Nutritional deficiencies after bariatric surgery
Abstract
Lifestyle intervention programmes often produce insufficient weight loss and poor weight loss maintenance. As a result, an increasing number of patients with obesity and related comorbidities undergo bariatric surgery, which includes approaches such as the adjustable gastric band or the 'divided' Roux-en-Y gastric bypass (RYGB). This Review summarizes the current knowledge on nutrient deficiencies that can develop after bariatric surgery and highlights follow-up and treatment options for bariatric surgery patients who develop a micronutrient deficiency. The major macronutrient deficiency after bariatric surgery is protein malnutrition. Deficiencies in micronutrients, which include trace elements, essential minerals, and water-soluble and fat-soluble vitamins, are common before bariatric surgery and often persist postoperatively, despite universal recommendations on multivitamin and mineral supplements. Other disorders, including small intestinal bacterial overgrowth, can promote micronutrient deficiencies, especially in patients with diabetes mellitus. Recognition of the clinical presentations of micronutrient deficiencies is important, both to enable early intervention and to minimize long-term adverse effects. A major clinical concern is the relationship between vitamin D deficiency and the development of metabolic bone diseases, such as osteoporosis or osteomalacia; metabolic bone diseases may explain the increased risk of hip fracture in patients after RYGB. Further studies are required to determine the optimal levels of nutrient supplementation and whether postoperative laboratory monitoring effectively detects nutrient deficiencies. In the absence of such data, clinicians should inquire about and treat symptoms that suggest nutrient deficiencies.
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Obesity is a paradoxical condition of malnutrition often associated with pathological fat deposition, low muscle mass and a lack of micronutrients, such as copper, zinc, and iodine, despite increased energy intake.
“Obesity is a paradoxical condition of malnutrition often associated with pathological fat deposition, low muscle mass and a lack of micronutrients, such as copper, zinc, and iodine, despite increased energy intake (9, 10).”
From Evolution of the diagnosis of malnutrition in adults: a primer for clinicians (2024) · cites this paper as [10]
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- Authors
- Bal, B. S., Finelli, F. C., Shope, T. R., & Koch, T. R.
- Affiliations
- MedStar Washington Hospital Center (US)
- Corresponding author
- Koch, Timothy R.
- Venue
- Nature Reviews Endocrinology
- Published
- 2012-04-24
- Volume
- 8
- Issue
- 9
- Pages
- 544-556
- ISSN
- 1759-5029 (ISSN-L)
- 1759-5037
- OpenAlex
- W2021396934
- Cited by
- 418
- References
- 7
- Citations by year
- 2026: 21 · 2025: 24 · 2024: 35 · 2023: 43 · 2022: 36 · 2021: 37 · 2020: 26 · 2019: 17 · 2018: 22 · 2017: 26 · 2016: 31 · 2015: 29 · 2014: 38 · 2013: 27 · 2012: 5
- FWCI
- 6.12
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Nature Reviews Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Keywords
- bariatric surgery, micronutrient deficiency, protein malnutrition, vitamin D deficiency, metabolic bone disease, osteoporosis, osteomalacia, hip fracture, Roux-en-Y gastric bypass, adjustable gastric band, small intestinal bacterial overgrowth, diabetes mellitus, multivitamin supplementation, mineral supplementation, obesity
- MeSH terms
- Deficiency Diseases, Humans, Models, Biological, Nutrition Disorders, Obesity, Postoperative Complications, Bariatric Surgery
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