Malnutrition in Obesity

Pitchumoni, C. S.

doi:10.1007/978-3-319-90761-1_110-1

C. S. Pitchumoni^3,4,5

184 Accesses

Abstract

Obesity and malnutrition appear to be at the opposite ends of the spectrum. On the contrary, the two clinical problems often coexist. According to the World Health Organization (WHO), malnutrition refers to deficiencies, excesses, or imbalances in a person’s intake of energy and nutrients. The clinical entity of malnutrition has many subdivisions and includes at the one end undernutrition (wasting, stunting, underweight) and at the other end overweight and obesity. Obesity obscures the subtle signs of nutritional deficiencies. The obesogenic diet is most often deficient in nutrients but dense in calories.

Multiple factors in older age intensify nutritional deficiencies. Poor eating habits because of a decline in taste, smell, and appetite, difficulty chewing, swallowing, dementia, depression, medications, restricted diets, limited income, and reduced social contact intensify the underlying nutritional deficiencies. The overall effects of obesity and malnutrition with poor eating lead to a weak immune system, sarcopenia, and decreased bone mass, increasing the risks for anemia, neurological problems, decreased immunity, and an increase in falls and fractures. A combination of physical, social, and psychological issues causes malnutrition in the obese setting.

Bariatric surgical procedures can be safely performed with substantial benefits in a small and selected group of older adults. They can be useful in inducing short-term and long-term weight loss without any added age-related risk. However, the well-intended goal of weight loss is never without adverse effects. All weight-reducing measures and bariatric surgical procedures more than diet therapies cause macro- and micronutrient deficiencies. There is an exacerbation of the preexisting nutrient deficiencies or onset of new deficiencies of macro- and micronutrients. A team approach is essential to accomplish the therapeutic goal. The team should include one or more qualified nutritionists and geriatricians in addition to the experienced surgical group. A preoperative geriatric and nutritional assessment and correction of deficiencies prepares the patient for bariatric surgery. Postoperative care by qualified nutritionists is mandatory to avoid overt and occult malnutrition.

