Annals of Clinical Nutrition and Metabolism

Micronutrient deficiencies in copper, zinc, and vitamin D as predictors of clinical outcomes in critically ill surgical patients in Korea: a retrospective cohort study: Jiae Kim, Yanghee Jun, Ye Rim Chang, Jong-Kwan Baek, Hak-Jae Lee, Hyewon Han, Suk-Kyung Hong; Ann Clin Nutr Metab 2024;16(3):158-167. Published online December 1, 2024; DOI: https://doi.org/10.15747/ACNM.2024.16.3.158

Abstract PDF: Purpose: To investigate the prevalence of copper, zinc, and vitamin D deficiencies in surgical intensive care unit (SICU) patients and the associations between those deficiencies and clinical outcomes.
Methods: We conducted a retrospective study of 210 patients admitted to the SICU of Asan Medical Center between June 2020 and June 2022. Micronutrient levels were measured within 7 days of SICU admission. Primary outcomes were the mortality rate, length of SICU stay, hospital stay duration, and mechanical ventilation duration.
Results: Copper deficiency was found in 35% (68/193), zinc deficiency in 52% (100/193), and severe vitamin D deficiency in 46% (82/179) of patients. Copper-deficient patients showed a significantly higher mortality rate (25.0% vs. 12.8%, P=0.044), longer hospital stays (57.8±47.0 vs. 45.2±36.6 days, P=0.041), and extended mechanical ventilation duration (26.9±23.3 vs. 18.8±15.7 days, P=0.012). Zinc deficiency was associated with higher C-reactive protein levels (16.2±9.5 vs. 11.5±8.8 mg/dL, P=0.001) and lower prealbumin levels (6.5±2.8 vs. 9.9±5.6 mg/dL, P<0.001). Severe vitamin D deficiency (<10 ng/mL) was not significantly associated with mortality or other clinical outcomes (mortality: <10 ng/mL vs. ≥10 ng/mL, 13% vs. 18%, P=0.583).
Conclusion: Micronutrient deficiencies are prevalent in SICU patients. Copper deficiency significantly correlated with poor clinical outcomes, and zinc deficiency showed a strong association with inflammatory markers. Early assessment and supplementation of micronutrients could be beneficial for critically ill surgical patients.

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Mental health and micronutrients: a narrative review: Hyun Wook Baik; Ann Clin Nutr Metab 2024;16(3):112-119. Published online December 1, 2024; DOI: https://doi.org/10.15747/ACNM.2024.16.3.112

Abstract PDF: Purpose: It aims to summarizes the evidence for the association between specific individual nutrients and mental disorders, focusing on vitamin B12 and related B vitamins, vitamin D, probiotics, and zinc.
Current concept: Vitamin D deficiency is linked to depression, anxiety, and cognitive decline. Vitamin D enhances serotonin synthesis, has anti-inflammatory and neuroprotective effects, and regulates the hypothalamic-pituitary-adrenal axis and circadian rhythms. Vitamin B12 deficiency causes neurological dysfunction, mood disorders, cognitive decline, and psychotic symptoms, especially in the elderly. Vitamin B12 is involved in myelin formation, neurotransmitter synthesis, and preventing homocysteine-related neurodegeneration. Zinc deficiency affects neurotransmitters, neurogenesis, and antioxidant function, contributing to depression, anxiety, and cognitive impairment. Zinc supplementation improves symptoms and increases brain-derived neurotrophic factor levels. The gut-brain axis involves bidirectional communication between the gut microbiome and the central nervous system via the vagus nerve, enteric nervous system, immune system, and neuroendocrine pathways. Probiotics can modulate the gut microbiome to improve depression, anxiety, stress response, and cognitive function by influencing neurotransmitter production, reducing inflammation, and supporting the gut-brain connection.
Conclusion: Nutritional interventions, including vitamin D, B12, zinc, and probiotics, show promise as adjunctive therapies or preventive strategies for mental disorders. These nutrients have specific mechanisms of action on brain function and the gut-brain axis. Further research is needed to establish optimal dosage, timing, and administration methods for these nutritional approaches in supporting mental health.

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Perioperative nutrition support: a narrative review: Rajeev Joshi, Asma Khalife; Ann Clin Nutr Metab 2023;15(2):40-45. Published online August 1, 2023; DOI: https://doi.org/10.15747/ACNM.2023.15.2.40

Abstract PDF: Purpose: Proper nutrition and supplementation are paramount in surgical patients. Suboptimal nutrition status is increasingly recognized as an independent predictor of poor surgical outcomes. The purpose of this review is to highlight the need for nutritional protocols, with an emphasis on perioperative nutrition.
Current concept: Perioperative nutrition support is considered an adjunctive strategy in most centers, although it is proven to be the key in improving surgical outcomes. There is a need to increase the standards and formulate policies and protocols to optimize perioperative nutrition support. Components of perioperative nutrition include nutritional screening and assessment, prehabilitation, preoperative metabolic optimization and carbohydrate loading, postoperative early enteral feeding and perioperative parenteral nutrition, immunonutrition and micronutrients, and oral nutritional supplementation vs. hospital-based kitchen feeds. Supplemental parenteral nutrition becomes valuable when enteral nutrition alone cannot fulfil energy needs. In patients in the surgical intensive care unit who are dealing with hemodynamic instability, high levels of serum lactate unrelated to thiamine deficiency, acidosis, significant liver dysfunction, high blood sugar, and high blood lipid levels, parenteral nutrition must be started with caution. In the post-surgery care ward, it is advisable to administer up to 30 kcal/kg/day and 1.2–2 g/kg/day of protein.
Conclusion: The positive impact of comprehensive nutritional support and the importance of setting and executing standards must be highlighted. Emphasis should be placed on overcoming existing challenges in implementing nutrition therapy in current surgical practice, as better perioperative nutrition supports better surgical outcomes.

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Incidence and Management of Micronutrient Deficiencies in Post-bariatric Surgery Patients: Young Suk Park, Ki Bum Park, Sa-Hong Min, Yoontaek Lee, Sang-Hoon Ahn, Do Joong Park, Hyung-Ho Kim; J Clin Nutr 2017;9(2):48-55. Published online December 31, 2017; DOI: https://doi.org/10.15747/jcn.2017.9.2.48

Abstract PDF: Bariatric surgery is considered one of the most effective methods of achieving long-term weight loss in morbidly obese patients. Nevertheless, bariatric procedures are associated with a number of complications, and nutrient deficiencies can lead to deleterious consequences. Furthermore, the diet of patients prior to bariatric surgery is often of poor nutrition quality that does not meet the recommended dietary guidelines for micronutrient intake. Therefore, optimization of the postoperative nutritional status should begin before surgery. This review covers the essential information about micronutrient management in patients before and after bariatric surgery.

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Micronutrients Deficiencies in Bariatric Patients: Yeon Ji Lee; Surg Metab Nutr 2016;7(1):7-12. Published online June 30, 2016; DOI: https://doi.org/10.18858/smn.2016.7.1.7

Abstract PDF: Paradoxically, the obese are more susceptible to malnutrition. The more obese they are, the greater the risk for micronutrient deficiencies particularly in fat-soluble vitamins and anti-oxidants. Several micronutrient deficiencies could be worsened because of poor intake and absorption difficulty after bariatric surgery. Micronutrient deficiencies could not only decrease the effect of bariatric surgery but also cause various diseases such as anemia, neurologic impairment, or osteoporosis. Micronutrient deficiencies should be monitored, recognized, and corrected properly in bariatric patients in order to maximize the effect of surgery and improve the health-related quality of life.

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