Skip to main content
Log in

Treatment of Micronutrient Deficiencies Pre and Post Bariatric Surgery

  • Nutrition and Obesity (O Pickett-Blakeley, Section Editor)
  • Published:
  • volume 19pages 169–182 (2021)
Current Treatment Options in Gastroenterology Aims and scope Submit manuscript

Cite this article

Abstract

Purpose of review

The goal of this article is to review micronutrient deficiencies in patients with obesity. We will describe the absorption of micronutrients and highlight the risk factors that may exist pre- and post-surgery that contribute to the development of micronutrient deficiency states. Furthermore, we will discuss the process involved in detecting, preventing, and treating micronutrient deficiencies.

Recent findings

Pre-bariatric surgery micronutrient deficiencies are commonly due to intake of a high energy, but low micronutrient diet. Deficiencies frequently include vitamin D, folate, vitamin B12, and iron. Post-bariatric surgery micronutrient deficiencies are commonly related to altered absorption in the setting of non-compliance with or intolerance of recommended diets, and frequently include abovementioned deficiencies as well as vitamin A, copper, and zinc deficiencies. All patients should have routine daily supplementation as well as close monitoring for the development of deficiency post-surgery.

Summary

It is important to understand a patient’s unique risk factors for developing a micronutrient deficiency, and to perform a complete nutritional evaluation to further assess, intervene on, and monitor a patient’s nutritional status throughout their pre- and post-operative course. Treatment of these deficiencies will require a multidisciplinary and multimodal approach involving risk factor modification and supplementation that depends on the severity and duration of the identified deficiency.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

References and Recommended Reading

  1. Schwartz MW, Seeley RJ, Zeltser LM, Drewnowski A, Ravussin E, Redman LM, et al. Obesity pathogenesis: an Endocrine Society scientific statement. Endocr Rev. 2017;38(4):267–96.

    Article  Google Scholar 

  2. Hruby A, Hu FB. The epidemiology of obesity: a big picture. Pharmacoeconomics. 2015;33(7):673–89.

    Article  Google Scholar 

  3. Strohmayer E, Via MA, Yanagisawa R. Metabolic management following bariatric surgery. Mt Sinai J Med. 2010;77(5):431–45.

    Article  Google Scholar 

  4. Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity and severe obesity among adults: United States, 2017-2018. NCHS Data Brief. 2020 Feb;(360):1-8.

  5. Kang JH, Le QA. Effectiveness of bariatric surgical procedures: a systematic review and network meta-analysis of randomized controlled trials. Medicine (Baltimore). 2017;96(46):e8632.

    Article  Google Scholar 

  6. Acosta A, Streett S, Kroh MD, Cheskin LJ, Saunders KH, Kurian M, et al. White Paper AGA: POWER - practice guide on obesity and weight management, education, and resources. Clin Gastroenterol Hepatol. 2017;15(5):631–49 e10.

  7. Karmali S, Johnson Stoklossa C, Sharma A, Stadnyk J, Christiansen S, Cottreau D, et al. Bariatric surgery: a primer. Can Fam Physician. 2010;56(9):873–9.

    PubMed  PubMed Central  Google Scholar 

  8. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.

    Article  CAS  Google Scholar 

  9. Kushner RF, Lawrence V, Kumar S. Practical manual of clinical obesity. Chichester: John Wiley & Sons; 2013.

    Book  Google Scholar 

  10. Wolfe BM, Kvach E, Eckel RH. Treatment of obesity: weight loss and bariatric surgery. Circ Res. 2016;118(11):1844–55.

    Article  CAS  Google Scholar 

  11. Gudzune KA, Huizinga MM, Chang HY, Asamoah V, Gadgil M, Clark JM. Screening and diagnosis of micronutrient deficiencies before and after bariatric surgery. Obes Surg. 2013;23(10):1581–9.

    Article  Google Scholar 

  12. Lupoli R, Lembo E, Saldalamacchia G, Avola CK, Angrisani L, Capaldo B. Bariatric surgery and long-term nutritional issues. World J Diabetes. 2017;8(11):464–74.

    Article  Google Scholar 

  13. Miras AD, le Roux CW. Mechanisms underlying weight loss after bariatric surgery. Nat Rev Gastroenterol Hepatol. 2013;10(10):575–84.

    Article  Google Scholar 

  14. Oussaada SM, van Galen KA, Cooiman MI, Kleinendorst L, Hazebroek EJ, van Haelst MM, et al. The pathogenesis of obesity. Metabolism. 2019;92:26–36.

    Article  CAS  Google Scholar 

  15. Patel JJ, Mundi MS, Hurt RT, Wolfe B, Martindale RG. Micronutrient deficiencies after bariatric surgery: an emphasis on vitamins and trace minerals [formula: see text]. Nutr Clin Pract. 2017;32(4):471–80.

    Article  CAS  Google Scholar 

  16. Jameson JL. Harrison’s principles of internal medicine. New York: McGraw-Hill Education; 2018.

    Google Scholar 

  17. World Health Organization., Food and Agriculture Organization of the United Nations. Vitamin and mineral requirements in human nutrition. 2nd ed. Geneva Rome: World Health Organization ; FAO; 2004. xix, 341 p. p.

  18. Institute of Medicine (U.S.). Food and Nutrition Board. Dietary reference intakes: a risk assessment model for establishing upper intake levels for nutrients. Washington, D.C.: National Academy Press; 1998. x, 71 p. p.

  19. In: Ross AC, Taylor CL, Yaktine AL, Del Valle HB, editors. Dietary reference intakes for calcium and vitamin D. The National Academies Collection: Reports funded by National Institutes of Health. Washington (DC)2011.

