Abstract
Previous studies have described multiple nutritional deficiencies after bariatric surgery (BS). However, few studies have evaluated these deficiencies prior to BS, specifically in Latin America. This study aimed to determine the factors associated with nutritional deficiency biomarkers in candidates for BS in Peru. We included adults of both sexes, aged 18 to 59 years, admitted to a Peruvian clinic with a body mass index (BMI) ≥30 kg/m2; they were candidates for BS from 2017 to 2020. We considered the serum levels of hemoglobin and albumin (in tertiles) as the nutritional deficiency biomarkers. In order to assess the associated factors, we calculated crude (cPR) and adjusted prevalence ratios (aPR) with their respective 95% confidence intervals (95%CI). We analyzed 255 patients: 63.1% were males, with a mean age of 37.1 ± 10.3 years and mean hemoglobin and albumin values of 14.0 ± 1.5 g/dL and 4.6 ± 0.4 g/dL, respectively. We found that males (aPR = 1.86; 95%CI: 1.26–2.73; p = 0.002), participants between 30 and 49 (aPR = 2.02; 95%CI: 1.24–3.28; p = 0.004) or 50 years or more (aPR = 2.42; 95%CI: 1.35–4.35; p = 0.003), participants with a BMI ≥40 kg/m2 (aPR = 1.68; 95%CI: 1.09–2.60; p = 0.018), participants with impaired high-density lipoprotein levels (aPR = 1.43; 95%CI: 1.01–2.05; p = 0.049) and individuals in the high tertile of C-reactive protein (aPR = 6.94; 95%CI: 3.37–14.32; p < 0.003) had a higher probability of being in the lower tertile of albumin. In addition, we found that the male sex (aPR = 6.94; 95%CI: 3.37–14.32; p < 0.001) and elevated cholesterol levels (aPR = 0.71; 95%CI: 0.52–0.97; p = 0.034) were associated with the lowest hemoglobin tertile. In our setting, nutritional deficiency biomarkers were associated with sociodemographic, anthropometric and laboratory markers. The pre-bariatric surgery correction of nutritional deficiencies is essential, and can prevent major complications after surgery.
Highlights
The prevalence of obesity tripled between 1975 and 2016
We found that the mean HOMA-IR was 6.4 ± 4.5 units; 96.5% (n = 246) of patients had Nonalcoholic fatty liver disease (NAFLD), 72.1% (n = 184) had a body mass index (BMI) greater than or equal to 35 kg/m2, and the median CRP was 6.1 units (IQR: 3.1–10.2) (Table 1)
We found that men, participants with an age between 30 and and those aged years or more were more likely to be in the lower tertile of albumin
Summary
The prevalence of obesity tripled between 1975 and 2016. In 2016, it was estimated that 39% of adults worldwide had overweight, and 13% had obesity [1]. Obesity represents a public health problem due to its association with diseases such as high blood pressure, type 2 diabetes mellitus, cardiovascular diseases, and cancer [2]. Obesity has ceased to represent a problem only in people at a high socioeconomic level [2], as the burden of obesity has been increasing, and is unevenly distributed in all socioeconomic groups. Among individuals with low resources, obesity is associated with a greater number of comorbidities compared to those with medium or high incomes, further driving health inequities, and requiring the development of national public policies to prevent and treat obesity-related disease [3]. In 2016, it was estimated that 685,874 bariatric surgery interventions were carried out worldwide [5]. The anatomical and physiological alteration of the gastrointestinal tract produced by surgery makes the patient more susceptible to disabling diseases such as anemia, protein malnutrition, deficiencies of calcium and vitamin D micronutrients, low serum levels of other fat-soluble vitamins, and essential mineral deficiencies including magnesium, zinc, copper, and selenium [8]
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