{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T17:09:36Z","timestamp":1788800976549,"version":"build-2803163510"},"reference-count":48,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Universit\u00e4tsklinikum des Saarlandes"},{"id":[{"id":"https:\/\/ror.org\/00nvxt968","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Obesity is frequently accompanied by metabolic dysfunction and micronutrient deficiencies, yet data on individuals with severe obesity (BMI \u2265 50 kg\/m2) remain limited. Understanding how vitamin and mineral status changes across the adiposity continuum may optimize personalized nutritional management in severe obesity. Methods: We analyzed anthropometric, metabolic, hepatic, and micronutrient parameters in a retrospective, single-center cohort of adults evaluated before bariatric surgery, with a BMI range of 30 to 91 kg\/m2 (mean 48.7 \u00b1 8.7). Measurements included bioimpedance-derived body composition, liver elastography (CAP and stiffness), and fasting laboratory parameters, vitamins B1, B6, B12, D, and folate and minerals (iron, selenium, and magnesium). Correlation analysis, principal component analysis (PCA), and random forest (RF) classification were applied to identify the variables most strongly associated with BMI and metabolic phenotypes. Results: Several micronutrient concentrations, most notably vitamin D, folate and vitamin B6, declined progressively with increasing BMI. Vitamin D additionally correlated inversely with HbA1c. PCA revealed a separation of participants with extreme obesity driven by anthropometric and hepatic parameters, while micronutrients clustered inversely. RF classification identified HbA1c, hepatic enzymes (ALAT and \u03b3-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, whereas vitamin D was low across metabolic subgroups. Conclusions: Severe obesity is associated with distinct micronutrient depletion patterns that mirror metabolic deterioration. Integrating nutritional and metabolic profiling enables refined risk stratification and may, pending prospective validation, inform targeted supplementation strategies in individuals with severe obesity.<\/jats:p>","DOI":"10.3390\/nu18172938","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T16:30:02Z","timestamp":1788798602000},"page":"2938","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.3390","volume":"18","author":[{"given":"Hannah","family":"Sabados","sequence":"first","affiliation":[{"name":"Nutrition and Dietetics, Saarland University, 66421 Homburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"M\u00f6wius","sequence":"additional","affiliation":[{"name":"Nutrition and Dietetics, Saarland University, 66421 Homburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7110-3692","authenticated-orcid":false,"given":"Ute M.","family":"Stern","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Saarland University, 66421 Homburg, Germany"},{"name":"Faculty of Medicine, Saarland University, 66123 Saarbr\u00fccken, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurice","family":"Michel","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Saarland University, 66421 Homburg, Germany"},{"name":"Faculty of Medicine, Saarland University, 66123 Saarbr\u00fccken, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4224-4703","authenticated-orcid":false,"given":"J\u00f6rn M.","family":"Schattenberg","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Saarland University, 66421 Homburg, Germany"},{"name":"Faculty of Medicine, Saarland University, 66123 Saarbr\u00fccken, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3240-1397","authenticated-orcid":false,"given":"Verena","family":"Keller","sequence":"additional","affiliation":[{"name":"Nutrition and Dietetics, Saarland University, 66421 Homburg, Germany"},{"name":"Department of Internal Medicine II, Saarland University, 66421 Homburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1477","DOI":"10.1161\/CIRCRESAHA.120.316101","article-title":"Obesity Phenotypes, Diabetes, and Cardiovascular Diseases","volume":"126","author":"Tchernof","year":"2020","journal-title":"Circ. Res."},{"key":"ref_2","first-page":"13","article-title":"Obesity as a Disease","volume":"102","author":"Upadhyay","year":"2018","journal-title":"Med. Clin."