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References

Aigner E, Feldman A, Datz C. Obesity as an emerging risk factor for iron deficiency. Nutrients. 2014;6:3587–600. https://doi.org/10.3390/nu6093587.
Article CAS PubMed PubMed Central Google Scholar
Aills L, Blankenship J, Buffington C, Furtado M, Parrott J. ASMBS allied health nutritional guidelines for the surgical weight loss patient. Surg Obes Relat Dis. 2008; https://doi.org/10.1016/j.soard.2008.03.002.
Bal BS, Finelli FC, Shope TR, Koch TR. Nutritional deficiencies after bariatric surgery. Nat Rev Endocrinol. 2012;8:544–56. https://doi.org/10.1038/nrendo.2012.48.
Article CAS PubMed Google Scholar
Baum JI, Kim IY, Wolfe RR. Protein consumption and the elderly: what is the optimal level of intake? Nutrients. 2016; https://doi.org/10.3390/nu8060359.
Becker DA, Balcer LJ, Galetta SL. The neurological complications of nutritional deficiency following bariatric surgery. J Obes. 2012;2012:608534. https://doi.org/10.1155/2012/608534.
Article CAS PubMed PubMed Central Google Scholar
Bennett SE, Schmitt WP, Stanford FC, Baron JM. Case 22-2018: a 64-year-old man with progressive leg weakness, recurrent falls, and Anemia. N Engl J Med. 2018;379:282–9. https://doi.org/10.1056/NEJMcpc1802826.
Article PubMed PubMed Central Google Scholar
Bétry C, Disse E, Chambrier C, Barnoud D, Gelas P, Baubet S, Laville M, Pelascini E, Robert M. Need for intensive nutrition care after bariatric surgery. J Parenter Enter Nutr. 2017;41:258–62. https://doi.org/10.1177/0148607116637935.
Article Google Scholar
Bianchi VE. Role of nutrition on anemia in elderly. Clin Nutr ESPEN. 2016; https://doi.org/10.1016/j.clnesp.2015.09.003.
Bird JK, Murphy RA, Ciappio ED, McBurney MI. Risk of deficiency in multiple concurrent micronutrients in children and adults in the United States. Nutrients. 2017;9 https://doi.org/10.3390/nu9070655.
Blumberg JB, Bailey RL, Sesso HD, Ulrich CM. The evolving role of multivitamin/multimineral supplement use among adults in the age of personalized nutrition. Nutrients. 2018; https://doi.org/10.3390/nu10020248.
Bowley MP, David WS, Cho TA, et al. Case 35–2017. A 57-year-old woman with hypoesthesia and weakness in the legs and arms. N Engl J Med. 2017;377(20):1977–84. https://doi.org/10.1056/NEJMcpc1710564.
Article PubMed Google Scholar
Btaiche IF, Yeh AY, Wu IJ, Khalidi N. Neurologic dysfunction and pancytopenia secondary to acquired copper deficiency following duodenal switch: case report and review of the literature. Nutr Clin Pract Off Publ Am Soc Parenter Enter Nutr. 2011;26:583–92. https://doi.org/10.1177/0884533611416127.
Article Google Scholar
Busetto L, Dicker D, Azran C, Batterham RL, Farpour-Lambert N, Fried M, Hjelmesæth J, Kinzl J, Leitner DR, Makaronidis JM, Schindler K, Toplak H, Yumuk V. Practical recommendations of the obesity management task force of the European Association for the study of obesity for the post-bariatric surgery medical management. Obes Facts. 2018; https://doi.org/10.1159/000481825.
Carmel R. Nutritional anemias and the elderly. Semin Hematol. 2008;45:225–34. https://doi.org/10.1053/j.seminhematol.2008.07.009.
Article PubMed Google Scholar
Centers for Disease Control and National Center for Environmental Health, 2012. Second national report on biochemical indicators of diet and nutrition in the U.S. population, Atlanta USA.
Google Scholar
Cepeda-Lopez AC, Aeberli I, Zimmermann MB. Does obesity increase risk for iron deficiency? A review of the literature and the potential mechanisms. Int J Vitam Nutr Res. Int Zeitschrift fur Vitamin- und Ernahrungsforschung. J Int Vitaminol Nutr. 2010;80:263–70. https://doi.org/10.1024/0300-9831/a000033.