  20. Parrott J, Frank L, Rabena R, Craggs-Dino L, Isom KA, Greiman L. American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient 2016 update: micronutrients. Surg Obes Relat Dis. 2017;13(5):727–41.

    Article  Google Scholar 

  21. Raj P. Bariatric surgical practice guide. New York: Springer Berlin Heidelberg; 2016. pages cm p

  22. Kiela PR, Ghishan FK. Physiology of intestinal absorption and secretion. Best Pract Res Clin Gastroenterol. 2016;30(2):145–59.

    Article  CAS  Google Scholar 

  23. Sabliov CM, Chen H, Yada RY. Nanotechnology and functional foods: effective delivery of bioactive ingredients. Chichester: Wiley Blackwell; 2015.

    Book  Google Scholar 

  24. Hallberg L, Brune M, Rossander L. The role of vitamin C in iron absorption. Int J Vitam Nutr Res Suppl. 1989;30:103–8.

    CAS  PubMed  Google Scholar 

  25. Roust LR, DiBaise JK. Nutrient deficiencies prior to bariatric surgery. Curr Opin Clin Nutr Metab Care. 2017;20(2):138–44.

    Article  CAS  Google Scholar 

  26. Frame-Peterson LA, Megill RD, Carobrese S, Schweitzer M. Nutrient deficiencies are common prior to bariatric surgery. Nutr Clin Pract. 2017;32(4):463–9.

    Article  Google Scholar 

  27. Peterson LA, Cheskin LJ, Furtado M, Papas K, Schweitzer MA, Magnuson TH, et al. Malnutrition in bariatric surgery candidates: multiple micronutrient deficiencies prior to surgery. Obes Surg. 2016;26(4):833–8.

    Article  Google Scholar 

  28. Bird JK,Murphy RA, Ciappio ED,McBurneyMI. Risk of Deficiency in Multiple Concurrent Micronutrients in Children and Adults in the United States Nutrients. 2017 Jun 24;9(7):655.

  29. Lefebvre P, Letois F, Sultan A, Nocca D, Mura T, Galtier F. Nutrient deficiencies in patients with obesity considering bariatric surgery: a cross-sectional study. Surg Obes Relat Dis. 2014;10(3):540–6.

    Article  Google Scholar 

  30. Valentino D, Sriram K, Shankar P. Update on micronutrients in bariatric surgery. Curr Opin Clin Nutr Metab Care. 2011;14(6):635–41.

    Article  CAS  Google Scholar 

  31. Gletsu-Miller N, Wright BN. Mineral malnutrition following bariatric surgery. Adv Nutr. 2013;4(5):506–17.

    Article  CAS  Google Scholar 

  32. Kazemi A, Frazier T, Cave M. Micronutrient-related neurologic complications following bariatric surgery. Curr Gastroenterol Rep. 2010;12(4):288–95.

    Article  Google Scholar 

  33. Osland E, Powlesland H, Guthrie T, Lewis CA, Memon MA. Micronutrient management following bariatric surgery: the role of the dietitian in the postoperative period. Ann Transl Med. 2020;8(Suppl 1):S9.

    Article  CAS  Google Scholar 

  34. Bal BS, Finelli FC, Shope TR, Koch TR. Nutritional deficiencies after bariatric surgery. Nat Rev Endocrinol. 2012;8(9):544–56.

    Article  CAS  Google Scholar 

  35. Shankar P, Boylan M, Sriram K. Micronutrient deficiencies after bariatric surgery. Nutrition. 2010;26(11–12):1031–7.

    Article  CAS  Google Scholar 

  36. Bettini S, Belligoli A, Fabris R, Busetto L. Diet approach before and after bariatric surgery. Rev Endocr Metab Disord. 2020;21(3):297–306.

    Article  Google Scholar 

  37. Richardson WS, Plaisance AM, Periou L, Buquoi J, Tillery D. Long-term management of patients after weight loss surgery. Ochsner J. 2009;9(3):154–9.

    PubMed  PubMed Central  Google Scholar 

  38. Mechanick JI, Kushner RF. Lifestyle medicine: a manual for clinical practice. Springer International Publishing Switzerland 2016.

  39. Thibault R, Huber O, Azagury DE, Pichard C. Twelve key nutritional issues in bariatric surgery. Clin Nutr. 2016;35(1):12–7.

    Article  Google Scholar 

  40. Sherf Dagan S, Goldenshluger A, Globus I, Schweiger C, Kessler Y, Kowen Sandbank G, et al. Nutritional recommendations for adult bariatric surgery patients: clinical practice. Adv Nutr. 2017;8(2):382–94.

    Article  Google Scholar 

  41. Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring). 2013;21(Suppl 1):S1–27.

    Article  CAS  Google Scholar 

  42. Lewis CA, de Jersey S, Hopkins G, Hickman I, Osland E. Does bariatric surgery cause vitamin A, B1, C or E deficiency? A systematic review. Obes Surg. 2018;28(11):3640–57.

    Article  Google Scholar 

  43. Duncan A, Talwar D, McMillan DC, Stefanowicz F, O'Reilly DS. Quantitative data on the magnitude of the systemic inflammatory response and its effect on micronutrient status based on plasma measurements. Am J Clin Nutr. 2012;95(1):64–71.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Monica Saumoy MD, MS.

Ethics declarations

This article does not contain any studies with human or animal subjects performed by any of the authors.

Conflict of Interest

Roohi Patel declares that she has no conflict of interest. Monica Saumoy declares that she has no conflict of interest

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Nutrition and Obesity

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Patel, R., Saumoy, M. Treatment of Micronutrient Deficiencies Pre and Post Bariatric Surgery. Curr Treat Options Gastro 19, 169–182 (2021). https://doi.org/10.1007/s11938-020-00328-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11938-020-00328-5

Keywords

Navigation