Prevalence of Micronutrient Deficiencies in Preoperative Bariatric Patients in a New Zealand Tertiary Centre.

PURPOSE: A potential complication of bariatric surgery is development of nutritional deficiencies. Study aims were to assess prevalence of micronutrient deficiencies in preoperative bariatric patients and to examine for ethnic differences. METHODS: Retrospective analysis of 573 patients that underwent bariatric surgery at Counties Manukau District Health Board was carried out. Mean preoperative levels of albumin, calcium, phosphate, folate, vitamin B12, vitamin D, magnesium, haemoglobin, haematocrit, mean cell volume, mean cell haemoglobin, ferritin, iron, and transferrin were calculated. Chi square, fisher exact test, and multiple logistic regression was used to assess for differences in prevalence of micronutrient deficiencies across ethnicities. RESULTS: The most common micronutrient deficiency was vitamin D (30.85%). There were statistically significant differences in vitamin D deficiency across ethnicities (p < 0.0001). Asians had the highest prevalence of vitamin D deficiency (60%), followed by Pacifica (44.57%), and Maori (31.68%). Asians were more likely to have vitamin D deficiency compared to NZ/Other Europeans (OR = 14.93, p < 0.001). Vitamin D deficiency was associated with higher BMI (OR = 1.05, p = 0.008). The second most common deficiency was iron (21.1%). Asians had the highest prevalence of iron deficiency (44%), followed by Maori (27.95%), and Pacifica (19.57%) (p = 0.0064). Compared to NZ/Other Europeans, Asians (OR = 4.26) and Maori (OR = 1.78) were more likely to be iron deficient (p = 0.004). Female gender was associated with iron deficiency (OR = 2.12, p = 0.007). CONCLUSION: Vitamin D and iron are the most common micronutrient deficiencies among preoperative bariatric patients in this cohort and ethnic differences were seen. There may be a role for preoperative supplementation in these at-risk ethnic groups.

Short and long-term impact of sarcopenia on outcomes from emergency laparotomy.

PURPOSE: Emergency laparotomy (EL) carries a high risk of morbidity and mortality, that is greater among older patients. Sarcopenia refers to an age- or pathology-associated muscle loss and has been demonstrated to correlate with poorer outcomes in several surgical conditions. This study assessed the impact of sarcopenia on morbidity and mortality in elderly patients undergoing EL. METHODS: Patients aged ≥ 65 years-old undergoing EL between May 2012-June 2017 with a pre-operative abdominal computerised tomography (CT) scan at Middlemore Hospital (New Zealand) were included. Psoas and Skeletal Muscle Index (PMI and SMI) were calculated from abdominal CT measurements after standardisation based on height. Validated cut-offs for sarcopenia were used. Frailty was estimated using the 11-point modified frailty index (mFI). The primary outcome was 30-day, 1-year, and 4-year post-operative mortality. Secondary outcomes included correlations between mFI and sarcopenic measures, unplanned readmissions, and post-operative complications. RESULTS: A total of 167 patients (84 sarcopenic; 83 non-sarcopenic) were included. Sarcopenic and non-sarcopenic patients had similar 30-day (14.2 vs. 12.0%; p = 0.84), 1-year (23.8 vs. 25.3%; p = 0.96), and 4-year (39.3 vs. 47.0%; p = 0.40) mortality rates following an EL. Survivors had a higher mean PMI at 1-year (p = 0.0078) and 4-year (p = 0.013) but not 30-day (p = 0.40) follow-up. Sarcopenia performed poorly in discriminating between 30-day (AUC 0.51) and 1-year (AUC 0.53) mortality. The mFI did not correlate with PMI (p = 0.85) nor SMI (p = 0.18). Rates of readmissions and post-operative complications did not differ between sarcopenic and non-sarcopenic cohorts. CONCLUSION: Sarcopenia does not provide useful short-term prognostic information in elderly EL patients.

Are There Ethnic Differences in Micronutrient Deficiencies in Preoperative Bariatric Patients? A Systematic Review and Meta-analysis.

The purpose of this systematic review was to determine if in patients presenting for bariatric surgery, patients of different ethnicities, have different micronutrient deficiencies preoperatively. Databases searched were PubMed, Embase, MEDLINE and Cochrane Library. A meta-analysis of prevalence of vitamin D insufficiency (<20ng/ml) was carried out using a random effects model. Twenty-eight articles were included assessing preoperative micronutrient status across different ethnic groups. The most common micronutrient assessed was vitamin D, and the most assessed ethnicity was Caucasian. African Americans had the greatest prevalence of vitamin D insufficiency when compared to other ethnicities with a pooled prevalence and 95% confidence interval of 0.80 [0.74; 0.85]. There was a significant difference in vitamin D insufficiency when compared across ethnicities (p <0.01).

Media portrayal of Maori and bariatric surgery in Aotearoa/New Zealand.

AIM: Media constructs in Aotearoa, New Zealand naturalise the dominant Western culture. Conversely, mainstream news about Maori is rare and prioritises negative stereotypical constructs that are often centred on Maori as economic threats via resource control and political activism. These narratives influence continued discrimination against Maori in New Zealand. Media representations of bariatric surgery in New Zealand are not widely understood. We explored the portrayal of Maori and bariatric surgery in print and online news media articles in New Zealand using an inductive approach to thematic analysis. METHOD: An electronic search of two databases (Proquest Australia/ New Zealand Newsstream and Newztext) and two New Zealand news media websites (Stuff and the New Zealand Herald) was performed to retrieve news articles reporting stories, opinion pieces or editorials concerning Maori and bariatric surgery published between January 2007 to June 2017. Articles were scored using a five-point scale to assess the level of reporting as either very negative, negative, neutral, positive or very positive. Included articles were then subjected to inductive thematic analysis using the NVIVO 11 to identify and explore common themes surrounding Maori and bariatric surgery. RESULTS: Of 246 articles related to bariatric surgery over the 10-year study period, 31 (13%) were representative of Maori. Articles were scored as 'neutral' to 'positive' with a mean reporting score of 3.7 (Kappa score of 0.72 [95% CI, 0.66-0.78, p<0.0001]). Five main themes were identified, these were: Attitudes towards bariatric surgery; complexity of obesity and weight loss; access to bariatric surgery; Maori advocacy and framing of Maori. Of the five themes, access to bariatric surgery and attitudes towards bariatric surgery were most prevalent. Maori advocacy was another common theme that arose largely due to the support of public funding of bariatric surgery championed by Dame Tariana Turia. Aside from this, narratives describing equity of bariatric surgery provision and equitable outcomes following bariatric surgery for Maori were sparse. CONCLUSION: There was limited reporting on Maori health inequalities and equitable access to publicly funded bariatric surgery in New Zealand. We argue that this lack of coverage may work against addressing disparities in obesity prevalence and access to publicly funded bariatric surgery for Maori in New Zealand.