Article CAS Google Scholar
Chakhtoura MT, Nakhoul NN, Shawwa K, Mantzoros C, El Hajj Fuleihan GA. Hypovitaminosis D in bariatric surgery: a systematic review of observational studies. Metabolism. 2016;65:574–85. https://doi.org/10.1016/J.METABOL.2015.12.004.
Article CAS PubMed Google Scholar
Ciangura C, Corigliano N. Chirurgie de l’obésité et ses complications. Rev Med Interne. 2012; https://doi.org/10.1016/j.revmed.2011.12.008.
Colombo ML. An update on vitamin E, tocopherol and tocotrienol-perspectives. Molecules. 2010; https://doi.org/10.3390/molecules15042103.
Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel J-P, Rolland Y, Schneider SM, Topinková E, Vandewoude M, Zamboni M. Sarcopenia: European consensus on definition and diagnosis: report of the European working group on sarcopenia in older people. Age Ageing. 2010;39:412–23. https://doi.org/10.1093/ageing/afq034.
Article PubMed PubMed Central Google Scholar
Damms-Machado A, Friedrich A, Kramer KM, Stingel K, Meile T, Küper MA, Königsrainer A, Bischoff SC. Pre- and postoperative nutritional deficiencies in obese patients undergoing laparoscopic sleeve gastrectomy. Obes Surg. 2012;22:881–9. https://doi.org/10.1007/s11695-012-0609-0.
Article PubMed Google Scholar
Dietch ZC, Guidry CA, Davies SW, Sawyer RG. Hypoalbuminemia is disproportionately associated with adverse outcomes in obese elective surgical patients. In: Surgery for obesity and related diseases: Elsevier Inc; 2015. p. 912–8. https://doi.org/10.1016/j.soard.2014.10.010.
Erie JC, Good JA, Butz JA, et al. Reduced zinc and copper in the retinal pigment epithelium and choroid in age-related macular degeneration. Am J Ophthalmol. 2009;147:276–82.
CAS PubMed Google Scholar
Fakhouri THI, Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity among older adults in the United States, 2007–2010. NCHS Data Br. No. 106. 2012.
Google Scholar
Ferraz ÁAB, Carvalho MRC, Siqueira LT, Santa-Cruz F, Campos JM. Micronutrient deficiencies following bariatric surgery: a comparative analysis between sleeve gastrectomy and Roux-en-y gastric bypass. Rev Col Bras Cir. 2018;45 https://doi.org/10.1590/0100-6991e-20182016.
Fieber JH, Sharoky CE, Wirtalla C, Williams NN, Dempsey DT, Kelz RR. The malnourished patient with obesity: a unique paradox in bariatric surgery. J Surg Res. 2018;232:456–63. https://doi.org/10.1016/j.jss.2018.06.056.
Article PubMed Google Scholar
Fielding RA, Vellas B, Evans WJ, Bhasin S, Morley JE, Newman AB, Abellan van Kan G, Andrieu S, Bauer J, Breuille D, Cederholm T, Chandler J, De Meynard C, Donini L, Harris T, Kannt A, Keime Guibert F, Onder G, Papanicolaou D, Rolland Y, Rooks D, Sieber C, Souhami E, Verlaan S, Zamboni M. Sarcopenia: An undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. J Am Med Dir Assoc. 2011;12:249–56. https://doi.org/10.1016/j.jamda.2011.01.003.
Article PubMed Google Scholar
Flaxel CJ, Adelman RA, Vemulakonda GA, Bailey ST, Fawzi A, Lim JI, Gui-shuang Y. Prevalence and surgical outcomes of macular hole in eyes with age-related macular degeneration. Am Acad Ophthalmol. 2020;127(9):1279. https://doi.org/10.1016/j.ophtha.2020.06.048.
Funk MD, Lee M, Vidoni ML, Reininger BM. Weight loss and weight gain among participants in a community-based weight loss challenge. BMC Obes. 2019;6 https://doi.org/10.1186/s40608-018-0225-1.
Gahche JJ, Bailey RL, Potischman N, Dwyer JT. Dietary supplement use was very high among older adults in the United States in 2011–2014. J Nutr. 2017;147:1968–76. https://doi.org/10.3945/jn.117.255984.
Article CAS PubMed PubMed Central Google Scholar
