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TalkingNutrition

Providing perspectives on recent research into vitamins and nutritionals

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Vitamins, Obesity, Bariatric Surgery, and Cystic Fibrosis

By Michael McBurney

Are you worried about getting too many vitamins? It is improbable. Experts informed the Secretaries of Agriculture and Health and Human Services that 8 essential nutrients are under-consumed (2015 DGAC Report ). About half of American adults (117 million people) have one or more preventable chronic diseases that relate to poor diet and physical inactivity. In addition, ≥ two-thirds of adults and nearly one-third of children and youth are overweight or obese.

Obesity results from an excess of nutrition (calories from fat, carbohydrate, protein and alcohol). Portion control, eating frequency, meal replacements, and very-low-energy diets are tools to curb energy intake. For some individuals, bariatric surgery is recommended to normalize body weight. It is difficult to obtain all the recommended nutrients when eating small portions. One has to choose foods with lots of essential nutrients and not many calories (nutrient density). Unfortunately, malnutrition can occur even when people are not restricting food intake.

Fifteen-to-29% of obese patients seeking bariatric surgery are reported to be thiamin deficient.  Yes, you read correctly, they were thiamin deficient before surgery. Bariatric surgery is known to increase risk of vitamin and mineral deficiencies. However, Kerns and colleagues dramatically demonstrate the double burden of obesity and malnutrition. Previously, reports indicate approximately 1/3 of patients entering American and European hospitals are malnourished. These statistics clearly demonstrate it is possible to eat too much food yet not enough essential vitamins such as thiamin, a condition known as hidden hunger.

Woestenenk and colleagues studied vitamin E intake and α-tocopherol concentrations in individuals with cystic fibrosis. Cystic fibrosis is a disease with pancreatic insufficiency leading to fat malabsorption and poor absorption of vitamins and minerals. Pulmonary inflammation may be caused by low vitamin E status. Similar to the general US population, dietary vitamin E intake, despite supplementation, was barely 50% of current recommendations. More importantly, the mean serum α-tocopherol concentrations (Fig 2) averaged ~750 mg/dL (17-18 µmol/L). These are much lower concentrations than the average 1,090 mg/dL (25 µmol/L) reported for Americans 6y and older.

In conclusion, nutrition status matters. Maintaining adequate serum vitamin D levels reduces risk of cardiovascular mortality. Maintaining adequate red blood cells folate concentrations reduces risk of birthing a child with a neural tube defect.

Whether one is in perfect health, overweight, or living with cystic fibrosis, don't wager with your health. Vitamins and minerals are essential for cells to function.

Main Citations

Kerns JC, Arundel C, Chawla LS. Thiamin deficiency in people with obesity. 2015 Adv Nutr doi: 10.3945/an.114.007526

Woestenenk J, Broos N, Stellato RK, Arets HGM, van der Ent C, Houwen RHJ. Vitamin E intake, α-tocopherol levels and pulmonary function in children and adolescents with cystic fibrosis. 2015 Br J Nutr doi: 10.1017/S0007114515000215

Other Citations

Seagle HM, Strain GW, Makris A, Reeves RS. Position of the American Dietetic Association: weight management. 2008 JADA doi:10.1016/j.jada.2008.1.041

Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, Heinburg LJ, Kushner R, Adams TD, Shikora S, Dixon JB, Brethauer S. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient – 2013 update: Cosponsored by American Association of Clinical Endocrinologies, The Obesity Society, and American Society for Metabolic and Bariatric Surgery. 2013 Obesity doi: 10.1002/oby.20461

Schindler K, Pernicka E, Laviano A, Howard P, Schutz T, Bauer P, Grecu I, Jonkers C, Kondrup J, Ljungqvist O,Mouhieddine M, Pichard C, Singer P, Schneider S, Schuh C, Hiesmayr M, The NutritionDay Audit Team. How nutritional risk is assessed and managed in European hospitals: A survey of 21,007 patients findings from the 2007-2008 cross-sectional nutritionDay survey. 2010 Clin Nutr doi:10.1016/j.clnu.2010.04.001

Muthayya S, Rah JH, Sugimoto JD, Roos FF, Kraemer K, Black RE. The global hidden hunger indices and maps: an advocacy tool for action. 2013 PLoSONE doi: 10.1371/journal.pone.0067860


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