GLOBAL ENDOCRINOLOGY: Global perspectives in endocrinology: coverage of iodized salt programs and iodine status in 2020.

Iodine deficiency has multiple adverse effects on growth and development. Diets in many countries cannot provide adequate iodine without iodine fortification of salt. In 2020, 124 countries have legislation for mandatory salt iodization and 21 have legislation allowing voluntary iodization. As a result, 88% of the global population uses iodized salt. For population surveys, the urinary iodine concentration (UIC) should be measured and expressed as the median, in µg/L. The quality of available survey data is high: UIC surveys have been done in 152 out of 194 countries in the past 15 years; in 132 countries, the studies were nationally representative. The number of countries with adequate iodine intake has nearly doubled from 67 in 2003 to 118 in 2020. However, 21 countries remain deficient, while 13 countries have excessive intakes, either due to excess groundwater iodine, or over-iodized salt. Iodine programs are reaching the poorest of the poor: of the 15 poorest countries in the world, 10 are iodine sufficient and only 3 (Burundi, Mozambique and Madagascar) remain mild-to-moderately deficient. Nigeria and India have unstable food systems and millions of malnourished children, but both are iodine-sufficient and population coverage with iodized salt is a remarkable 93% in both. Once entrenched, iodine programs are often surprisingly durable even during national crises, for example, war-torn Afghanistan and Yemen are iodine-sufficient. However, the equity of iodized salt programs within countries remains an important issue. In summary, continued support of iodine programs is needed to sustain these remarkable global achievements, and to reach the remaining iodine-deficient countries.

A prospective analysis of micronutrient status in quiescent inflammatory bowel disease.

BACKGROUND AND AIMS: ESPEN guidelines advocate patients with inflammatory bowel disease (IBD) have their micronutrient levels checked regularly. This study described the micronutrient status of patients with quiescent IBD and explores whether biochemical micronutrient deficiencies related to time to subsequent disease relapse. METHODS: Sixteen micronutrients were measured prospectively in blood of patients with IBD in clinical remission [Harvey Bradshaw Index (HBI) ≤4 in Crohn's disease (CD) and a partial Mayo score <2 in ulcerative colitis (UC)]. Patients were followed prospectively using the electronic patient records. The ability of micronutrient status to predict time to relapse was tested with survival analysis and Cox regression. RESULTS: Ninety-three patients were enrolled; Fifty (54%) were also in biochemical remission defined as a normal faecal calprotectin (<250 µg/g), C-reactive protein (<10 mg/L) and serum albumin (>35 g/L). Deficiencies in vitamin D were identified in 27 (29%), zinc in 15 (16%), vitamin B6 in 13 (14%), vitamin C in 12 (13%) and vitamin B12 in 10 (11%). Fewer participants had low serum folate 7 (8%), ferritin 8 (9%), copper 4 (4%), magnesium 4 (4%) and plasma selenium 3 (3%). Zinc deficiency was predictive of a shorter time to subsequent relapse (HR: 6.9; 95%CI [1.9 to 26], p = 0.008); in sub analysis of those with CD this effect was even more profound (p = 0.001). CONCLUSION: We identified biochemical deficiencies for several micronutrients among adults with IBD clinically in remission. We have also highlighted a significant association between zinc deficiency and time to subsequent disease relapse in patients with CD which needs further investigation.

Prevalence of nutritional deficiencies in bariatric surgery candidates and its effect on metabolic status.

BACKGROUND: Nutritional deficiencies are common among obese individuals and constitute one of the main concerns in the bariatric field. The aim of this study was to investigate nutritional status in bariatric surgery candidates, comparing individuals with and without metabolic syndrome (MetS) and to explore possible associations between nutritional and metabolic status. METHODS: Patients accepted for gastric sleeve surgery between 2010 and 2015 were included and anthropometric and metabolic parameters were recorded before surgery. Univariate and multivariate analyses were applied in order to find possible associations between MetS, nutritional, anthropometric, and metabolic parameters. RESULTS: A total of 330 patients were evaluated (285 females, mean age of 41.88 ± 10.4 years old, mean body mass index 43.91 ± 6.2 kg/m2) and MetS was present in 47% of them. Patients without MetS presented a higher prevalence of folate deficiency (12 vs. 2%, p < 0.001). Male gender, older age, lower magnesium levels, and higher BMI and calcium levels were predictors of a greater number of MetS components. Male gender, a greater number of MetS components, and lower magnesium were predictors of higher homeostatic model assessment for insulin resistance (HOMA-IR). CONCLUSIONS: The rising prevalence of obesity is causing a parallel increase in the use of bariatric surgery. The high occurrence of preoperative nutritional deficiencies can impair metabolic status and contribute to a worse outcome after surgery. Nutritional assessment and improvement before surgery may be crucial to optimize patient status, and future studies should explore the effect of the correction of these deficiencies in the metabolic status of these patients.

