Severe obesity is associated with distinct micronutrient depletion patterns that mirror metabolic deterioration, with vitamin D, folate, and vitamin B6 declining progressively with increasing BMI, and combined MASLD and T2DM associated with the most pronounced vitamin B6 depletion.
Vitamin D, folate, and vitamin B6 concentrations declined progressively with increasing BMI across the obesity spectrum.
Vitamin D inversely correlated with HbA1c in addition to its inverse association with BMI.
Principal component analysis (PCA) revealed separation of participants with extreme obesity driven by anthropometric and hepatic parameters, with micronutrients clustering inversely.
Random forest classification identified HbA1c, hepatic enzymes (ALAT and γ-GT), and body composition measures (waist circumference and visceral fat) as the strongest discriminators of T2DM, MASLD, and high BMI, respectively.
Combined MASLD and T2DM was associated with the most pronounced vitamin B6 depletion among metabolic subgroups.
Data on individuals with severe obesity (BMI ≥ 50 kg/m2) with respect to micronutrient status were described as limited prior to this study.
Integrating nutritional and metabolic profiling enables refined risk stratification and may inform targeted supplementation strategies in individuals with severe obesity.
This research suggests that people with severe obesity — particularly those with a BMI of 50 or higher — show a consistent pattern of declining levels of certain vitamins and minerals as their weight increases. Specifically, vitamin D, folate (a B vitamin important for cell function), and vitamin B6 were found to decrease progressively as BMI rose. Vitamin D was low across virtually all patients regardless of whether they also had diabetes or liver disease, while vitamin B6 was particularly depleted in those who had both liver disease (MASLD) and type 2 diabetes at the same time. These findings come from a study of adults assessed before bariatric (weight-loss) surgery, with body weights ranging from moderately obese to extremely obese. The study also used advanced statistical techniques — including principal component analysis and random forest machine learning — to understand which measurements best identified different metabolic conditions. Blood sugar control (HbA1c) was most useful for identifying type 2 diabetes, liver enzymes best identified liver disease, and waist circumference along with visceral (belly) fat measurements best identified those with the highest BMIs. Together, these tools revealed that nutritional deficiencies and metabolic problems tend to worsen together as obesity becomes more severe. This research suggests that people with severe obesity should not be treated as a uniform group when it comes to nutritional assessment. Instead, combining information about their specific metabolic conditions (such as whether they have diabetes or liver disease) with micronutrient testing could help identify who is at greatest nutritional risk and who might benefit most from targeted vitamin or mineral supplementation. However, the authors caution that this was a retrospective study from a single center, and prospective studies are needed before these findings can be used to make specific clinical recommendations.
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Upload Your LabsSabados H, Möwius S, Stern U, Michel M, Schattenberg J, Keller V. (2026). Vitamin (B1, B6, B12, D, and Folate) and Mineral (Iron, Selenium, and Magnesium) Status Across the Spectrum of Severe Obesity: An Integrative Multivariate Analysis of Metabolic and Nutritional Profiles.. Nutrients. https://doi.org/10.3390/nu18172938