Nutritional deficiencies in obesity and after bariatric surgery

Abstract

The presence of nutritional deficiencies in overweight and obesity may seem paradoxical in light of excess caloric intake, but several micronutrient deficiencies appear to be higher in prevalence in overweight and obese adults and children. Causes are multifactorial and include decreased consumption of fruits and vegetables, increased intake of high-calorie, but nutritionally poor-quality foods, and increased adiposity, which may influence the storage and availability of some nutrients. As the obesity epidemic continues unabated and the popularity of bariatric surgery rises for severely obese adults and adolescents, medical practitioners must be aware of pre-existing nutritional deficiencies in overweight and obese patients and appropriately recognize and treat common and rare nutritional deficiencies that may arise or worsen following bariatric surgery. This article reviews current knowledge of nutritional deficits in obese and overweight individuals and those that commonly present after bariatric surgery and summarizes current recommendations for screening and supplementation.

Figure 1

Types of Past and Present Bariatric Surgery Procedures. Jejunoileal bypass (1a) has been largely abandoned due to high risk of malabsorptive complications. Biliopancreatic diversion (1b) is also less commonly performed. The most commonly performed procedures include the Roux-en-y gastric bypass (1f), the biliopancreatic diversion with duodenal switch (1c) and the purely restrictive procedures, the adjustable gastric band (1e), vertical-banded gastroplasty (1d), and the vertical sleeve gastrectomy (1g).[10] From Xanthakos SA. Bariatric surgery for extreme adolescent obesity: indications, outcome and physiologic effects on the gut-brain axis. Pathophysiology 2008;15:135, with permission.