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Jurek, J.M., Zablocka-Slowinska, K., Pieczynska, J., Mestres, H.C., and Auguet, T. (2025). Systematic Review of the Effects of Plant-Based Foods on Metabolic Outcomes in Adults with MASLD and Comorbidities Such as Obesity, Metabolic Syndrome, and Type 2 Diabetes. Nutrients, 17.","DOI":"10.3390\/nu17183020"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1542","DOI":"10.1016\/j.jhep.2023.06.003","article-title":"A multisociety Delphi consensus statement on new fatty liver disease nomenclature","volume":"79","author":"Rinella","year":"2023","journal-title":"J. Hepatol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Tembo, P., Zhao, L., Le Marchand, L., Wilkens, L.R., Park, S.Y., Haiman, C.A., Wirth, M.D., and H\u00e9bert, J.R. (2025). Sleep Duration, Dietary Inflammatory Potential, and Obesity in Relation to Colorectal Cancer Incidence in the Multiethnic Cohort. Nutrients, 17.","DOI":"10.3390\/nu17030370"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Son, D.S., Done, K.A., Son, J., Izban, M.G., Virgous, C., Lee, E.S., and Adunyah, S.E. (2024). Intermittent Fasting Attenuates Obesity-Induced Triple-Negative Breast Cancer Progression by Disrupting Cell Cycle, Epithelial-Mesenchymal Transition, Immune Contexture, and Proinflammatory Signature. Nutrients, 16.","DOI":"10.3390\/nu16132101"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1038\/nature12347","article-title":"Obesity-induced gut microbial metabolite promotes liver cancer through senescence secretome","volume":"499","author":"Yoshimoto","year":"2013","journal-title":"Nature"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"(2018). Plump mice help to unravel the tangled ties between obesity and cancer. Nature, 563, 446.","DOI":"10.1038\/d41586-018-07390-1"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"110478","DOI":"10.1016\/j.ejso.2025.110478","article-title":"From obesity to oncology; bariatric surgery and the impact on breast cancer- what is the link?-A systematic review and meta-analysis","volume":"51","author":"Clifford","year":"2025","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1056\/NEJMsr1606602","article-title":"Body Fatness and Cancer\u2014Viewpoint of the IARC Working Group","volume":"375","author":"Scoccianti","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"161","DOI":"10.21037\/atm.2017.03.107","article-title":"Morbidity and mortality associated with obesity","volume":"5","author":"Abdelaal","year":"2017","journal-title":"Ann. Transl. Med."},{"key":"ref_12","first-page":"s176","article-title":"Obesity: Definition, comorbidities, causes, and burden","volume":"22","author":"Apovian","year":"2016","journal-title":"Am. J. Manag. Care"},{"key":"ref_13","unstructured":"NCD Risk Factor Collaboration (NCD-RisC) (2024). Worldwide trends in underweight and obesity from 1990 to 2022: A pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. Lancet, 403, 1027\u20131050."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"The Global BMI Mortality Collaboration, Di Angelantonio, E., Bhupathiraju, S.N., Wormser, D., Gao, P., Kaptoge, S., de Gonzalez, A.B., Cairns, B.J., Huxley, R., and Jackson, C.L. (2016). Body-mass index and all-cause mortality: Individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet, 388, 776\u2013786.","DOI":"10.1016\/S0140-6736(16)30175-1"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1159\/000531032","article-title":"Disease Burden and Health Status among People with Severe Obesity Who Do Not Receive Bariatric Surgery: A Retrospective Study","volume":"16","author":"Ard","year":"2023","journal-title":"Obes. Facts"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e2235003","DOI":"10.1001\/jamanetworkopen.2022.35003","article-title":"Association of Bariatric Surgery with Cardiovascular Outcomes in Adults with Severe Obesity and Nonalcoholic Fatty Liver Disease","volume":"5","author":"Elsaid","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"jjaf010","DOI":"10.1093\/ecco-jcc\/jjaf010","article-title":"Severe obesity, a susceptibility factor for developing inflammatory bowel disease: Results of a population-based study","volume":"19","author":"Vela","year":"2025","journal-title":"J. Crohns Colitis"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"237","DOI":"10.14740\/jocmr4741","article-title":"Association of Severe Obesity and Chronic Obstructive Pulmonary Disease with Pneumonia Following Non-Cardiac Surgery","volume":"14","author":"Pfaff","year":"2022","journal-title":"J. Clin. Med. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"19484","DOI":"10.1038\/s41598-024-66327-z","article-title":"Effect of vitamin E on energy metabolism indicators and gill tissue structure of crucian carp (Carassius auratus) under cooling stress","volume":"14","author":"Tang","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Michels, A.J., Butler, J.A., Uesugi, S.L., Lee, K., Frei, B.B., Bobe, G., Magnusson, K.R., and Hagen, T.M. (2023). Multivitamin\/Multimineral Supplementation Prevents or Reverses Decline in Vitamin Biomarkers and Cellular Energy Metabolism in Healthy Older Men: A Randomized, Double-Blind, Placebo-Controlled Study. Nutrients, 15.","DOI":"10.3390\/nu15122691"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Knuth, M.M., Xue, J., Elnagheeb, M., Gharaibeh, R.Z., Schoenrock, S.A., McRitchie, S., Brouwer, C., Sumner, S.J., Tarantino, L., and Valdar, W. (2024). Early life exposure to vitamin D deficiency impairs molecular mechanisms that regulate liver cholesterol biosynthesis, energy metabolism, inflammation, and detoxification. Front. Endocrinol., 15.","DOI":"10.3389\/fendo.2024.1335855"},{"key":"ref_22","first-page":"92","article-title":"Vitamin D and immune function: Autocrine, paracrine or endocrine?","volume":"243","author":"Hewison","year":"2012","journal-title":"Scand. J. Clin. Lab. Investig. Suppl."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Vrani\u0107, L., Mikola\u0161evi\u0107, I., and Mili\u0107, S. (2019). Vitamin D Deficiency: Consequence or Cause of Obesity?. Medicina, 55.","DOI":"10.3390\/medicina55090541"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.1210\/clinem\/dgae290","article-title":"Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline","volume":"109","author":"Demay","year":"2024","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1093\/ajcn\/87.2.362","article-title":"Vitamin status in morbidly obese patients: A cross-sectional study","volume":"87","author":"Aasheim","year":"2008","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Sun, Y., Sun, M., Liu, B., Du, Y., Rong, S., Xu, G., Snetselaar, L.G., and Bao, W. (2019). Inverse Association Between Serum Vitamin B12 Concentration and Obesity Among Adults in the United States. Front. Endocrinol., 10.","DOI":"10.3389\/fendo.2019.00414"},{"key":"ref_27","first-page":"203","article-title":"Association of vitamin B12 with obesity, overweight, insulin resistance and metabolic syndrome, and body fat composition; primary care-based study","volume":"10","author":"Baltaci","year":"2013","journal-title":"Med. Glas."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Zou, Y., Huang, L.C., He, M.J., Han, D., Su, D.T., Xu, P.W., and Zhang, R.H. (2025). Factors influencing type 2 diabetes in adults: A cross-sectional study. Front. Public Health, 13.","DOI":"10.3389\/fpubh.2025.1662519"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Peng, T., Zhang, Z., Liang, W., and Zhang, J. (2025). Can Vitamin D supplementation enhance the effectiveness of exercise-induced weight loss in overweight or obese adults? Evidence from integrated transcriptomic and meta-analysis. Front. Nutr., 12.","DOI":"10.3389\/fnut.2025.1664960"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"glaf215","DOI":"10.1093\/gerona\/glaf215","article-title":"Joint association of serum 25-hydroxyvitamin D concentration and body mass index on the acceleration of clinical biomarker-based biological aging","volume":"81","author":"Pan","year":"2025","journal-title":"J. Gerontol. Ser. A Biol. Sci. Med. Sci."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Rakab, M.S., Rateb, R.M., Maamoun, A., Radwan, N., Shubietah, A., Manasrah, A., Rajab, I., Scichilone, G., Tussing-Humphreys, L., and Mahmoud, A.M. (2025). Impact of Probiotic\/Synbiotic Supplementation on Post-Bariatric Surgery Anthropometric and Cardiometabolic Outcomes: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients, 17.","DOI":"10.3390\/nu17132193"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Bendotti, G., Biamonte, E., Leporati, P., Goglia, U., Ruggeri, R.M., and Gallo, M. (2025). Vitamin D Supplementation: Practical Advice in Different Clinical Settings. Nutrients, 17.","DOI":"10.3390\/nu17050783"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Lee, J.H., Kim, Y.A., Kim, Y.S., Lee, Y., and Seo, J.H. (2023). Association between Vitamin D Deficiency and Clinical Parameters in Men and Women Aged 50 Years or Older: A Cross-Sectional Cohort Study. Nutrients, 15.","DOI":"10.3390\/nu15133043"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1686","DOI":"10.21105\/joss.01686","article-title":"Welcome to the tidyverse","volume":"4","author":"Wickham","year":"2019","journal-title":"J. Open Source Softw."