title: Mineral malnutrition following bariatric surgery.
abstract: Moderate/severe obesity is on the rise in the United States. Weight management includes bariatric surgery, which is effective and can alleviate morbidity and mortality from obesity-associated diseases. However, many individuals are dealing with nutritional complications. Risk factors include: 1) preoperative malnutrition (e.g., vitamin D, iron); 2) decreased food intake (due to reduced hunger and increased satiety, food intolerances, frequent vomiting); 3) inadequate nutrient supplementation (due to poor compliance with multivitamin/multimineral regimen, insufficient amounts of vitamins and/or minerals in supplements); 4) nutrient malabsorption; and 5) inadequate nutritional support (due to lack of follow-up, insufficient monitoring, difficulty in recognizing symptoms of deficiency). For some nutrients (e.g., protein, vitamin B-12, vitamin D), malnutrition issues are reasonably addressed through patient education, routine monitoring, and effective treatment strategies. However, there is little attention paid to other nutrients (e.g., zinc, copper), which if left untreated may have devastating consequences (e.g., hair loss, poor immunity, anemia, defects in neuro-muscular function). This review focuses on malnutrition in essential minerals, including calcium (and vitamin D), iron, zinc, and copper, which commonly occur following popular bariatric procedures. There will be emphasis on the complexities, including confounding factors, related to screening, recognition of symptoms, and, when available, current recommendations for treatment. There is an exceptionally high risk of malnutrition in adolescents and pregnant women and their fetuses, who may be vulnerable to problems in growth and development. More research is required to inform evidence-based recommendations for improving nutritional status following bariatric surgery and optimizing weight loss, metabolic, and nutritional outcomes.
authors.affiliation: Department of Nutrition Science, Purdue University, West Lafayette, IN.
authors.forename: Nana
authors.initials: N
authors.lastname: Gletsu-Miller
authors.forename: Breanne N
authors.initials: BN
authors.lastname: Wright
mesh_terms: D050110:Bariatric Surgery / Q000009:adverse effects*; D002118:Calcium / Q000172:deficiency / Q000378:metabolism; D003300:Copper / Q000172:deficiency / Q000378:metabolism; D003677:Deficiency Diseases / Q000209:etiology* / Q000378:metabolism / Q000517:prevention & control; D006801:Humans; D007408:Intestinal Absorption; D007501:Iron / Q000378:metabolism; D000090463:Iron Deficiencies; D008286:Malabsorption Syndromes / Q000150:complications / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology*; D008903:Minerals / Q000378:metabolism*; D014808:Vitamin D Deficiency / Q000150:complications; D015032:Zinc / Q000172:deficiency / Q000378:metabolism
chemical_list: D008903:Minerals; D003300:Copper; D007501:Iron; D015032:Zinc; D002118:Calcium
references.citation: JAMA. 2005 Oct 19;294(15):1909-17
references.pmid: 16234497
references.citation: MedGenMed. 2006 Dec 19;8(4):59
references.pmid: 17415336
references.citation: Annu Rev Nutr. 2013;33:183-203
references.pmid: 23642197
references.citation: Obes Surg. 2008 Mar;18(3):288-93
references.pmid: 18214631
references.citation: Gastroenterology. 2012 Oct;143(4):897-912
references.pmid: 22885332
references.citation: Ann Surg. 2008 Mar;247(3):401-7
references.pmid: 18376181
references.citation: Obes Surg. 2012 May;22(5):740-8
references.pmid: 22354457