Griffith DP, Liff DA, Ziegler TR, Esper GJ, Winton EF. Acquired copper deficiency: a potentially serious and preventable complication following gastric bypass surgery. Obesity (Silver Spring). 2009;17:827–31. https://doi.org/10.1038/oby.2008.614.
Article CAS Google Scholar
Gudzune KA, Huizinga MM, Chang HY, Asamoah V, Gadgil M, Clark JM. Screening and diagnosis of micronutrient deficiencies before and after bariatric surgery. Obes Surg. 2013;23:1581–9. https://doi.org/10.1007/s11695-013-0919-x.
Article PubMed PubMed Central Google Scholar
Haynes BMH, Pfeiffer CM, Sternberg MR, Schleicher RL. Selected physiologic variables are weakly to moderately associated with 29 biomarkers of diet and nutrition, NHANES 2003–2006. J Nutr. 2013;143:1001S–10S. https://doi.org/10.3945/jn.112.172882.
Article CAS PubMed PubMed Central Google Scholar
Institute of Medicine (U.S.) Food and Nutrition Board. Dietary reference intakes: a risk assessment model for establishing upper intake levels for nutrients. 1998. https://doi.org/10.17226/6432.
Institute of Medicine (U.S.) Standing Committee on the Scientific Evaluation of Dietary Reference Intakes and its Panel on Folate Other B Vitamins and Choline. Dietary reference intakes for thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin, and choline, dietary reference intakes for thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin, and choline: National Academies Press; 1998. https://doi.org/10.17226/6015.
Kaidar-Person O, Person B, Szomstein S, Rosenthal RJ. Nutritional deficiencies in morbidly obese patients: a new form of malnutrition? Obes Surg. 2008;18:870–6. https://doi.org/10.1007/s11695-007-9349-y.
Article PubMed Google Scholar
Kalyani RR, Corriere M, Ferrucci L. Age-related and disease-related muscle loss: the effect of diabetes, obesity, and other diseases. Lancet Diabetes Endocrinol. 2014; https://doi.org/10.1016/S2213-8587(14)70034-8.
Kamel HK. Sarcopenia and aging. Nutr Rev. 2003; https://doi.org/10.1301/nr.2003.may.157-167.
Keller U. Nutritional laboratory markers in malnutrition. J Clin Med. 2019;8:775. https://doi.org/10.3390/jcm8060775.
Article CAS PubMed Central Google Scholar
Keller K, Engelhardt M. Strength and muscle mass loss with aging process. Age and strength loss. Muscles Ligaments Tendons J. 2013;3:346–50. https://doi.org/10.11138/mltj/2013.3.4.346.
Article PubMed Google Scholar
Koch TR, Finelli FC. Postoperative metabolic and nutritional complications of bariatric surgery, gastroenterology clinics of North America. Gastroenterol Clin N Am. 2010; https://doi.org/10.1016/j.gtc.2009.12.003.
Koffman BM, Greenfield LJ, Ali II, Pirzada NA. Neurologic complications after surgery for obesity. Muscle Nerve. 2006;33:166–76. https://doi.org/10.1002/mus.20394.
Article PubMed Google Scholar
Kuin C, den Ouden F, Brandts H, Deden L, Hazebroek E, van Borren M, de Boer H. Treatment of severe protein malnutrition after bariatric surgery. Obes Surg. 2019;29:3095–102. https://doi.org/10.1007/s11695-019-04035-8.
Article PubMed Google Scholar
Kumar N, Ahlskog JE, Gross JBJ. Acquired hypocupremia after gastric surgery. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2004a;2:1074–9. https://doi.org/10.1016/s1542-3565(04)00546-4.
Article Google Scholar
Kumar N, Gross JB, Ahlskog JE. Copper deficiency myelopathy produces a clinical picture like subacute combined degeneration. Neurology. 2004b;63:33–9.
Article CAS Google Scholar
Kumar P, Hamza N, Madhok B, De Alwis N, Sharma M, Miras AD, Mahawar KK. Copper deficiency after gastric bypass for morbid obesity: a systematic review. Obes Surg. 2016; https://doi.org/10.1007/s11695-016-2162-8.
