Mineral Malnutrition Following Bariatric Surgery

Nana Gletsu-Miller and Breanne N. Wright Department of Nutrition Science, Purdue University, West Lafayette, IN Advanced Nutrition. 4: 506-517, 2013.


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: preoperative malnutrition (e.g., vitamin D, iron); decreased food intake (due to reduced hunger and increased satiety, food intolerances, frequent vomiting); inadequate nutrient supplementation (due to poor compliance with multivitamin/multimineral regimen, insufficient amounts of vitamins and/or minerals in supplements); nutrient malabsorption; and inadequate nutritional support (due to lack of follow-up, insufficient monitoring, difficulty in recognizing symptoms of deficiency).

In conclusion, the benefits of bariatric surgery are tempered by the high frequency of nutritional deficiencies that occur, some of which are under-recognized and left untreated and lead to devastating consequences to bone health and to the functioning of the immune, nervous, and muscular systems. Bariatric surgery exacerbates pre-existing malnutrition in calcium and vitamin D as well as iron due to reduced bioavailability and malabsorption and poor dietary intake and compliance with micronutrient supplementation following surgery. These issues are of great importance, especially in special populations such as adolescents as well as pregnant women and their fetuses who may be at risk for developmental problems that affect physical and mental function. Additional research is needed to establish recommendations for prevention and treatment to optimize nutritional outcomes following bariatric surgery.

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