Effects of standard v. very long Roux limb Roux-en-Y gastric bypass on nutrient status: a 1-year follow-up report from the Dutch Common Channel Trial (DUCATI) Study.

Laparoscopic Roux-en-Y gastric bypass (RYGB) is considered the 'gold standard' for surgical treatment of morbid obesity. It is hypothesised that reducing the length of the common limb positively affects the magnitude and preservation of weight loss but may also impose a risk of malnutrition. The aim of this study was to compare patients' nutrient and vitamin deficiencies in standard RYGB with a very long Roux limb RYGB (VLRL-RYGB). This study was part of the multicentre randomised controlled trial (Dutch Common Channel Trial), including 444 patients undergoing an RYGB or a VLRL-RYGB. Laboratory results, use of multivitamin supplements and reoperations were collected at baseline and 1 year postoperative. Primary outcome measure was nutrient deficiency after 1 year postoperative. Secondary outcome measure was the reoperation rate due to malabsorption. In total, 227 patients underwent RYGB and 196 patients underwent VLRL-RYGB. Most common deficiencies at 1 year postoperative were ferritin (17·2-18·2 %), Fe (23·4-35·6 %), K (7·4-15·2 %), vitamin B12 (9·0-9·9 %) and vitamin D (22·7-34·5 %). Patients undergoing VLRL-RYGB had slightly but significantly lower levels of Ca, Fe and vitamin D compared with those undergoing RYGB at 1 year postoperative, but significantly higher levels of folic acid and Na. Reoperation rates due to malabsorption were not significantly different between RYGB (2/227, 0·9 %) and VLRL-RYGB (7/196, 3·6 %) (P = 0·088). We concluded that patients undergoing VLRL-RYGB had significantly lower levels of Ca, Fe and vitamin D compared with those undergoing RYGB at 1 year postoperative, but higher levels of folic acid and Na. Reoperation rates did not differ. Close monitoring on nutrient deficiencies should be performed in patients undergoing VLRL-RYGB.

Nutritional Deficiencies in Patients with Severe Obesity before Bariatric Surgery: What Should Be the Focus During the Preoperative Assessment?

BACKGROUND: Nutritional deficiencies are a well-recognized long-term complication following bariatric surgery. The presence of preoperative deficiencies has been shown to be predictive of postoperative deficiencies. OBJECTIVE: The aim of the study was to investigate the prevalence of micronutrient deficiency in a large sample of patients with severe obesity preoperatively, and to determine whether such deficiencies may be related to patient's sex, body mass index, or ethnic subgroup. DESIGN: A cross-sectional study of data collected at the time of the preoperative evaluation. PARTICIPANTS/SETTING: Data were collected during the preoperative evaluation of 872 bariatric surgery candidates in a university hospital in Israel between 2011 and 2018. The patients were 72.9% women, with a mean age of 37.9±12.1 years and mean body mass index of 42.4±4.7 MAIN OUTCOME MEASURES: Nutritional deficiencies according to blood assays. Data on anthropometrics, comorbidities, and demographic characteristics was also collected. STATISTICAL ANALYSES: Baseline differences between patient subgroups were analyzed using independent-samples t test, analysis of variance, or χ2 test. RESULTS: Deficiencies of vitamin D, iron, folate, vitamin B-12, elevated parathyroid hormone and low transferrin saturation were present in 75.2%, 42.6%, 28.5%, 8.5%, 35.5%, and 70% of patients, respectively. Nutritional deficiencies were significantly more common among women compared with men for iron (45.9% vs 33.5%; P=0.002), low transferrin saturation (77.7% vs 44.6%; P<0.001), vitamin D (77.5% vs 69.2%; P=0.019) and elevated parathyroid hormone level (39.5% vs 22.9%; P=0.002). Iron, transferrin saturation, and vitamin D deficiencies were more prevalent in Arab patients compared with Jewish patients: 59.6% vs 36%; P<0.001, 80.2% vs 62.8%; P=0.003, and 85.1% vs 71.6%; P<0.001, respectively. Vitamin D and iron deficiency were more common among higher body mass index subgroups (P=0.004 and P=0.040, respectively). CONCLUSIONS: The results indicate a high prevalence of nutritional deficiencies, mainly of iron and vitamin D in bariatric surgery candidates. Patients at higher risk for nutritional deficiencies include those with higher body mass index, women, and Arabs.

Impact of Nutritional Deficiencies on Children and Young Adults with Crohn's Disease Undergoing Intraabdominal Surgery.