references.citation: J Nutr. 2012 Feb;142(2):292-7
references.pmid: 22190021
references.citation: Int J Obes (Lond). 2012 Mar;36(3):328-35
references.pmid: 21876546
references.citation: Int J Obes (Lond). 2013 Jun;37(6):889-91
references.pmid: 22986681
references.citation: Ann Surg. 2004 Sep;240(3):416-23; discussion 423-4
references.pmid: 15319713
references.citation: Obes Surg. 2003 Aug;13(4):661-2
references.pmid: 12935373
references.citation: Surg Obes Relat Dis. 2011 Jul-Aug;7(4):516-25
references.pmid: 21333610
references.citation: Nutrition. 2009 Nov-Dec;25(11-12):1150-6
references.pmid: 19487104
references.citation: Endocrinology. 2010 Apr;151(4):1588-97
references.pmid: 20179262
references.citation: South Med J. 1994 Dec;87(12):1208-13
references.pmid: 7973919
references.citation: Surg Obes Relat Dis. 2012 Jan-Feb;8(1):1-7
references.pmid: 22030146
references.citation: Nutrition. 1996 Jun;12(6):397-404
references.pmid: 8991515
references.citation: Obesity (Silver Spring). 2009 Apr;17 Suppl 1:S1-70, v
references.pmid: 19319140
references.citation: J Bone Miner Res. 2012 Mar;27(3):619-27
references.pmid: 22354851
references.citation: JAMA. 2008 Jan 23;299(3):316-23
references.pmid: 18212316
references.citation: Circulation. 2012 Mar 20;125(11):1381-9
references.pmid: 22344037
references.citation: Obes Surg. 2011 Apr;21(4):465-72
references.pmid: 21188546
references.citation: J Nutr. 1979 Nov;109(11):1979-2066
references.pmid: 387922
references.citation: Am J Clin Nutr. 2011 Oct;94(4):1004-11
references.pmid: 21865332
references.citation: Am J Case Rep. 2012;13:209-13
references.pmid: 23569531
references.citation: J Clin Endocrinol Metab. 2005 Feb;90(2):813-9
references.pmid: 15585553
references.citation: Am J Clin Nutr. 2009 Sep;90(3):527-32
references.pmid: 19625680
references.citation: J Pediatr Gastroenterol Nutr. 2012 Jan;54(1):125-35
references.pmid: 21857247
references.citation: Nat Genet. 1999 Feb;21(2):195-9
references.pmid: 9988272
references.citation: J Pediatr Surg. 2008 Jan;43(1):141-6
references.pmid: 18206472
references.citation: Ann Intern Med. 1978 Oct;89(4):491-3
references.pmid: 697228
references.citation: Am J Gastroenterol. 2007 Nov;102(11):2571-80; quiz 2581
references.pmid: 17640325
references.citation: Arch Gynecol Obstet. 2012 May;285(5):1211-8
references.pmid: 22057892
references.citation: J Am Coll Surg. 2011 Aug;213(2):261-6
references.pmid: 21624841
references.citation: Int J Vitam Nutr Res. 2010 Oct;80(4-5):263-70
references.pmid: 21462109
references.citation: Obesity (Silver Spring). 2009 May;17(5):996-1002
references.pmid: 19165167
references.citation: Lancet Oncol. 2009 Jul;10(7):653-62
references.pmid: 19556163
references.citation: Crit Care Nurs Q. 2003 Apr-Jun;26(2):133-8
references.pmid: 12744593
references.citation: Obes Surg. 2013 Oct;23(10):1581-9
references.pmid: 23515975
references.citation: Obes Surg. 2013 Apr;23(4):427-36
references.pmid: 23338049
references.citation: JAMA. 2010 Jan 20;303(3):242-9
references.pmid: 20071470
references.citation: Obes Surg. 2008 Dec;18(12):1526-31
references.pmid: 18716852
references.citation: J Gastrointest Surg. 2004 Jan;8(1):48-55; discussion 54-5
references.pmid: 14746835
references.citation: Obes Surg. 2010 Nov;20(11):1524-9
references.pmid: 20740379
references.citation: Gastroenterology. 1988 Feb;94(2):508-12
references.pmid: 3335323
references.citation: Obes Surg. 2009 Sep;19(9):1286-92
references.pmid: 19618246
references.citation: Obes Surg. 2010 Oct;20(10):1393-9
references.pmid: 20680506
references.citation: JAMA. 2012 Sep 19;308(11):1122-31
