. RESULTS Pre-operative micronutrient deficiency was common, for vitamin D (29-30%), iron (13-22%) and selenium (39% GB cohort). Supplement intake increased after surgery; however, dose was <50% of target for most nutrients. After SG, folate was vulnerable to deficiency at 6 months (OR 13 [95% CI 2, 84]; p = 0.007), with folic acid supplementation being independently associated with reduced risk. Within 1-3 months of GB, three nutrients had higher deficiency rates compared to pre-operative levels; vitamin B1 (21% vs. 6%, p < 0.01), vitamin A (21% vs. 3%, p < 0.01) and selenium (59% vs. 39%, p < 0.05). Vitamin B1 deficiency was independently associated with surgery and inflammation, selenium deficiency with improved glycaemic control after surgery and inflammation, whilst vitamin A deficiency was associated with inflammation only. CONCLUSION In the setting of prophylactic post-surgical micronutrient prescription, few nutrients are at risk of de novo deficiency. Although micronutrient supplementation and monitoring remains important, rationalising high-frequency biochemical testing protocols in the first year after surgery may be warranted.
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Affiliation(s)
- Carrie-Anne Lewis
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.
- The University of Queensland, Greater Brisbane Clinical School, Faculty of Medicine, Brisbane, QLD, Australia.
| | - Emma J Osland
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
- The University of Queensland, School of Human Movements and Nutrition Science, Brisbane, QLD, Australia
| | - Susan de Jersey
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
- The University of Queensland, Centre for Health Services Research, Faculty of Medicine, Brisbane, QLD, Australia
| | - George Hopkins
- Department of Surgery, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Matthew Seymour
- Department of Endocrinology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Lindsey Webb
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Mark D Chatfield
- The University of Queensland, Centre for Health Services Research, Faculty of Medicine, Brisbane, QLD, Australia
- The University of Queensland, Centre for Clinical Research, Faculty of Medicine, Brisbane, Australia
| | - Ingrid J Hickman
- The University of Queensland, Greater Brisbane Clinical School, Faculty of Medicine, Brisbane, QLD, Australia
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD, Australia
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Framework of Methodology to Assess the Link between A Posteriori Dietary Patterns and Nutritional Adequacy: Application to Pregnancy. Metabolites 2022; 12:metabo12050395. [PMID: 35629899 PMCID: PMC9148035 DOI: 10.3390/metabo12050395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 04/21/2022] [Accepted: 04/26/2022] [Indexed: 02/07/2023] Open
Abstract
This study aimed to explore the nutritional profile of 608 women during the second trimester of pregnancy, in terms of nutrient patterns, dietary quality and nutritional adequacy. Dietary data were collected using a validated Mediterranean-oriented, culture-specific FFQ. Principal component analysis was performed on 18 energy-adjusted nutrients. Two main nutrient patterns, “plant-origin” (PLO) and “animal-origin” (ANO), were extracted. Six homogenous clusters (C) relative to nutrient patterns were obtained and analyzed through a multidimensional methodological approach. C1, C5 and C6 scored positively on PLO, while C1, C2 and C3 scored positively on ANO. When dietary quality was mapped on food choices and dietary indexes, C6 unveiled a group with a distinct image resembling the Mediterranean-type diet (MedDiet Score = 33.8). Although C1–C5 shared common dietary characteristics, their diet quality differed as reflected in the HEI-2010 (C1:79.7; C2:73.3; C3:70.9; C4:63.2; C5:76.6). The appraisal of nutritional adequacy mirrored a “nutritional-quality gradient”. A total of 50% of participants in C6 had almost 100% adequate magnesium intake, while 50% of participants in C4 had a probability of adequacy of ≤10%. Our methodological framework is efficient for assessing the link between a posteriori dietary patterns and nutritional adequacy during pregnancy. Given that macro- and micronutrient distributions may induce metabolic modifications of potential relevance to offspring’s health, public health strategies should be implemented.
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Oh H, Kim J, Huh Y, Kim SH, Jang SI. Association of Household Income Level with Vitamin and Mineral Intake. Nutrients 2021; 14:38. [PMID: 35010913 PMCID: PMC8746700 DOI: 10.3390/nu14010038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 11/16/2022] Open
Abstract
Appropriate nutrient intake is essential for maintaining health and resisting disease. The current study investigated the association between household income quintile and nutrient intake using data from KNHANES 2019. A total of 5088 South Korean adults were analyzed. The estimated average requirement cut-point method, extended to handle participants with intakes higher than the tolerable upper level, was utilized to determine the need for dietary modification. The suitability of overall vitamin, overall mineral, and individual nutrient intake was evaluated by logistic regression analysis. Subgroup analysis was performed on overall mineral intake suitability. None of the individual nutrients had an intake ratio of over 70%, with the ratio being under 30% for some nutrients. The intake of iron, phosphorus, vitamin B9, and vitamin C had a significant upward trend as household income rose. A subgroup analysis revealed sex differences in the trends of overall mineral intake. The results revealed that some nutrients are not consumed appropriately in the Korean population. Furthermore, they suggest that household income is significantly associated with the intake of overall minerals and several individual nutrients. These results suggest that nutritional assistance is required for certain vulnerable groups, and provide supplementary data for appropriate interventions or further research.
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Affiliation(s)
- Haegyu Oh
- Premedical Courses, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Juyeon Kim
- Premedical Courses, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Yune Huh
- Premedical Courses, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Seung Hoon Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
- Institute of Health Services Research, Yonsei University, Seoul 03722, Korea
| | - Sung-In Jang
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
- Institute of Health Services Research, Yonsei University, Seoul 03722, Korea
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