Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Obesity Surgery
Published in: Obesity Surgery 2/2017

01-02-2017 | Review Article

Zinc Deficiency after Gastric Bypass for Morbid Obesity: a Systematic Review

Authors: Kamal K. Mahawar, Aparna Govil Bhasker, Vivek Bindal, Yitka Graham, Usha Dudeja, Muffazal Lakdawala, Peter K. Small

Published in: Obesity Surgery | Issue 2/2017

Login to get access

Abstract

Up to 50% of patients have zinc deficiency before bariatric surgery. Roux-en-Y gastric bypass (RYGB) is the commonest bariatric procedure worldwide. It can further exacerbate zinc deficiency by reducing intake as well as absorption. The British Obesity and Metabolic Surgery Society, therefore, recommends that zinc level should be monitored routinely following gastric bypass. However, the American guidance does not recommend such monitoring for all RYGB patients and reserves it for patients with ‘specific findings’. This review concludes that clinically relevant Zn deficiency is rare after RYGB. Routine monitoring of zinc levels is hence unnecessary for asymptomatic patients after RYGB and should be reserved for patients with skin lesions, hair loss, pica, dysgeusia, hypogonadism or erectile dysfunction in male patients, and unexplained iron deficiency anaemia.
Literature
1.
2.
3.
Livingstone C. Zinc: physiology, deficiency, and parenteral nutrition. Nutr Clin Pract. 2015;30(3):371–82.CrossRefPubMed
4.
Stein J, Stier C, Raab H, et al. Review article: the nutritional and pharmacological consequences of obesity surgery. Aliment Pharmacol Ther. 2014;40(6):582–609.CrossRefPubMed
5.
6.
Mechanick JI, Youdim A, Jones DB, 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.CrossRef
7.
Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25(10):1822–32.CrossRefPubMed
8.
9.
Billeter AT, Probst P, Fischer L, et al. Risk of malnutrition, trace metal, and vitamin deficiency post Roux-en-Y gastric bypass—a prospective study of 20 patients with BMI <35 kg/m2. Obes Surg. 2015;25(11):2125–34.CrossRefPubMed
10.
Papamargaritis D, Aasheim ET, Sampson B, et al. Copper, selenium and zinc levels after bariatric surgery in patients recommended to take multivitamin-mineral supplementation. J Trace Elem Med Biol. 2015;31:167–72.CrossRefPubMed
11.
Ernst B, Thurnheer M, Schmid SM, et al. Evidence for the necessity to systematically assess micronutrient status prior to bariatric surgery. Obes Surg. 2009;19(1):66–73.CrossRefPubMed
12.
Gobato RC, Seixas Chaves DF, Chaim EA. Micronutrient and physiologic parameters before and 6 months after RYRYGB. Surg Obes Relat Dis. 2014;10(5):944–51.CrossRefPubMed
13.
Remedios C, Bhasker AG, Dhulla N, et al. Bariatric nutrition guidelines for the Indian population. Obes Surg. 2016;26(5):1057–68.CrossRefPubMed
14.
Ruz M, Carrasco F, Rojas P, et al. Zinc absorption and zinc status are reduced after Roux-en-Y gastric bypass: a randomized study using 2 supplements. Am J Clin Nutr. 2011;94(4):1004–11.CrossRefPubMed
15.
Pires LV, Martins LM, Geloneze B, et al. Hadad do Monte SJ, do Nascimento Nagueira N, et al. the effect of Roux-en-Y gastric bypass on zinc nutritional status. Obes Surg. 2007;17(5):617–21.CrossRefPubMed
16.
de Torres Rossi RG, Dos Santos MT, de Souza FI, et al. Nutrient intake of women 3 years after Roux-en-Y gastric bypass surgery. Obes Surg. 2012;22(10):1548–53.CrossRefPubMed
17.
Cominetti C, Garrido Jr AB, Cozzolino SM. Zinc nutritional status of morbidly obese patients before and after Roux-en-Y gastric bypass: a preliminary report. Obes Surg. 2006;16(4):448–53.CrossRefPubMed
18.
Rosa FT, de Oliveira-Penaforte FR, de Arruda LI, et al. Altered plasma response to zinc and iron tolerance test after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2011;7(3):309–14.CrossRefPubMed
19.
Freeland-Graves JH, Lee JJ, Mousa TY, et al. Patients at risk for trace element deficiencies: bariatric surgery. J Trace Elem Med Biol. 2014;28(4):495–503.CrossRefPubMed
20.
Lewandowski H, Breen TL, Huang EY. Kwashiorkor and an acrodermatitis enteropathica-like eruption after a distal gastric bypass surgical procedure. Endocr Pract. 2007;13(3):277–82.CrossRefPubMed
21.
Basfi-Fer K, Rojas P, Carrasco F, et al. Evolution of the intake and nutritional status of zinc, iron and copper in women undergoing bariatric surgery until the second year after surgery. [article in Spanish]. Nutr Hosp. 2012;27(5):1527–35.PubMed
22.
Monshi B, Stockinger T, Vigl K, et al. Phrynoderma and acquired acrodermatitis enteropathica in breastfeeding women after bariatric surgery. J Dtsch Dermatol Ges. 2015;13(11):1147–54.PubMed
23.