PURPOSE: We examined the impact of comorbidities on length of stay and total hospital charges for children and young adults with Crohn's Disease (CD) undergoing surgery. METHODS: Patients (<21 years) were identified with a diagnosis of CD and an intraabdominal surgery in the Kids' Inpatient Database for the years 2006, 2009 and 2012. Length of stay (LOS) and total hospital charges (THC; USD$) were stratified by anemia, anxiety, depression and nutritional deficiency. National estimates were obtained using case weighting and multivariable linear regression was performed. RESULTS: We identified 3224 CD admissions with an intraabdominal surgery. The population was predominantly male, non-Hispanic white, and high school aged. There was an increase in LOS and THC for nutritional deficiency in all study years, and for depression and anemia in specific years. Multivariable linear regression revealed a 3.3-5.5 day increase in LOS associated with a comorbid diagnosis of nutritional deficiency. However, no increase in THC was seen for any comorbidity under evaluation. CONCLUSIONS: Behavioral health and, particularly, nutritional status have a significant impact on the care of children and young adults with CD. Nutritional deficiency, anemia, and depression resulted in increased LOS for those undergoing surgery. Improved presurgical management of comorbidities may reduce LOS for these patients. LEVEL OF EVIDENCE: III.

Association of Serum Zinc Concentration with Preservation of Renal Function After Bariatric Surgery: a Retrospective Pilot Study.

BACKGROUND: Although serum zinc level (Zn) is known to impact renal function in patients with diabetes, their correlation following bariatric surgery remains unknown. This study aimed at assessing the association of Zn with estimated glomerular filtration rate (eGFR) after laparoscopic sleeve gastrectomy (LSG). METHODS: One hundred and twenty-nine patients in total (mean age, 38.1 ± 10.8; body mass index, 39.1 ± 5.1 kg/m2) with normal preoperative kidney function undergoing LSG at a single tertiary referral center were reviewed. The primary study endpoint was the relationship between Zn and post-LSG eGFR at 12-month follow-up. The secondary outcomes were the associations of percentage weight loss (%WL) with changes in Zn (△Zn) and eGFR (△eGFR). RESULTS: The incidence of zinc deficiency was 8.5%, 8.1%, and 29.9% at baseline, post-LSG and one- and 12-month follow-up, respectively. At 12-month follow-up, Zn dropped from 104.1 ± 19.2 to 85.3 ± 38.9 µg/dL (p = 0.001), while eGFR levels decreased from 106.6 ± 10.3 to 102.1 ± 19.4 mL/min per 1.73 m2 (p = 0.025). Zn correlated positively with eGFR at 6-month (r = 0.252, p = 0.037) and 12-month (r = 0.41, p = 0.001) follow-ups. Multiple linear regression analyses including baseline variables of age, sex, BMI, %WL, and diabetes identified Zn and %WL as independent predictors of eGFR at 12-month follow-up. There was no evidence of multicollinearity among these variables. Despite positive association between %WL and △eGFR (r = 0.222, p = 0.031), no correlation was noted between %WL and △Zn (r = - 0.129, p = 0.40). CONCLUSION: The results demonstrated a positive relationship between post-LSG serum zinc levels and preservation of renal function among patients with obesity in a surgical setting. Large-scale studies are warranted to support the findings.

Iron intake and iron status during pregnancy and risk of congenital heart defects: A case-control study.

BACKGROUND: The relationships between iron nutritional status and congenital heart defects (CHDs) among humans are still unclear. This study aimed to explore the associations of maternal iron intake during pregnancy and maternal and neonatal iron status with CHDs. METHODS: This hospital-based case-control study analyzed 474 cases and 948 controls in Shaanxi China. Eligible women waiting for delivery in the hospital were interviewed to report their diets and characteristics during pregnancy. We conveniently collected maternal blood before delivery and neonatal cord blood to get a subgroup of 50 cases and 100 controls. Mixed logistic regression models were used to estimate ORs (95%CIs) for CHDs associated with iron intake. Mixed linear regression models were used to assess the relationships between CHDs and iron status. RESULTS: Mothers whose fetuses have CHDs were less likely to have higher intakes of total iron and heme iron during pregnancy, and the tests for linear trend were significant (all P < 0.05). Mothers whose fetuses have CHDs were less likely to take iron supplements during pregnancy (OR = 0.28, 95%CI: 0.21, 0.36) and during the first trimester (OR = 0.32, 95%CI: 0.12, 0.84). Maternal SF and Hb concentrations before delivery were lower and maternal sTfR/SF before delivery was higher among the cases than the controls. CONCLUSIONS: Mothers whose fetuses have CHDs are less likely to have higher intakes of total iron and heme iron and take iron supplements during pregnancy compared to their counterparts. Maternal iron status before delivery is low among mothers whose fetuses have CHDs.