references.pmid: 22990271
references.citation: J Nutr. 1986 Jun;116(6):927-35
references.pmid: 3522825
references.citation: Proc Natl Acad Sci U S A. 2013 Jul 9;110(28):11439-44
references.pmid: 23716672
references.citation: Eur J Clin Nutr. 2012 May;66(5):645-7
references.pmid: 22318651
references.citation: Obes Surg. 1999 Apr;9(2):150-4
references.pmid: 10340768
references.citation: J Clin Endocrinol Metab. 2008 Oct;93(10):3735-40
references.pmid: 18647809
references.citation: J Clin Endocrinol Metab. 2011 Sep;96(9):E1372-9
references.pmid: 21778221
references.citation: J Clin Endocrinol Metab. 2011 Jul;96(7):2171-7
references.pmid: 21490075
references.citation: Obes Surg. 2012 Nov;22(11):1676-85
references.pmid: 22684818
references.citation: Am J Clin Nutr. 2010 Oct;92(4):704-13
references.pmid: 20739420
references.citation: Biol Trace Elem Res. 2004 Aug;100(2):137-49
references.pmid: 15326363
references.citation: N Engl J Med. 2005 Jul 21;353(3):249-54
references.pmid: 16034010
references.citation: J Clin Endocrinol Metab. 2008 Jul;93(7):2479-85
references.pmid: 18430778
references.citation: Am J Clin Nutr. 1991 May;53(5):1295-303
references.pmid: 2021137
references.citation: Obes Surg. 2010 Apr;20(4):447-53
references.pmid: 20101473
references.citation: Obes Surg. 2008 May;18(5):573-7
references.pmid: 18365290
references.citation: Int J Obes (Lond). 2011 Sep;35 Suppl 3:S26-30
references.pmid: 21912383
references.citation: Paediatr Perinat Epidemiol. 2012 Jul;26 Suppl 1:302-14
references.pmid: 22742617
references.citation: Obes Surg. 2011 Sep;21(9):1382-8
references.pmid: 21298509
references.citation: Surg Clin North Am. 1967 Dec;47(6):1345-51
references.pmid: 6073761
references.citation: Ann Intern Med. 2011 Mar 1;154(5):356-64
references.pmid: 21242341
references.citation: Crit Rev Clin Lab Sci. 2010 Aug;47(4):181-95
references.pmid: 21182397
references.citation: Obesity (Silver Spring). 2009 Apr;17(4):827-31
references.pmid: 19148115
references.citation: Lancet. 2007 Aug 11;370(9586):511-20
references.pmid: 17693180
references.citation: Obes Surg. 2010 Dec;20(12):1660-70
references.pmid: 20706804
references.citation: Obesity (Silver Spring). 2006 Nov;14(11):1940-8
references.pmid: 17135609
references.citation: J Clin Endocrinol Metab. 2012 Dec;97(12):4540-8
references.pmid: 23066115
references.citation: J Am Coll Nutr. 2006 Feb;25(1):64-9
references.pmid: 16522934
references.citation: N Engl J Med. 2007 Aug 23;357(8):753-61
references.pmid: 17715409
references.citation: Br J Surg. 2006 Feb;93(2):210-5
references.pmid: 16392104
references.citation: Surg Obes Relat Dis. 2012 May-Jun;8(3):331-6
references.pmid: 22260884
references.citation: Crit Care Med. 2006 Apr;34(4):964-70; quiz 971
references.pmid: 16484910
references.citation: Am J Clin Nutr. 2000 Sep;72(3):690-3
references.pmid: 10966885
references.citation: Health Technol Assess. 2009 Sep;13(41):1-190, 215-357, iii-iv
references.pmid: 19726018
references.citation: Am J Clin Nutr. 2004 Dec;80(6 Suppl):1735S-9S
references.pmid: 15585797
references.citation: Int J Pediatr Obes. 2011 Aug;6(3-4):289-97
references.pmid: 21299450
references.citation: Am J Clin Nutr. 1997 Aug;66(2):327-333
references.pmid: 9250111
references.citation: N Engl J Med. 2007 Jul 19;357(3):266-81
references.pmid: 17634462
references.citation: Obes Surg. 2012 Sep;22(9):1427-36
references.pmid: 22798263
references.citation: Surg Obes Relat Dis. 2009 Jan-Feb;5(1):54-9
references.pmid: 18848507
references.citation: Clin Chim Acta. 1979 Nov 15;99(1):23-9
