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Screening and Diagnosis of Micronutrient Deficiencies Before and After Bariatric Surgery
Open accessAbstract
Background Micronutrient deficiencies are key concerns after bariatric surgery. We describe the prevalence of perioperative testing and diagnosis of micronutrient deficiencies among a cohort of insured bariatric surgery patients.Methods We used claims data from seven health insurers to identify bariatric surgery patients from 2002-2008. Our outcomes were perioperative claims for vitamin D, B12, folate, and iron testing and diagnosed deficiencies. We analyzed results by bariatric surgery type: Roux-en-Y gastric bypass (RYGB), restrictive, and malabsorptive. We calculated the prevalence of testing and deficiency diagnosis, and performed multivariate logistic regression to determine the association with surgery type.Results Of 21,345 eligible patients, 84% underwent RYGB. The pre-surgical testing prevalence for all micronutrients was <25%. The testing prevalence during the first 12 months after surgery varied: vitamin D (12%), vitamin B12 (60%), folate (47%) and iron (49%), and declined during 13-24 and 25-36 months. The deficiency prevalence during 0-12 months post-survey varied: vitamin D (34%), vitamin B12 (20%), folate (13%), and iron (10%). The odds of vitamin B12, folate, and iron deficiency during 0-12 months were significantly lower for restrictive as compared to RYGB, but were not different during 13-24 and 25-36 months post-surgery. The odds of vitamin D deficiency were significantly greater for malabsorptive as compared to RYGB during all post-surgical periods.Conclusion Many patients did not receive micronutrient testing pre- or post-surgery, yet deficiencies were relatively common among those tested. These results highlight the need for surgeons and primary care providers to test all bariatric surgery patients for micronutrient deficiencies.
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“Early satiety, nausea, and changes in food preferences often result in reduced dietary variety and diminished intake of essential nutrients, including iron, vitamin B12, vitamin D, calcium, and thiamine [6, 9].”
From Bridging the nutrition guidance gap for GLP-1 receptor agonist therapy assisted weight loss: Lessons from bariatric surgery (2026) · cites this paper as [6]
In the citing paper
“Unlike bariatric surgery, where preoperative screening for micronutrient deficiencies is standard practice [6], no formal consensus recommendations currently exist for individuals commencing GLP-1 RAs.”
From Bridging the nutrition guidance gap for GLP-1 receptor agonist therapy assisted weight loss: Lessons from bariatric surgery (2026) · cites this paper as [6]
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“Loss of skeletal muscle can impair metabolic health, diminish physical function, and compromise weight maintenance [6].”
From Bridging the nutrition guidance gap for GLP-1 receptor agonist therapy assisted weight loss: Lessons from bariatric surgery (2026) · cites this paper as [6]
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Metadata
- Authors
- Gudzune, K. A., Huizinga, M. M., Chang, H.-Y., Asamoah, V., Gadgil, M., & Clark, J. M.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Gudzune, Kimberly A.
- Venue
- Obesity Surgery
- Published
- 2013-03-21
- Volume
- 23
- Issue
- 10
- Pages
- 1581-1589
- ISSN
- 0960-8923 (ISSN-L)
- 1708-0428
- PMC
- PMC3740071
- OpenAlex
- W2011950248
- Cited by
- 109
- References
- 24
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 6 · 2023: 5 · 2022: 8 · 2021: 9 · 2020: 12 · 2019: 5 · 2018: 9 · 2017: 15 · 2016: 7 · 2015: 12 · 2014: 8 · 2013: 5
- FWCI
- 10.52
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Obesity Surgery (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Health Resources and Services Administration
- U.S. Public Health Service (T32-HP10025)
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK079637, R01DK089557)
- Ethicon Endo-Surgery
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Keywords
- micronutrient deficiency, bariatric surgery
- MeSH terms
- Iron Deficiencies, Adult, Female, Folic Acid Deficiency, Humans, Iron, Male, Maryland, Mass Screening, Obesity, Morbid, Postoperative Period, Time Factors, United States, Vitamin B 12 Deficiency, Vitamin D Deficiency, Gastric Bypass, Prevalence, Practice Guidelines as Topic, Micronutrients, Preoperative Period
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