},{"key":"ref_35","unstructured":"Firke, S. (2024). Janitor: Simple Tools for Examining and Cleaning Dirty Data, R Foundation for Statistical Computing."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v077.i01","article-title":"ranger: A Fast Implementation of Random Forests for High Dimensional Data in C++ and R","volume":"77","author":"Wright","year":"2017","journal-title":"J. Stat. Softw."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Robin, X., Turck, N., Hainard, A., Tiberti, N., Lisacek, F., Sanchez, J.C., and M\u00fcller, M. (2011). pROC: An open-source package for R and S+ to analyze and compare ROC curves. BMC Bioinform., 12.","DOI":"10.1186\/1471-2105-12-77"},{"key":"ref_38","first-page":"1","article-title":"FactoMineR: An R Package for Multivariate Analysis","volume":"25","author":"Josse","year":"2008","journal-title":"J. Stat. Softw."},{"key":"ref_39","unstructured":"Wickham, H., Pedersen, T.L., and Seidel, D. (2023). Scales: Scale Functions for Visualization, Posit, PBC."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"3055","DOI":"10.1002\/sim.1545","article-title":"Estimating regression models with unknown break-points","volume":"22","author":"Muggeo","year":"2003","journal-title":"Stat. Med."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Spyksma, E.E., Alexandridou, A., Mai, K., Volmer, D.A., and Stokes, C.S. (2024). An Overview of Different Vitamin D Compounds in the Setting of Adiposity. Nutrients, 16.","DOI":"10.3390\/nu16020231"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1159\/000458765","article-title":"Vitamin D Status, Gender Differences, and Cardiometabolic Health Disparities","volume":"70","author":"Sanghera","year":"2017","journal-title":"Ann. Nutr. Metab."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1016\/j.tips.2024.05.004","article-title":"Implications of innate immune sexual dimorphism for MASLD pathogenesis and treatment","volume":"45","author":"Booijink","year":"2024","journal-title":"Trends Pharmacol. Sci."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"c2181","DOI":"10.1136\/bmj.c2181","article-title":"Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B-12 deficiency: Randomised placebo controlled trial","volume":"340","author":"Kooy","year":"2010","journal-title":"BMJ"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/S2213-8587(13)70165-7","article-title":"Vitamin D status and ill health: A systematic review","volume":"2","author":"Autier","year":"2014","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"156028","DOI":"10.1016\/j.metabol.2024.156028","article-title":"The role of dietary modification in the prevention and management of metabolic dysfunction-associated fatty liver disease: An international multidisciplinary expert consensus","volume":"161","author":"Zeng","year":"2024","journal-title":"Metabolism"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1016\/j.soard.2016.12.018","article-title":"American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient 2016 Update: Micronutrients","volume":"13","author":"Parrott","year":"2017","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e13087","DOI":"10.1111\/obr.13087","article-title":"British Obesity and Metabolic Surgery Society Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery\u20142020 update","volume":"21","author":"Parretti","year":"2020","journal-title":"Obes. Rev."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/17\/2938\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T16:43:59Z","timestamp":1788799439000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/17\/2938"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,7]]},"references-count":48,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["nu18172938"],"URL":"https:\/\/doi.org\/10.3390\/nu18172938","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,7]]}}}