Obesity and micronutrients deficit, when and how to suplement

Figures & data

Figure 1. Factors Leading to Micronutrient Imbalance in Patients with Obesity.

Figure 2. Absorption, Transport, and Metabolism of Vitamin D.

Table 1. Type of diets for losing body weight and possible micronutrient deficiencies.

Type of diet	Diet characteristics	Possible micronutrient deficiencies.
Ketogenic diet	Low CHO (< 50 g/day), high fat, and a defined or variable protein content. Contraindicated in pregnant women, those with T1DM, kidney failure, or cardiac arrhythmia; and in older patients with frailty (Kim, 2021).	Vitamin D and calcium, zinc, magnesium, vitamin C, thiamine, and selenium (Tummolo et al., 2023)
Intermittent fasting	Periods of fasting that alternate with periods of feeding. Focuses more on the timing of meals than on calorie calculations or macronutrient composition (Kim, 2021).	Fibre, potassium, vitamin A, iron, calcium, iodine, magnesium, linoleic acid, and α-linolenic acid (Athanasian et al., 2021).
Low glycemic diet	Classifies foods containing CHO according to their ability to increase blood glucose levels. Based solely on the CHO and does not make recommendations for daily intake of fat, protein or fibre (Kim, 2021).	Deficits are not usually reported (Athanasian et al., 2021).
Low carbohydrate diet	Defined as a CHO intake below the lower limit of the macronutrient distribution range proposed for healthy adults, which is 45%−65% of total daily energy (Kim, 2021).	Fibre, folate, potassium, calcium, magnesium, iron, vitamin A, iodine, linoleic acid, and α-linolenic acid (Jebeile et al., 2020).
Very low-calorie diets	Calorie restriction of ≤800 kcal per day. Used in limited circumstances along with medical monitoring according to obesity guidelines (Seo et al., 2019).	Due to its low caloric intake, it should always be supplemented with micronutrients (Gow et al., 2021).

CHO: Carbohydrates. T1DM: Type 1 Diabetes Mellitus

Table 2. Relationship between vitamin D and obesity.

Hormone	Results	Authors
25(OH)D	Children and adolescents with obesity have a higher risk of vitamin D deficiency.	(Fiamenghi & Mello, 2021)
25(OH)D	Total and free 25(OH)D and 1.25(OH)2D are lower at higher BMI.	(Walsh et al., 2017)
25(OH)D	The prevalence of vitamin D deficiency was 35% higher in subjects with obesity compared to the eutrophic group and 24% higher than in the overweight group.	(Pereira-Santos et al., 2015)
25(OH)D	The prevalence of vitamin D deficiency (25(OH)D < 20 ng/ml) was threefold higher in those with high SAT and high VAT than in those with low SAT and low VAT (P < 0.0001).	(Cheng et al., 2010)
25(OH)D and 1.25(OH)2D.	An inverse association has been found between BMI and serum levels of vitamin 25(OH)D and 1.25(OH)2D.	(Konradsen et al., 2008)
25(OH)D	Serum 25(OH)D was inversely related to weight, BMI, and markers of T2DM (large waist, increased HbA1c)	(McGill et al., 2008)
Plasma levels of 1,25(OH)2D	Significantly lower in subjects with obesity than in non-obese subjects.	(Parikh et al., 2004)
25(OH)D	Mean serum 25(OH)D was significantly lower in the individuals with obesity than in the individuals without obesity.	(Bell et al., 1985)

25(OH)D: 25-hydroxyvitamin, 1.25(OH)2D: 1,25-hydroxyvitamin D, SAT: subcutaneous adipose tissue, VAT: visceral adipose tissue. T2DM: Type 2 Diabetes Mellitus

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