references.pmid: 498541
references.citation: Surg Obes Relat Dis. 2011 Nov-Dec;7(6):727-32
references.pmid: 21497142
references.citation: J Clin Endocrinol Metab. 2012 Aug;97(8):E1440-50
references.pmid: 22585089
references.citation: Pediatrics. 2011 Apr;127(4):e956-61
references.pmid: 21444596
references.citation: JAMA Surg. 2013 Jun;148(6):555-62
references.pmid: 23426865
references.citation: N Engl J Med. 2007 Aug 23;357(8):741-52
references.pmid: 17715408
references.citation: Obes Res. 2004 Jan;12(1):40-7
references.pmid: 14742841
references.citation: J Clin Endocrinol Metab. 2009 Nov;94(11):4275-83
references.pmid: 19820018
references.citation: J Med. 1993;24(2-3):177-83
references.pmid: 8409780
references.citation: J Am Diet Assoc. 2004 Sep;104(9):1393-7
references.pmid: 15354156
references.citation: Pediatrics. 2010 Oct;126(4):e746-53
references.pmid: 20855388
references.citation: Osteoporos Int. 2001;12(3):199-206
references.pmid: 11315238
references.citation: Am Surg. 2006 Dec;72(12):1196-202; discussion 1203-4
references.pmid: 17216818
references.citation: Obes Surg. 2009 Jan;19(1):56-65
references.pmid: 18542847
references.citation: Obes Surg. 2009 Jan;19(1):66-73
references.pmid: 18491197
references.citation: Public Health. 2007 Jul;121(7):492-6
references.pmid: 17399752
references.citation: Obes Surg. 2009 Mar;19(3):274-80
references.pmid: 19034589
references.citation: Obesity (Silver Spring). 2011 Mar;19(3):588-94
references.pmid: 20948527
references.citation: Obes Surg. 2011 Dec;21(12):1921-7
references.pmid: 21197604
references.citation: Am J Clin Nutr. 2009 Jul;90(1):15-22
references.pmid: 19439456
references.citation: JAMA. 2012 Jan 4;307(1):56-65
references.pmid: 22215166
references.citation: Surg Obes Relat Dis. 2012 May-Jun;8(3):346-54
references.pmid: 22336495
references.citation: N Engl J Med. 2012 Aug 23;367(8):695-704
references.pmid: 22913680
references.citation: Obes Surg. 2010 Sep;20(9):1251-7
references.pmid: 20524157
references.citation: Obesity (Silver Spring). 2011 Nov;19(11):2228-34
references.pmid: 21701564
references.citation: Obstet Gynecol. 2012 Mar;119(3):547-54
references.pmid: 22353952
references.citation: BMC Surg. 2012 Jul 05;12:13
references.pmid: 22765843
references.citation: Obes Surg. 2012 Sep;22(9):1456-64
references.pmid: 22644802
references.citation: Dig Dis Sci. 1994 Feb;39(2):315-20
references.pmid: 8313814
references.citation: Obes Surg. 2011 May;21(5):561-8
references.pmid: 21331505
references.citation: Am J Physiol Regul Integr Comp Physiol. 2011 Oct;301(4):R1057-66
references.pmid: 21734019
references.citation: Am Fam Physician. 2006 Apr 15;73(8):1403-8
references.pmid: 16669563
references.citation: Obes Surg. 2013 May;23(5):698-702
references.pmid: 23430478
references.citation: Obes Surg. 2008 Jun;18(6):648-51
references.pmid: 18392907
references.citation: J Clin Endocrinol Metab. 2013 Feb;98(2):541-9
references.pmid: 23295461
references.citation: Obes Surg. 2008 Sep;18(9):1144-8
references.pmid: 18335295
references.citation: Clin Chem. 1991 May;37(5):709-14
references.pmid: 2032325
references.citation: Surg Obes Relat Dis. 2010 Jul-Aug;6(4):347-55
references.pmid: 20176512
references.citation: Plast Reconstr Surg. 2010 Aug;126(2):602-610
references.pmid: 20679842
references.citation: J Clin Endocrinol Metab. 2010 Mar;95(3):1069-75
references.pmid: 20097707
references.citation: Nutr Res. 2008 May;28(5):293-8
references.pmid: 19083422
references.citation: Adv Nutr. 2011 May;2(3):293-4
references.pmid: 22332062
references.citation: Obes Surg. 2013 Sep;23(9):1413-20