Micronutrient Deficiencies After Roux-en-Y Gastric Bypass: Long-Term Results.

BACKGROUND: Patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) are under risk of micronutrient deficiencies. We aimed to assess the preoperative and postoperative micronutrient deficiencies in a sample of patients with obesity who underwent LRYGB. METHODS: We evaluated 169 patients-satisfying the National Institute of Health criteria for bariatric surgery-who underwent a LRYGB from January 2014 to July 2017. Before surgery, we recorded a detailed medical history for every patient, and after surgery, we instructed them to return at 1, 6, 12, 24, 36, and 48 months after surgery. RESULTS: Preoperatively, anemia was present in 4.24% of patients, iron deficiency in 5.33%, vitamin B12 deficiency in 12.3%, and vitamin D deficiency in 74.35%. Postoperatively, the deficiency rates of calcium, magnesium, folate, and vitamins A, B1, and B6 were markedly low at 1, 2, and 3 years after surgery. In regard to anemia, iron, and vitamin B12, rates of deficiency were higher at 2 and 3 years postoperatively versus preoperatively, but only anemia (4% vs 14% and 4% vs 27%, at 2 and 3 years) and iron (5% vs 23% at 3 years) reached statistical significance. Compared with the preoperative assessment, the rates of vitamin D deficiency decreased over time (74% vs 50% at 1 year [p < 0.001], 74% vs 45% at 2 years [p < 0.002] and 74% vs 41% at 3 years [p < 0.04]). CONCLUSIONS: Vitamin D deficiency remains the most common preoperative deficiency. Anemia and deficiencies of iron and vitamin B12 are common before and after surgery. Deficiencies of calcium, magnesium, folate, and vitamins A, B1, and B6 are markedly low in the postoperative period.

Micronutrient Deficiencies in Children With Inflammatory Bowel Diseases.

BACKGROUND: Children with inflammatory bowel diseases (IBDs) are at risk of developing nutrition deficiencies, particularly because of reduced intake, restrictive diets, malabsorption, and excessive nutrient loss. In this study, we aimed to assess the status of trace elements, minerals, and vitamins in a large cohort of children with IBDs. METHODS: Medical records of children diagnosed with IBDs during 2000-2016 were reviewed retrospectively. Retrieved data included demographics, disease characteristics, disease activity indices, anthropometric measures, and specific trace elements, minerals, and vitamins at diagnosis and during follow-up. RESULTS: Out of 359 children with IBD (158 [44%] females, median age at diagnosis 14.1 years, interquartile range [IQR] 12.0-16.0), 240 (67%) were diagnosed with Crohn's disease (CD) and 119 (33%) with ulcerative colitis (UC). Median follow-up time was 7 years (IQR 5-10). The prevalence of deficiencies in patients with CD at diagnosis and last follow-up, respectively, were iron (88% and 39.5%), zinc (53% and 11.5%), vitamin D (39% and 36%), and folic acid (10% and 13%). In patients with UC, frequencies were: iron (77% and 40%), vitamin D (49% and 33%), zinc (31% and 10%), and folic acid (3.8% and 9.7%). Magnesium and vitamin B12 deficiencies were rare. For both diseases, iron deficiency was associated with hypoalbuminemia. Deficiencies in iron and zinc were more common in patients with CD than those with UC. CONCLUSIONS: Deficiencies in iron, zinc, and vitamin D are common at pediatric IBD diagnosis with limited improvement during follow-up, whereas deficiencies in magnesium and vitamin B12 are rare.

[Anemia, iron and zinc deficiencies, supplements consumption and morbidity in Mexican children aged 1 to 4: analysis of Ensanut 100k.] / Anemia, deficiencias de zinc y hierro, consumo de suplementos y morbilidad en niños mexicanos de 1 a 4 años: resultados de la Ensanut 100k.

OBJECTIVE: To analyze the association between supplements and Liconsa milk intake, with anemia, zinc (ZD) and iron (ID) deficiencies, and morbidity in Mexican children resident of less than 100 000 habitants' localities. MATERIALS AND METHODS: A subsample of 1 516 children aged 1-4 participants of Ensanut 100k was analyzed, carried out in 2018. Anemia was considered if [Hb]<11 g/dL, ZD if [Zn]<65 µg/dL and ID if [ferritin]<12 µg/L. Supplements and Liconsa milk consumption were obtained from a semi-quantitative food frequency; morbidity by self-report of the mother. Multiple logistic regression models were used adjusted by confounders. RESULTS: Medium and high consumption of Liconsa milk was associated to lower odds of ID (OR=0.02, [95%CI 0.002,0.24] and OR=0.07, [95%CI 0.01,0.52]) and anemia (OR=0.13, [95%CI 0.04,0.37] and OR=0.17, [95%CI 0.03,0.87]). A high intake of Liconsa milk (OR=0.09, [95%CI 0.01,0.44]) and Vitaniño (OR=0.05 [95%CI 0.005, 0.46]) were both associated to lower diarrhea risk. CONCLUSIONS: To assure the continuity of the consumption of nutritional supplements is necessary for improving the health and the micronutrients status in vulnerable Mexican children.

