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Malnutrition and Obesity

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Title: Malnutrition and Obesity


1
Malnutrition and Obesity
  • Whitney Hegedus MS RD CSO LDN CNSC
  • St. Jude Childrens Research Hospital

2
Objective
  • The Learner will
  • Understand the definition of malnutrition
  • Understand how obesity is defined
  • Understand the prevalence of obesity in the
    United States
  • Understand potential micronutrient deficiencies
    among the obese population

3
What Is Obesity
  • A life-long, progressive, life-threatening,
    costly, genetically related, multi-factorial
    disease of excess fat storage with multiple
    co-morbidities
  • ASMBS.org

4
Malnutrition
  • Any disorder of nutrition status including
    disorders resulting from a deficiency of nutrient
    intake, impaired nutrient metabolism or over
    nutrition
  • Therefore obesity is a form of malnutrition
  • ASPEN Board of Directors and Standards Committee

5
Malnutrition
  • Historically, thought that micronutrient
    deficiencies were rare in Western countries
    because of the relatively low cost and ample food
    supply
  • Many people consume food that is of poor
    nutritional quality however high in calories,
    fat, salt and/or sugar
  • Kaidar-Person O, Person B, Szomstein S, Rosenthal
    RJ. Nutrition deficiencies in morbidly obese
    patients a new form of malnutrition? Part A
    Vitamins. Obes Surg 200818870-976.

6
Measuring Obesity
  • Determined by height and weight
  • Body Mass Index (BMI)
  • BMI weight (kg)_____
  • height (m) x height (m)

7
BMI Chart
  • lt 18.5 Underweight
  • 18.5-24.9 Healthy Weight
  • 25.0-29.9 Overweight
  • 30.0-34.9 Class I Obesity
  • 35.0-39.9 Class II Obesity
  • gt40.0 Class III Obesity (Morbid Obesity)

8
BMI to Weight Examples
  • A person 65 would have the following BMIs
  • Weight (lbs) BMI (kg/m2) Classification
  • 105 17 Underweight
  • 130 22 Healthy Wt
  • 165 27 Overweight
  • 195 32 Obesity I
  • 235 37 Obesity II
  • 265 44 Obesity III

9
Prevalence and Trends in Obesity Among US Adults
2009-2010
  • 69.2 American adults are considered overweight
    (BMI gt25)
  • 35.9 considered obese (BMI gt30)
  • 6.3 considered morbidly obese (BMI gt40)
  • When compared to the 2003-2008 data there is no
    significant change in the prevalence of obesity
    however all percentages did increase
  • Flegal KM, Caroll MD, Kit BK, Ogden CL.
    Prevalence of obesity and trends in the
    distribution of body mass index amount US adults,
    1999-2010. JAMA. 2012307(5)doi10.1001/jama.2012
    .39.

10
Prevalence of High Body Mass Index in US
Children and Adolescents, 2009-2010Ages 2-19 for
both sexes and all ethnicities
  • 31.8 considered overweight
  • BMI gt85th percentile on CDC BMI Growth Charts
  • 16.9 considered obese
  • BMI gt95th percentile on CDC BMI Growth Charts
  • 12.3 of children and adolescents have a BMI
    gt97th percentile
  • Ogden CL, Caroll MD, Kit BK, Flegal KM.
    Prevalence of obesity and trends in body mass
    index among US children and adolescents,
    1999-2010. JAMA. 2012307(5)dio10.1001/jama.201
    2.40.

11
Leading Cause of Death
  • CDC announced in 2004 that unless current trends
    are reversed poor diet and physical inactivity
    will soon become the leading cause of death in
    America

12
Actual Cause of Death
  • In 2000
  • 435,000 deaths attributed to smoking (18.1)
  • 400,000 deaths attributed to poor diet and
    physical inactivity (16.6)
  • Mokdad AH, Marks JS, Stroup DF, Gerberding JL.
    Actual Causes of Death in the United States,
    2000. JAMA. 20042911238-1245.

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Prevalence and Trends in Obesity Among US Adults
2009-2010
  • 69.2 American adults are considered overweight
    (BMI gt25)
  • 35.9 considered obese (BMI gt30)
  • 6.3 considered morbidly obese (BMI gt40)
  • When compared to the 2003-2008 data there is no
    significant change in the prevalence of obesity
    however all percentages did increase
  • Flegal KM, Caroll MD, Kit BK, Ogden CL.
    Prevalence of obesity and trends in the
    distribution of body mass index amount US adults,
    1999-2010. JAMA. 2012307(5)doi10.1001/jama.2012
    .39.