references.pmid: 23553506
references.citation: Nutr Metab. 1974;16(2):94-100
references.pmid: 4209332
references.citation: Obes Surg. 2008 Mar;18(3):314-20
references.pmid: 18214630
references.citation: Surg Obes Relat Dis. 2008 Sep-Oct;4(5):640-6
references.pmid: 18586571
references.citation: J Matern Fetal Neonatal Med. 2013 Feb;26(3):275-8
references.pmid: 23043220
references.citation: Obes Surg. 2011 Aug;21(8):1168-71
references.pmid: 21128003
references.citation: Obesity (Silver Spring). 2009 Apr;17(4):796-802
references.pmid: 19148123
references.citation: Obesity (Silver Spring). 2013 Mar;21 Suppl 1:S1-27
references.pmid: 23529939
references.citation: N Engl J Med. 2009 Jul 30;361(5):445-54
references.pmid: 19641201
references.citation: Am J Clin Nutr. 2008 May;87(5):1128-33
references.pmid: 18469230
references.citation: Obes Surg. 2012 Jun;22(6):881-9
references.pmid: 22403000
references.citation: Arch Pediatr Adolesc Med. 2007 Mar;161(3):217-21
references.pmid: 17339501
references.citation: Am J Surg. 1981 Jul;142(1):67-72
references.pmid: 7020460
references.citation: Am J Clin Nutr. 2012 Oct;96(4):810-7
references.pmid: 22952172
references.citation: N Engl J Med. 2012 Apr 26;366(17):1567-76
references.pmid: 22449319
references.citation: Int J Equity Health. 2012 Sep 18;11:54
references.pmid: 22984790
references.citation: Nutrition. 2012 Jul;28(7-8):757-61
references.pmid: 22305536
references.citation: Surg Obes Relat Dis. 2010 Mar 4;6(2):152-7
references.pmid: 20189465
references.citation: ISRN Obes. 2013;2013:
references.pmid: 23724340
references.citation: J Neurol Neurosurg Psychiatry. 2006 Sep;77(9):1092-3
references.pmid: 16914761
references.citation: Obes Surg. 2011 Jun;21(6):744-50
references.pmid: 21442375
references.citation: Am J Obstet Gynecol. 2011 Sep;205(3):206.e1-8
references.pmid: 21596369
references.citation: Nutr Clin Pract. 2011 Feb;26(1):66-9
references.pmid: 21266700
references.citation: Biometals. 2012 Aug;25(4):657-64
references.pmid: 22297381
references.citation: Obesity (Silver Spring). 2009 Nov;17(11):1980-1
references.pmid: 19859058
references.citation: J Acad Nutr Diet. 2013 Mar;113(3):400-410
references.pmid: 23438491
references.citation: Obes Surg. 2012 Aug;22(8):1287-92
references.pmid: 22692668
references.citation: J Clin Endocrinol Metab. 2008 Dec;93(12):4743-8
references.pmid: 18840643
references.citation: Obes Surg. 2005 Feb;15(2):145-54
references.pmid: 15802055
references.citation: Obes Surg. 2005 Nov-Dec;15(10):1389-95
references.pmid: 16354517
references.citation: Surg Obes Relat Dis. 2012 Jul-Aug;8(4):429-33
references.pmid: 21955747
references.citation: Surgery. 2011 May;149(5):654-61
references.pmid: 21295813
references.citation: Obes Surg. 2010 Nov;20(11):1501-8
references.pmid: 20803358
references.citation: Am J Obstet Gynecol. 2013 Jun;208(6):464.e1-5
references.pmid: 23467053
references.citation: Obes Surg. 2011 May;21(5):574-81
references.pmid: 20143180
references.citation: Surg Endosc. 2005 May;19(5):616-20
references.pmid: 15759185
references.citation: Obesity (Silver Spring). 2009 May;17(5):842-62
references.pmid: 19396063
references.citation: Surg Obes Relat Dis. 2012 Jul-Aug;8(4):440-4
references.pmid: 22169760
references.citation: J Nutr. 1988 Jun;118(6):739-46
references.pmid: 3373340
references.citation: Obes Surg. 2011 Oct;21(10):1546-51
references.pmid: 20820939
references.citation: J Nutr. 2003 May;133(5 Suppl 1):1521S-6S
references.pmid: 12730457
references.citation: J Gastrointest Surg. 2009 Jun;13(6):1052-7
references.pmid: 19283435