Vitamin and Mineral Deficiencies

Articles highlighting vitamin and mineral deficiencies
after Duodenal Switch surgery.


Neurologic dysfunction and pancytopenia secondary to
acquired copper deficiency following duodenal switch:
case report and review of the literature.

Btaiche et al. Oct 2011

PubMed Abstract

ABSTRACT: The duodenal switch (DS) procedure is a type of
restrictive-malabsorptive bariatric surgery that is typically
reserved for severe morbidly obese people (body mass index
>50 kg/m(2)) with obesity-related comorbidities, when diet,
lifestyle changes, and pharmacologic therapy fail to achieve
adequate weight loss. Patients who undergo the DS procedure
are at risk for malabsorption, malnutrition, and nutrient
deficiencies. Copper deficiency is a commonly reported long-term
complication of Roux-en-Y gastric bypass (RYGB) surgery.
However, data are limited on copper deficiency-associated
complications and their treatment in DS patients. This article
presents a case of a patient who developed hypocupremia with
associated pancytopenia, myeloneuropathy, and leukoencephalopathy
following DS and reviews the literature related to the pathophysiology
of copper deficiency and copper replacement in bariatric surgery
patients. When severe diarrhea was present, intravenous elemental
copper 4 mg (as cupric chloride)/d in addition to daily oral
copper gluconate was necessary to correct the hypocupremia
and improve the hematologic indices and neurologic symptoms
of copper deficiency. When diarrhea subsided, oral elemental
copper 4 mg (as copper gluconate) 3 times daily maintained
normal serum copper concentrations and avoided the relapse of
severe neurologic dysfunction. Regular monitoring of serum
copper and ceruloplasmin concentrations is recommended following
DS surgery to detect any copper deficiency before irreversible
neurologic damage occurs. Long-term copper supplementation
is likely necessary to maintain normal copper status in DS

Nutritional deficiencies in bariatric surgery patients:
prevention, diagnosis and treatment.

Schweiger et al. Nov 2010

PubMed Abstract

ABSTRACT: The number of people suffering from surgery and
obesity in the western world is constantly growing. In 1997
the World Health Organization (WHO) defined obesity as a
plague and one of greatest public health hazards of our time.
The National Institution of Health (NIH) declared that surgery
is the only long-term solution for obesity. Today there are
four different types of bariatric surgery. Each variation
has different implications on the nutritional status of bariatric
surgery patients. Bariatric surgery candidates are at risk
of developing vitamin and mineral nutritional deficiencies
in the post-operative stage, due to vomiting, decrease in
food intake, food intolerance, diminution of gastric secretions
and bypass of absorption area. It is easier and more efficient
to treat nutritional deficiencies in the preoperative stage.
Therefore, preoperative detection and correction are crucial.
Blood tests before surgery to detect and treat nutritional
deficiencies are crucial. In the postoperative period, blood
tests should be conducted every 3 months in the first year
after operation, every six months in the second year and
annually thereafter. Multivitamin is recommended to prevent
nutritional deficiencies in all bariatric surgery patients.
Furthermore, iron, calcium, Vitamin D and B12 are additionally
recommended for Roux-en-Y Gastric Bypass patients. Patients
with Biliopancreatic diversion and Duodenal Switch should
also take fat soluble vitamins.

Zinc Deficiency: A Frequent and Underestimated Complication
After Bariatric Surgery.

Sallé et al. Aug 2010

PubMed Abstract

BACKGROUND: Although zinc deficiency is common after bariatric
surgery, its incidence is underestimated. The objective was
to monitor zinc and nutritional status before and 6, 12 and
24 months (M6, M12 and M24) after gastric bypass (Roux-en-Y
gastric bypass), sleeve gastrectomy and biliopancreatic diversion
with duodenal switch (DS) in patients receiving systematised
nutritional care.

METHODS: Data for 324 morbidly obese patients (mean body mass
index 46.2 +/- 7.3 kg/m(2)) were reviewed retrospectively. The
follow-up period was 6 months for 272 patients, 12 months for
175, and 24 months for 70. Anthropometric, dietary and serum
albumin, prealbumin, zinc, iron and transferrin saturation
measures were determined at each timepoint.

RESULTS: Nine percent of patients had zinc deficiency pre-operatively.
Zinc deficiency was present in 42.5% of the population at M12
and then remained stable. Zinc deficiency was significantly
more frequent after DS, with a prevalence of 91.7% at M12.
Between M0 and M6, variation in plasma prealbumin, surgery
type and zinc supplementation explained 27.2% of the variance
in plasma zinc concentration. Surgery type explained 22.1%
of this variance between M0 and M24. Mean supplemental zinc
intake was low (22 mg/day). The percentage of patients taking
zinc supplementation at M6, M12 and M24 was 8.9%, 20.6% and
29%, respectively.

CONCLUSIONS: Reduced protein intake, impaired zinc absorption
and worsening compensatory mechanisms contribute to zinc
deficiency. The mechanisms involved differ according to the
type of surgery and time since surgery. Zinc supplementation
is necessary early after bariatric surgery, but this requirement
is often underestimated or is inadequate.


Vitamin status after bariatric surgery: a randomized
study of gastric bypass and duodenal switch.

Aasheim et al. Jul 2009

PubMed Abstract

BACKGROUND: Bariatric surgery is widely performed to induce
weight loss.

OBJECTIVE: The objective was to examine changes in vitamin
status after 2 bariatric surgical techniques.

DESIGN: A randomized controlled trial was conducted in 2
Scandinavian hospitals. The subjects were 60 superobese
patients [body mass index (BMI; in kg/m(2)): 50-60]. The
surgical interventions were either laparoscopic Roux-en-Y
gastric bypass or laparoscopic biliopancreatic diversion
with duodenal switch. All patients received multivitamins,
iron, calcium, and vitamin D supplements. Gastric bypass
patients also received a vitamin B-12 substitute. The patients
were examined before surgery and 6 wk, 6 mo, and 1 y after

RESULTS: Of 60 surgically treated patients, 59 completed
the follow-up. After surgery, duodenal switch patients had
lower mean vitamin A and 25-hydroxyvitamin D concentrations
and a steeper decline in thiamine concentrations than did
the gastric bypass patients. Other vitamins (riboflavin,
vitamin B-6, vitamin C, and vitamin E adjusted for serum
lipids) did not change differently in the surgical groups,
and concentrations were either stable or increased. Furthermore,
duodenal switch patients had lower hemoglobin and total cholesterol
concentrations and a lower BMI (mean reduction: 41% compared
with 30%) than did gastric bypass patients 1 y after surgery.
Additional dietary supplement use was more frequent among
duodenal switch patients (55%) than among gastric bypass
patients (26%).

CONCLUSIONS: Compared with gastric bypass, duodenal switch
may be associated with a greater risk of vitamin A and D
deficiencies in the first year after surgery and of thiamine
deficiency in the initial months after surgery. Patients who
undergo these 2 surgical interventions may require different
monitoring and supplementation regimens in the first year
after surgery. This trial was registered at
as NCT00327912.