Lakhani SV, Shah HN, Alexander K, Finelli FC, Kirkpatrick JR, Koch TR. Small intestinal bacterial overgrowth and thiamine deficiency after Roux-en-Y gastric bypass surgery in obese patients. Nutr Res. 2008;28:293–8. https://doi.org/10.1016/j.nutres.2008.03.002.
Article CAS PubMed Google Scholar
Landais A. Neurological complications of bariatric surgery. Obes Surg. 2014; https://doi.org/10.1007/s11695-014-1376-x.
Langan RC, Goodbred AJ. Vitamin B12 deficiency: recognition and management. Am Fam Physician. 2017;96:384–9.
PubMed Google Scholar
Ledoux S, Flamant M, Calabrese D, Bogard C, Sami O, Coupaye M. What are the micronutrient deficiencies responsible for the Most common nutritional symptoms after bariatric surgery? Obes Surg. 2020;30:1891–7. https://doi.org/10.1007/s11695-020-04412-8.
Article PubMed Google Scholar
Lupoli R, Lembo E, Saldalamacchia G, Avola CK, Angrisani L, Capaldo B. Bariatric surgery and long-term nutritional issues. World J Diabetes. 2017;8:464. https://doi.org/10.4239/wjd.v8.i11.464.
Article PubMed PubMed Central Google Scholar
Mahawar KK, Bhasker AG, Bindal V, Graham Y, Dudeja U, Lakdawala M, Small PK. Zinc deficiency after gastric bypass for morbid obesity: a systematic review. Obes Surg. 2017; https://doi.org/10.1007/s11695-016-2474-8.
Malinowski SS. Nutritional and metabolic complications of bariatric surgery. Am J Med Sci. 2006;331:219–25. https://doi.org/10.1097/00000441-200604000-00009.
Article PubMed Google Scholar
Manatakis DK, Georgopoulos N. A fatal case of Wernicke’s encephalopathy after sleeve gastrectomy for morbid obesity. Case Rep Surg. 2014;2014:281210. https://doi.org/10.1155/2014/281210.
Article PubMed PubMed Central Google Scholar
Marcellini F, Giuli C, Papa R, Gagliardi C, Dedoussis G, Herbein G, Fulop T, Monti D, Rink L, Jajte J, Mocchegiani E. Zinc status, psychological and nutritional assessment in old people recruited in five European countries: Zincage study. Biogerontology. 2006;7:339–45. https://doi.org/10.1007/s10522-006-9048-4.
Article CAS PubMed Google Scholar
Marra V, Bailey L. Position of the Academy of Nutrition and Dietetics: Micronutrient Supplementation. Acad Nutr Diet. 2019;119(2):344. https://doi.org/10.1016/j.jand.2018.12.012.
Article Google Scholar
Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Guven S, Spitz AF, Apovian CM, Livingston EH, Brolin R, Sarwer DB, Anderson WA, Dixon J. American association of clinical endocrinologists, the obesity society, and American society for metabolic & bariatric surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Endocr Pract. 2008; https://doi.org/10.4158/ep.14.s1.1.
Mechanick J, Youdim A, Jones D, Garvey W, Hurley D, McMahon M, Heinberg L, Kushner R, Adams T, Shikora S, Dixon J, Brethauer S, American Association of Clinical Endocrinologists, Obesity Society, American Society for Metabolic & Bariatric Surgery. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American association of clinical endocrinologists, the obesity society, and American society for metabolic & bariatric surgery. Endocr Pract. 2013;19:337–72. https://doi.org/10.4158/EP12437.GL.
Article PubMed PubMed Central Google Scholar
Mohammadifard N, Gotay C, Humphries KH, Ignaszewski A, Esmaillzadeh A, Sarrafzadegan N. Electrolyte minerals intake and cardiovascular health. Crit Rev Food Sci Nutr. 2019; https://doi.org/10.1080/10408398.2018.1453474.
Mohapatra S, Gangadharan K, Pitchumoni CS. Malnutrition in obesity before and after bariatric surgery. Dis Mon. 2020;66:100866. https://doi.org/10.1016/j.disamonth.2019.06.008.
Article PubMed Google Scholar