OBJETIVO: Analizar la asociación entre el consumo de suplementos o leche Liconsa y anemia, deficiencias de zinc (DZ) y hierro (DH) y morbilidad en niños mexicanos residentes de localidades menores a 100 000 habitantes. MATERIAL Y MÉTODOS: Se analizó información de 1 516 niños de 1 a 4 años de la Encuesta Nacional de Salud y Nutrición en localidades con menos de 100 000 habitantes realizada en el año 2018. Se definió Anemia si [Hb]<11 g/dL, DZ: [Zn]<65 µg/dL y DH: [ferritina]<12 µg/L. El consumo de suplementos y de leche Liconsa se obtuvo del cuestionario de Frecuencia de Consumo de Alimentos y morbilidad por autorreporte de la madre. Se emplearon modelos de regresión logística múltiple para el análisis de las asociaciones, ajustados por confusores. RESULTADOS: El consumo medio y alto de leche Liconsa se asoció con menor momio de DH (RM=0.02 [IC95% 0.002,0.24] y RM=0.07 [IC95% 0.01,0.52]) y anemia (RM=0.13 [IC95% 0.04,0.37] y RM=0.17 [IC95% 0.03,0.87]). Un alto consumo de leche Liconsa (RM=0.09, [IC95% 0.01,0.44]) y de Vitaniño (RM=0.05 [IC95% 0.005, 0.46]) se asoció con menor momio de diarrea. CONCLUSIONES: Es necesario considerar la continuidad del consumo de suplementos nutricionales para mejorar la salud y el estado de micronutrimentos en población infantil mexicana vulnerable.

Anemia, deficiencias de zinc y hierro, consumo de suplementos y morbilidad en niños mexicanos de 1 a 4 años: resultados de la Ensanut 100k / Anemia, iron and zinc deficiencies, supplements consumption and morbidity in Mexican children aged 1 to 4: analysis of Ensanut 100k

Resumen: Objetivo: Analizar la asociación entre el consumo de suplementos o leche Liconsa y anemia, deficiencias de zinc (DZ) y hierro (DH) y morbilidad en niños mexicanos residentes de localidades menores a 100 000 habitantes. Material y métodos: Se analizó información de 1 516 niños de 1 a 4 años de la Encuesta Nacional de Salud y Nutrición en localidades con menos de 100 000 habitantes realizada en el año 2018. Se definió Anemia si [Hb]<11 g/dL, DZ: [Zn]<65 µg/dL y DH: [ferritina]<12 µg/L. El consumo de suplementos y de leche Liconsa se obtuvo del cuestionario de Frecuencia de Consumo de Alimentos y morbilidad por autorreporte de la madre. Se emplearon modelos de regresión logística múltiple para el análisis de las asociaciones, ajustados por confusores. Resultados: El consumo medio y alto de leche Liconsa se asoció con menor momio de DH (RM=0.02 [IC95% 0.002,0.24] y RM=0.07 [IC95% 0.01,0.52]) y anemia (RM=0.13 [IC95% 0.04,0.37] y RM=0.17 [IC95% 0.03,0.87]). Un alto consumo de leche Liconsa (RM=0.09, [IC95% 0.01,0.44]) y de Vitaniño (RM=0.05 [IC95% 0.005, 0.46]) se asoció con menor momio de diarrea. Conclusiones: Es necesario considerar la continuidad del consumo de suplementos nutricionales para mejorar la salud y el estado de micronutrimentos en población infantil mexicana vulnerable.

Abstract: Objective: To analyze the association between supplements and Liconsa milk intake, with anemia, zinc (ZD) and iron (ID) deficiencies, and morbidity in Mexican children resident of less than 100 000 habitants' localities. Materials and methods: A subsample of 1 516 children aged 1-4 participants of Ensanut 100k was analyzed, carried out in 2018. Anemia was considered if [Hb]<11 g/dL, ZD if [Zn]<65 µg/dL and ID if [ferritin]<12 µg/L. Supplements and Liconsa milk consumption were obtained from a semi-quantitative food frequency; morbidity by self-report of the mother. Multiple logistic regression models were used adjusted by confounders. Results: Medium and high consumption of Liconsa milk was associated to lower odds of ID (OR=0.02, [95%CI 0.002,0.24] and OR=0.07, [95%CI 0.01,0.52]) and anemia (OR=0.13, [95%CI 0.04,0.37] and OR=0.17, [95%CI 0.03,0.87]). A high intake of Liconsa milk (OR=0.09, [95%CI 0.01,0.44]) and Vitaniño (OR=0.05 [95%CI 0.005, 0.46]) were both associated to lower diarrhea risk. Conclusions: To assure the continuity of the consumption of nutritional supplements is necessary for improving the health and the micronutrients status in vulnerable Mexican children.