40
Original Question
  • If obesity is a form of malnutrition, what
    excesses or deficiencies should be evaluated,
    monitored and/or treated?
  • Most research reporting micronutrient
    deficiencies in obese patients are the result of
    presurgical evaluations of bariatric patients

41
Study 1
  • Aim to assess concentrations of vitamins A, B1,
    B2, B6, folate, B12, C, D and E in morbidly obese
    patients compared to the concentrations in a
    healthy control group
  • Aasheim ET, Hofso D, Hjelmesaeth J, Birkeland KI,
    Bohmer T. Vitamin status in morbidly obese
    patients a cross-sectional study. Am J Clin
    Nutr. 200887362-9.

42
Participants
Woman Woman Men Men
Control (n30) Patient (n76) Control (n28) Patient (n34)
Age (y) 39 11 41 11 39 11 41 10
BMI (kg/m2) 23 3 45 7 25 3 45 7
Smoker n() 1 24 4 10
Systolic BP (mm Hg) 117 9 136 18 122 13 142 21
Diastolic BP (mm Hg) 80 7 84 18 81 10 87 13
43
Vitamin Concentrations in Morbidly Obese Patients
and Healthy Controls
Woman Woman Men Men
Vitamin Control (n30) Patient (n76) Control (n28) Patient (n34)
A ┬Ámol/L 1.9 0.5 1.7 0.4 2.3 0.6 1.9 0.4
B1 nmol/L 99 19 125 34 106 17 151 37
B2 nmol/L 20 7 20 9 25 14 21 7
B6 nmol/L 46 24 29 30 58 31 39 33
Folic Acid nmol/L 16 4 16 8 16 5 13 3
B12 pmol/L 307 98 303 69 368 116 331 97
C mmol/L 74 14 48 18 63 15 48 14
D nmol/L 54 22 40 16 59 20 34 15
E ┬Ámol/L 26.6 4.9 28 6.9 29.4 9.5 26.8 6.1
E (lipid standardized) 5.0 0.7 4.3 0.8 5.0 0.8 4.0 0.7
44
Results
  • Significant differences were noticed in 6 out of
    the 9 vitamins examined
  • Obese patients had significantly lower mean serum
    concentrations of vitamins A, B6, C, D and lipid
    standardized vitamin E
  • A range of 11-38 of obese patients were
    considered to have inadequate vitamin B6, C, D
    and lipid standardized vitamin E
  • The obese patients had a higher concentration of
    B1 compared to the healthy control group

45
Conclusion
  • Morbidly obese Norwegian patients may have lower
    circulating concentrations of several vitamins
    including vitamin B6, C, D and lipid-standardized
    vitamin E

46
Study 2
  • Study design was to investigate the vitamin and
    trace mineral levels of patients before and after
    laparoscopic gastric bypass
  • Madan AK, Orth WS, Tichansky DS, Ternovits CA.
    Vitamin and trace mineral levels after
    laparoscopic gastric bypass. Obes Surg. 2006
    16603-606.

47
Design
Total Number of Patients per Vitamin Level Total Number of Patients per Vitamin Level
Vitamin Number of Patients Preoperatively
Vitamin A 55
Vitamin B12 59
Vitamin D-25 58
Zinc 69
Iron 64
Ferritin 67
Selenium 59
Folate 62
48
Results
Abnormal Levels (n) Deficient Levels (n)
Vitamin A 11 7
Vitamin B12 13 5
Vitamin D25 40 40
Zinc 30 28
Iron 16 14
Ferritin 9 6
Selenium 58 58
Folate 6 2
49
Discussion
  • Having excess weight does not imply appropriate
    vitamin and trace mineral levels
  • Poor nutrition habits of morbidly obese patients
    may make them more susceptible to lower levels
    of vitamins and minerals

50
Conclusions
  • Consideration should be given to testing vitamin
    and trace minerals on any morbidly obese patients
  • Other paper conclusions were specific to gastric
    bypass surgery

51
Overall Conclusions
  • When evaluated, obese patients presented with
    abnormal and deficient levels of several vitamin
    and trace minerals

52
Considerations
  • Weight loss patients
  • Intentional and Unintentional
  • Nutrition support patient
  • EN and PN
  • Children

53
Questions
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