Muñoz M, Botella-Romero F, Gómez-Ramírez S, Campos A, García-Erce JA. Iron deficiency and anaemia in bariatric surgical patients: causes, diagnosis and proper management. Nutr Hosp. 2009;24:640–54.
PubMed Google Scholar
Nassif PAN, Malafaia O, Ribas-Filho JM, Czeczko NG, Garcia RF, Ariede BL. When and why operate elderly obese. Arq Bras Cir Dig. 2015; https://doi.org/10.1590/S0102-6720201500S100022.
Nations SP, Boyer PJ, Love LA, Burritt MF, Butz JA, Wolfe GI, Hynan LS, Reisch J, Trivedi JR. Denture cream: an unusual source of excess zinc, leading to hypocupremia and neurologic disease. Neurology. 2008;71:639–43. https://doi.org/10.1212/01.wnl.0000312375.79881.94.
Article CAS PubMed Google Scholar
Nett P, Borbély Y, Kröll D. Micronutrient supplementation after biliopancreatic diversion with duodenal switch in the long term. Obes Surg. 2016;26:2469–74. https://doi.org/10.1007/s11695-016-2132-1.
Article PubMed Google Scholar
O’Donnell KB, Simmons M. Early-onset copper deficiency following Roux-en-Y gastric bypass. Nutr Clin Pract Off Publ Am Soc Parenter Enter Nutr. 2011;26:66–9. https://doi.org/10.1177/0884533610392921.
Article Google Scholar
O’Kane M, Pinkney J, Aasheim ET, Barth JH, Batterham RL, Welbourn R. BOMSS Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery September 2014. Report. British Obesity and Metabolic Surgery Society. 2014.
Google Scholar
O’Keefe KL, Kemmeter PR, Kemmeter KD. Bariatric surgery outcomes in patients aged 65 years and older at an American society for metabolic and bariatric surgery center of excellence. Obes Surg. 2010;20:1199–205. https://doi.org/10.1007/s11695-010-0201-4.
Article PubMed Google Scholar
Oliveira YS, Iba Ba J, Mba Angoué J-M, Emery Itoudi Bignoumba P, Nzenze J-R. Copper deficiency and peripheral neuropathy as an outcome of gastrectomy. La Rev Med. 2013;34:234–6. https://doi.org/10.1016/j.revmed.2012.12.019.
Article CAS Google Scholar
Osland E, Powlesland H, Guthrie T, Lewis C-A, Memon MA. Micronutrient management following bariatric surgery: the role of the dietitian in the postoperative period. Ann Transl Med. 2020;8:S9. https://doi.org/10.21037/atm.2019.06.04.
Article CAS PubMed PubMed Central Google Scholar
Pajecki D, Santo MA, Kanagi AL, Riccioppo D, de Cleva R, Cecconello I. Functional assessment of older obese patients candidates for bariatric surgery. Arq Gastroenterol. 2014;51:25–8. https://doi.org/10.1590/S0004-28032014000100006.
Article PubMed Google Scholar
Pardo-Aranda F, Perez-Romero N, Osorio J, Rodriguez-Santiago J, Muñoz E, Puértolas N, Veloso E. Wernicke’s encephalopathy after sleeve gastrectomy: literature review. Int J Surg Case Rep. 2016;20:92–5. https://doi.org/10.1016/j.ijscr.2016.01.016.
Article PubMed PubMed Central Google Scholar
Parrott J, Frank L, Rabena R, Craggs-Dino L, Isom KA, Greiman L. American society for metabolic and bariatric surgery integrated health nutritional guidelines for the surgical weight loss patient 2016 update: micronutrients; 2016. https://doi.org/10.1016/j.soard.2016.12.018.
Book Google Scholar
Pellitero S, Martínez E, Puig R, Leis A, Zavala R, Granada ML, Pastor C, Moreno P, Tarascó J, Puig-Domingo M. Evaluation of vitamin and trace element requirements after sleeve gastrectomy at long term. Obes Surg. 2017;27:1–9. https://doi.org/10.1007/s11695-017-2557-1.
Article Google Scholar
Ross AC, Taylor CL, Yaktine AL, Del Valle HB. Dietary reference intakes for calcium and vitamin D. Dietary reference intakes for calcium and vitamin D. National Academies Press. 2011. https://doi.org/10.17226/13050.
Rounis E, Laing CM, Davenport A. Acute neurological presentation due to copper deficiency in a hemodialysis patient following gastric bypass surgery. Clin Nephrol. 2010 Nov;74(5):389–92.