Infant feeding practices in relation to iron status and other possible nutritional deficiencies in Pathumthani, Thailand.

BACKGROUND AND OBJECTIVES: Iron deficiency (ID) is the most common micronutrient deficiency worldwide and usually leads to impaired neurodevelopment. Appropriate introduction of complementary foods is mandatory for all infants to prevent iron insufficiency. We aimed to demonstrate feeding behaviors in relation to infant iron status and also identify potential concomitant nutrient inadequacies. METHODS AND STUDY DESIGN: A cross-sectional descriptive study of infants 6-12 months old was performed at the Well Baby Clinic at Thammasat University Hospital, Pathumthani. Demographic data, feeding practices and nutritional status were obtained. Dietary intake was evaluated using general and food frequency questionnaires. Blood samples for complete blood count and iron studies were investigated. RESULTS: We enrolled 206 infants (mean age 8.552.1 months). Prevalence of ID and iron deficiency anemia (IDA) was 34.0% and 25.7%, respectively. In multivariable ordinal continuation ratio logistic regression analysis for risk of iron depletion severity among the 3 groups (normal, ID and IDA infants), we found a stepwise increase in odds ratios for iron depletion with lower family income, longer duration of breastfeeding, delayed introduction of meat, and lower dietary iron intake. IDA infants had significantly lower intakes of energy, protein, fat and various micronutrients, compared to those with normal iron status. CONCLUSIONS: Infants with ID may have low intakes of other nutrients due to reduced complementary food intake. Nutritional education for appropriate feeding practices should be provided to prevent ID and other possible micronutrient deficiencies.

Supplementation Adherence and Outcomes Among Pregnant Women After Bariatric Surgery.

PURPOSE: Most patients undergoing bariatric surgery (BS) are fertile women whose postoperative (post-op) hormonal balance and weight loss increases fertility, frequently leading to pregnancy. This study aims to analyze supplementation adherence of pregnant women after BS and perinatal outcomes. MATERIALS AND METHODS: This retrospective study analyzed records from women after BS who consulted nutritionists at least twice during pregnancy. Each patient received nutritional guidance about vitamin and mineral supplementation and protein intake. Demographic data, body mass index (BMI), percentage of weight loss (%WL) at conception, maximum post-op BMI and %WL, post-op time at conception, supplementation adherence, biochemical data, possible gestational complications, and infant's birth weight were collected. RESULTS: Data was obtained from 23 women (mean age 33 ± 4 years). On average, patients became pregnant 43 months after surgery. The mean preoperative BMI was 40.2 kg/m2, the maximum post-op %WL was 36.6%, and the mean %WL at conception was 32.0%. No gestational intercurrence was related to biochemical data. Supplementation adherence was 34.7% for one multivitamin and 34.7% for two multivitamins; 43.5% for iron, 43.5% for omega 3, 39.1% for folic acid, 17.4% for B complex, and 60.8% for calcium. Mean infant birth weight was 3.0 kg, and it was not associated with maximum %WL, % WL at conception, and time since BS at conception. CONCLUSION: Our data indicate satisfactory adherence to post-op micronutrient supplementation and few gestational complications following BS. Moreover, child's birth weight was not associated with maximum %WL, %WL at conception, or time since BS.

Nutritional Deficiencies in Severe Obesity: a Multiethnic Asian Cohort.