Mankaney GN, Vipperla K. Images in clinical medicine. Acquired acrodermatitis enteropathica. N Engl J Med. 2014;371(1):67.CrossRefPubMed
24.
Vick G, Mahmoudizad R, Fiala K. Intravenous zinc therapy for acquired zinc deficiency secondary to gastric bypass surgery: a case report. Dermatol Ther. 2015;28(4):222–5.CrossRefPubMed
25.
Shahsavari D, Ahmed Z, Karikkineth A, Williams R, Zigel C. Zinc-deficiency acrodermatitis in a patient with chronic alcoholism and gastric bypass: a case report. J Commun Hosp Intern Med Perspect. 2014; 4. eCollection 2014.
26.
Zouridaki E, Papafragkaki DK, Papafragkakis H, et al. Dermatological complications after bariatric surgery: report of two cases and review of the literature. Dermatology. 2014;228(1):5–9.CrossRefPubMed
27.
28.
Balsa JA, Botella-Carretero JI, Gómez-Martín JM, et al. Copper and zinc serum levels after derivative bariatric surgery: differences between Roux-en-Y gastric bypass and biliopancreatic diversion. Obes Surg. 2011;21(6):744–50.CrossRefPubMed
29.
Rojas P, Carrasco F, Codoceo J, et al. Trace element status and inflammation parameters after 6 months of Roux-en-Y gastric bypass. Obes Surg. 2011;21(5):561–8.CrossRefPubMed
30.
Gasteyger C, Suter M, Gaillard RC, et al. Nutritional deficiencies after Roux-en-Y gastric bypass for morbid obesity often cannot be prevented by standard multivitamin supplementation. Am J Clin Nutr. 2008;87(5):1128–33.PubMed
31.
Gong K, Gagner M, Pomp A, et al. Micronutrient deficiencies after laparoscopic gastric bypass: recommendations. Obes Surg. 2008;18(9):1062–6.CrossRefPubMed
32.
Sallé A, Demarsy D, Poirier AL, et al. Zinc deficiency: a frequent and underestimated complication after bariatric surgery. Obes Surg. 2010;20(12):1660–70.CrossRefPubMed
33.
Gehrer S, Kern B, Peters T, et al. Fewer nutrient deficiencies after laparoscopic sleeve gastrectomy (LSG) than after laparoscopic Roux-Y-gastric bypass (LRYGB)—a prospective study. Obes Surg. 2010;20(4):447–53.CrossRefPubMed
34.
Dalcanale L, Oliveira CP, Faintuch J, et al. Long-term nutritional outcome after gastric bypass. Obes Surg. 2010;20(2):181–7.CrossRefPubMed
35.
Madan AK, Orth WS, Tichansky DS, et al. Vitamin and trace mineral levels after laparoscopic gastric bypass. Obes Surg. 2006;16(5):603–6.CrossRefPubMed
36.
Moizé V, Andreu A, Flores L, et al. Long-term dietary intake and nutritional deficiencies following sleeve gastrectomy or Roux-En-Y gastric bypass in a mediterranean population. J Acad Nutr Diet. 2013;113(3):400–10.CrossRefPubMed
37.
Homan J, Schijns W, Aarts EO, et al. An optimized multivitamin supplement lowers the number of vitamin and mineral deficiencies three years after Roux-en-Y gastric bypass: a cohort study. Surg Obes Relat Dis. 2016;12(3):659–67.CrossRefPubMed
38.
Roohani N, Hurrell R, Kelishadi R, et al. Zinc and its importance for human health: an integrative review. J Res Med Sci. 2013;18(2):144–57.PubMedPubMedCentral
39.
No Authors Listed. Food and Nutrition Board, Institute of Medicine. Zinc. Dietary reference intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. Washington, D.C.: National Academy Press; 2001. p. 442–501.
40.
Klevay LM. Bariatric surgery and the assessment of copper and zinc nutriture. Obes Surg. 2010;20(5):672–3.CrossRefPubMed
41.
Lowe NM, Fekete K, Decsi T. Methods of assessment of zinc status in humans: a systematic review. Am J Clin Nutr. 2009;89(6):2040S–51S.CrossRefPubMed
Metadata
Title
Zinc Deficiency after Gastric Bypass for Morbid Obesity: a Systematic Review
Authors
Kamal K. Mahawar
Aparna Govil Bhasker
Vivek Bindal
Yitka Graham
Usha Dudeja
Muffazal Lakdawala
Peter K. Small
Publication date
01-02-2017
Publisher
Springer US
Published in
Obesity Surgery / Issue 2/2017
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-016-2474-8

Other articles of this Issue 2/2017

Obesity Surgery 2/2017 Go to the issue

Original Contributions

Physical Fitness and Body Composition Two Years after Roux-En-Y Gastric Bypass in Adolescents

Original Contributions

MILEPOST Multicenter Randomized Controlled Trial: 12-Month Weight Loss and Satiety Outcomes After pose SM vs. Medical Therapy

Original Contributions

Concomitant Removal of Gastric Band and Gastric Bypass: Analysis of Outcomes and Complications from the ACS-NSQIP Database

Original Contributions

Laparoscopic Adjustable Gastric Banding After Failed Roux-En-Y Gastric Bypass

Review Article

Effect of Protein Intake on the Protein Status and Lean Mass of Post-Bariatric Surgery Patients: a Systematic Review

Brief Communication

The Recovery of Beta-Cell Function is Critical for Antidiabetic Outcomes of Gastric Bypass in Asian Subjects with Type 2 Diabetes and a Body Mass Index Below 30