CAS PubMed Google Scholar
Saly DL, Brewster UC, Sze GK, Louis ED, Shirali AC. An element of unsteadiness. N Engl J Med. 2017;377:1379–85. https://doi.org/10.1056/NEJMcps1701934.
Article PubMed Google Scholar
Sandvik J, Hole T, Klöckner CA, Kulseng BE, Wibe A. Intravenous iron treatment in the prevention of iron deficiency and anaemia after Roux-en-Y gastric bypass. Obes Surg. 2020;30:1745–52. https://doi.org/10.1007/s11695-020-04396-5.
Article PubMed PubMed Central Google Scholar
Santilli V, Bernetti A, Mangone M, Paoloni M. Clinical definition of sarcopenia. Clin Cases Miner Bone Metab. 2014; https://doi.org/10.11138/ccmbm/2014.11.3.177.
Shankar P, Boylan M, Sriram K. Micronutrient deficiencies after bariatric surgery. Nutrition. 2010;26:1031–7. https://doi.org/10.1016/j.nut.2009.12.003.
Article CAS PubMed Google Scholar
Sherf Dagan S, Goldenshluger A, Globus I, Schweiger C, Kessler Y, Kowen Sandbank G, Ben-Porat T, Sinai T. Nutritional recommendations for adult bariatric surgery patients: clinical practice. Adv Nutr An Int Rev J. 2017;8:382–94. https://doi.org/10.3945/an.116.014258.
Article CAS Google Scholar
Smelt HJM, van Loon S, Pouwels S, Boer AK, Smulders JF, Aarts EO. Do specialized bariatric multivitamins lower deficiencies after sleeve gastrectomy? Obes Surg. 2020;30:427–38. https://doi.org/10.1007/s11695-019-04191-x.
Article PubMed Google Scholar
Stabler SP. Clinical practice. Vitamin B12 deficiency. N Engl J Med. 2013;368:149–60. https://doi.org/10.1056/NEJMcp1113996.
Article CAS PubMed Google Scholar
Steenackers N, Gesquiere I, Matthys C. The relevance of dietary protein after bariatric surgery: what do we know? Curr Opin Clin Nutr Metab Care. 2018; https://doi.org/10.1097/MCO.0000000000000437.
Stern L, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J, Williams M, Gracely EJ, Samaha FF. The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: One-Year Follow-up of a Randomized Trial. Ann Intern Med. 2004; https://doi.org/10.7326/0003-4819-140-10-200405180-00007.
Stroh C, Manger T, Benedix F. Metabolic surgery and nutritional deficiencies. Minerva Chir. 2017; https://doi.org/10.23736/S0026-4733.17.07408-9.
Targher G, Bertolini L, Scala L, Cigolini M, Zenari L, Falezza G, Arcaro G. Associations between serum 25-hydroxyvitamin D3 concentrations and liver histology in patients with non-alcoholic fatty liver disease. Nutr Metab Cardiovasc Dis. 2007;17:517–24. https://doi.org/10.1016/j.numecd.2006.04.002.
Article CAS PubMed Google Scholar
Tatineni V, An JY, Leffew MR, Mahesh SA. Anemia from a to zinc: hypocupremia in the setting of gastric bypass and zinc excess. Clin Case Rep. 2020;8:745–50. https://doi.org/10.1002/ccr3.2741.
Article PubMed PubMed Central Google Scholar
Tian H, Guo X, Wang X, He Z, Sun R, Ge S, Zhang Z. Chromium picolinate supplementation for overweight or obese adults. Cochrane Database Syst Rev. 2013; https://doi.org/10.1002/14651858.CD010063.pub2.
Toh SY, Zarshenas N, Jorgensen J. Prevalence of nutrient deficiencies in bariatric patients. Nutrition. 2009;25:1150–6. https://doi.org/10.1016/j.nut.2009.03.012.
Article CAS PubMed Google Scholar
Trumbo P, Schlicker S, Yates AA, Poos M. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein and amino acids. J Am Diet Assoc. 2002;102:1621–30. https://doi.org/10.1016/S0002-8223(02)90346-9.
Article PubMed Google Scholar
Turnlund J. Copper. In: Shils ME, Shike M, editors. Modern nutrition in health and disease. Williams and Wilkins: Lippincott; 2006. p. 286–99.
Google Scholar