BACKGROUND: Micronutrient deficiencies are highly prevalent in patients seeking metabolic-bariatric surgery (MBS), although literature remains scant in Asia. In this study, we assess the prevalence of nutritional deficiencies in patients with clinically severe obesity in Singapore and examine factors associated with the deficiencies. METHODS: This is a prospective, observational study of 577 consecutive patients scheduled to undergo MBS. Nutritional profile including renal panel, calcium, phosphate, intact parathyroid hormone (iPTH), 25-hydroxyvitamin D (25(OH)D), vitamin B12, folate, ferritin, iron studies, hemoglobin, albumin, and alkaline phosphatase were analyzed. RESULTS: Mean age was 40.6 ± 10.3 years, 61.2% female, and mean BMI 42.4 ± 8.4 kg/m2. 92.9% had suboptimal vitamin D levels; of which 25.6% had vitamin D insufficiency (25(OH)D < 30 mcg/L), 57.5% had vitamin D deficiency (25(OH)D < 20 mcg/L), and 9.8% had severe vitamin D deficiency (25(OH)D < 10 mcg/L). Younger age, female gender, and higher BMI were independent factors associated with lower 25(OH)D. There was an inverse relationship between iPTH and 25(OH)D, with an inflection point at 25(OH)D of approximately 20 mcg/L. Folate deficiency was present in 31% and vitamin B12 deficiency in 9.5% of the cohort. Serum ferritin levels were low in 29.3%. 25(OH)D, ferritin, serum iron, and albumin were also significantly higher in Chinese compared to Malay and Indian patients. CONCLUSION: Vitamin D deficiency was the most common micronutrient deficiency observed in this multi-ethnic Asian cohort presenting for MBS. Ethnic differences in nutritional status were observed.

Polyneuropathy in Severely Obese Women Without Diabetes: Prevalence and Associated Factors.

BACKGROUND: Obesity and its complications are prevalent in women and increase with age. Polyneuropathy (PNP) is a complication of obesity and bariatric surgery (BS). In subjects with severe (grades II and III) obesity and without DM who are candidates for BS, the prevalence of PNP and associated conditions are not well characterized. The aim of this study was to evaluate the prevalence of PNP in severely obese (SO) women without DM or common nutritional deficiencies in order to determine factors associated with the presence of PNP. METHODS: A cross-sectional study was performed on 450 SO women. They were evaluated with the Michigan Neuropathy Screening Instrument, a Sleep Apnea Questionnaire, and the short form of the International Physical Activity Questionnaire. Data on blood pressure, body mass index, waist circumference, serum glucose, glycated hemoglobin, LDL and HDL cholesterol, triglycerides, vitamin B12, and postmenopausal (PM) status were also collected. Patients with DM and other common causes of PNP were excluded. To evaluate which variables were independently associated with PNP (dependent variable), Poisson regression models were used. RESULTS: The prevalence of PNP was 11.6%. In univariate analysis, PNP was associated with age, PM status, and diagnosis of systemic arterial hypertension (p < 0.001, p < 0.001, and p = 0.016, respectively), and there was a trend toward an association with sleep apnea risk (p = 0.101). In multivariate analysis, PM status (PR = 2.836, 95% CI 1.735-4.636, p = 0.001) and age (PR = 1.0511, 95% CI 1.031-1.071, p = 0.001) were independently associated with PNP diagnosis in two different models. CONCLUSION: Even prior to BS, PNP is highly prevalent and is associated with PM status and age in SO women without diabetes.

Low yield for routine laboratory checks in follow-up of coeliac disease.

AIM: To evaluate the yield of routine laboratory tests and Dual Energy X-ray Absorptiometry (DEXA) scans in coeliac disease. METHODS: A retrospective analysis of medical files of all followed-up patients with coeliac disease attending Rijnstate Hospital in 2016 was conducted with respect to blood tests of hemoglobin, vitamin B12, folate acid, iron status, calcium, vitamin D, glucose, thyroid function, DEXA-scans and related symptoms or signs of abnormalities. All patients had positive coeliac serology and/or biopsy-proven coeliac disease and attended regular visits after diagnosis. The chi-square test for trend was used for statistical analysis: a two-tailed probability of p < 0.05 was considered significant. RESULTS: We analyzed 250 patients with a median follow-up of 7.8 (1-22) years. At diagnosis, we found anemia in 24.4%, iron deficiency in 38%, folic acid deficiency in 22.6% and vitamin B12 deficiency in 15.9%. All deficiencies recovered within 1-2 years with or without supplements. Deficiencies or autoimmune diseases occurred in 50 patients (37 possibly coeliac-related) during follow-up. Twelve cases of coeliac-related deficiencies or autoimmune diseases occurred in patients with normal values at diagnosis of whom 10 were asymptomatic (incidence 10/1000 patient years). Osteoporosis and osteopenia were present in 23.3% and 35% at diagnosis. In most patients bone mineral density (BMD) improved or stabilized during follow up (p < 0.05), 8% deteriorated. CONCLUSIONS: The incidence of asymptomatic coeliac-related deficiencies or autoimmune diseases is low in patients with normal values at diagnosis. Therefore, routine laboratory screening is not necessary in this group: attending regular follow-up visits should be sufficient. DEXA scans are recommended.

Projected effectiveness of mandatory industrial fortification of wheat flour, milk, and edible oil with multiple micronutrients among Mongolian adults.