U.S. Department of Health and Human Services and the U.S. Department of Agriculture. 2015–2020 dietary guidelines|health.gov [WWW Document]. 2015. URL https://health.gov/our-work/food-nutrition/2015-2020-dietary-guidelines/guidelines/. Accessed 8 July 2020.
Vanlint S. Vitamin D and obesity. Nutrients. 2013;5:949–56. https://doi.org/10.3390/nu5030949.
Article CAS PubMed PubMed Central Google Scholar
Via MA, Mechanick JI. Nutritional and micronutrient care of bariatric surgery patients: current evidence update. Curr Obes Rep. 2017; https://doi.org/10.1007/s13679-017-0271-x.
von Drygalski A, Andris DA, Nuttleman PR, Jackson S, Klein J, Wallace JR. Anemia after bariatric surgery cannot be explained by iron deficiency alone: results of a large cohort study. Surg Obes Relat Dis. 2011;7:151–6. https://doi.org/10.1016/j.soard.2010.04.008.
Article Google Scholar
Weng T-C, Chang C-H, Dong Y-H, Chang Y-C, Chuang L-M. Anaemia and related nutrient deficiencies after Roux-en-Y gastric bypass surgery: a systematic review and meta-analysis. BMJ Open. 2015;5:e006964. https://doi.org/10.1136/bmjopen-2014-006964.
Article PubMed PubMed Central Google Scholar
Willoughby D, Hewlings S, Kalman D. Body composition changes in weight loss: strategies and supplementation for maintaining lean body mass, a brief review. Nutrients. 2018;10:1876. https://doi.org/10.3390/nu10121876.
Article CAS PubMed Central Google Scholar
Wolfe RR, Miller SL, Miller KB. Optimal protein intake in the elderly. Clin Nutr. 2008; https://doi.org/10.1016/j.clnu.2008.06.008.
Wolff T, Witkop CT, Miller T, Syed SB. Folic acid supplementation for the prevention of neural tube defects. Rockville (MD): Agency for Healthcare Research and Quality (US). 2009;Report No.: 09-05132-EF-1
Google Scholar
Zakharova I, Klimov L, Kuryaninova V, et al. Vitamin D insufficiency in overweight and obese children and adolescents. Front Endocrinol (Lausanne). 2019;10:103.
Google Scholar
Zarshenas N, Tapsell LC, Neale EP, Batterham M, Talbot ML. The relationship between bariatric surgery and diet quality: a systematic review. Obes Surg. 2020;30:1768–92. https://doi.org/10.1007/s11695-020-04392-9.
Article PubMed Google Scholar
Zhou S-S. Vitamin paradox in obesity: deficiency or excess? World J. Diabetes. 2015;6:1158. https://doi.org/10.4239/wjd.v6.i10.1158.
Article Google Scholar

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Department of Gastroenterology, Hepatology and Clinical Nutrition, Saint Peter’s University Hospital – Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ, USA
C. S. Pitchumoni
New York Medical College, Valhalla, NY, USA
C. S. Pitchumoni
Robert Wood Johnson School of Medicine, Rutgers University, New Brunswick, NJ, USA
C. S. Pitchumoni

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C. S. Pitchumoni
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Saint Peter's Healthcare System, New Brunswick, NJ, USA
C. S. Pitchumoni
Albert Einstein College of Medicine, Montefiore Medical Center, Wakefield Campus, Bronx, NY, USA
T.S. Dharmarajan

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Pitchumoni, C.S. (2020). Malnutrition in Obesity. In: Pitchumoni, C.S., Dharmarajan, T. (eds) Geriatric Gastroenterology. Springer, Cham. https://doi.org/10.1007/978-3-319-90761-1_110-1

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DOI: https://doi.org/10.1007/978-3-319-90761-1_110-1
Received: 16 July 2020
Accepted: 16 July 2020
Published: 12 October 2020
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-90761-1
Online ISBN: 978-3-319-90761-1
eBook Packages: Springer Reference MedicineReference Module Medicine

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Malnutrition in Obesity

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