Industrial fortification of wheat flour is a potentially effective strategy for addressing micronutrient deficiencies in Mongolia, given its ubiquitous consumption and centralized production. However, Mongolia has not mandated fortification of any foods except for salt with iodine. This study modeled the effectiveness and safety of mandatory industrial fortification of wheat flour alone and in combination with edible oil and milk in reducing the prevalence of multiple micronutrient intake deficiencies among healthy non-pregnant adults in Mongolia. Six days of diet records (3 summer, 3 winter) were collected from 320 urban and rural adults across the country and analyzed for food and nutrient consumption using a purpose-built food composition table, and the Intake Monitoring and Planning Program (IMAPP) was used to project the effects of fortification on summer and winter bioavailable micronutrient intake and intake deficiency under different fortification guidelines within population subgroups defined by urban or rural locality and sex. Projections showed that flour fortification would be effective in reducing intake deficiencies of thiamin and folate, while marginal benefits of fortification with iron and riboflavin would be smaller given these nutrients' higher baseline consumption, and fortification with zinc, niacin, and vitamin B12 may be unnecessary. Fortification of flour, oil, and milk with vitamins A, D, and E at levels suggested by international guidelines would substantially reduce vitamin A intake deficiency and would increase vitamin D intake considerably, with the greatest benefits elicited by flour fortification and smaller benefits by additionally fortifying oil and milk. These results support mandatory industrial fortification of wheat flour, edible oil, and milk with iron, thiamin, riboflavin, folate, and vitamins A, D, and E in Mongolia. Considerations will be necessary to ensure the fortification of these nutrients is also effective for children, for whom the potential benefit of zinc, niacin, and vitamin B12 fortification should be assessed.

MGB-OAGB: Effect of Biliopancreatic Limb Length on Nutritional Deficiency, Weight Loss, and Comorbidity Resolution.

INTRODUCTION: Mini gastric bypass-one anastomosis gastric bypass (MGB-OAGB) has been approved as a mainstream metabolic/bariatric procedure by IFSO. Still there are lots of concerns regarding nutritional deficiency after MGB-OAGB. The purpose of this retrospective analysis is to evaluate the effect of biliopancreatic limb (BPL) length on weight loss, comorbidity resolution, and nutritional deficiencies in patients 1 year after MGB-OAGB and to find suitable BPL length. MATERIAL AND METHODS: One hundred and one patients who underwent MGB-OAGB were divided into three groups of 150 cm, 180 cm, and 250 cm depending on the length of BPL bypassed. The nutritional parameters (vitamin D3, vitamin B12, serum iron, serum ferritin, total protein, serum albumin, serum globulin), anthropometric measurements (weight, BMI), and comorbidity resolution (T2DM, hypertension) were compared between the three groups at 1-year follow-up. RESULTS: There was statistically significant difference in number of patients having deficiencies in all the nutritional parameters except globulin between 150 cm and 250 cm groups (P < 0.05). While on comparing 180- and 250-cm group, a statistically significant difference was present in vitamin D3, vitamin B12, and total protein (P < 0.05) only. The difference was statistically insignificant between the three groups on T2DM, hypertension resolution, and %EWL but TWL between 150 cm vs 180 cm and 150 cm vs 250 cm showed significant difference. CONCLUSION: A 150-cm BPL length is adequate with very minimal nutritional complications and good results. A 180-cm BPL can be used in super obese while a 250-cm BPL should be used with utmost care as it results in significant nutritional deficiencies.

Suboptimal Iodine Status among Pregnant Women in the Oslo Area, Norway.

Norway has been considered iodine replete for decades; however, recent studies indicate reemergence of inadequate iodine status in different population groups. We assessed iodine status in pregnant women based on urinary iodine concentration (UIC), urinary iodine excretion (UIE), and iodine intake from food and supplements. In 804 pregnant women, 24-h iodine intakes from iodine-rich foods and iodine-containing supplements were calculated. In 777 women, iodine concentration was measured in spot urine samples by inductively coupled plasma/mass spectrometry (ICP-MS). In addition, 49 of the women collected a 24-h urine sample for assessment of UIE and iodine intake from food frequency questionnaire (FFQ). Median UIC was 92 µg/L. Fifty-five percent had a calculated iodine intake below estimated average requirement (EAR) (160 µg/day). Iodine intake from food alone did not provide the amount of iodine required to meet maternal and fetal needs during pregnancy. In multiple regression models, hypothyroidism, supplemental iodine and maternal age were positively associated with UIC, while gestational age and smoking were negatively associated, explaining 11% of the variance. This study clearly shows that pregnant women in the Oslo area are mild to moderate iodine deficient and public health strategies are needed to improve and secure adequate iodine status.