Hair Loss in Females after Sleeve Gastrectomy: Predictive Value of Serum Zinc and Iron Levels

Abstract

A common complication after bariatric surgery is hair loss, which is related to rapid weight reduction, but zinc, iron, and other micronutrient deficiencies can also be involved. Little is studied after laparoscopic sleeve gastrectomy (LSG). A prospective observational study was performed of 42 morbidly obese females undergoing LSG. Incidence of hair loss was monitored. Micronutrients were investigated preoperatively and three, six, and 12 months after surgery. Sixteen patients (41%) reported hair loss in the postoperative course. A significant association was observed between hair loss and zinc levels ( P = 0.021) but mean zinc levels were within the normal range in patients reporting hair loss. Only three patients (7.7%) presented low zinc levels, all of them reporting hair loss. There was also a significant association between iron levels and alopecia ( P = 0.017), but mean values of the patients with hair loss were within normal range. Only four patients (10.2%) presented low iron levels, all of them presenting hair loss. A variable consisting of the addition of zinc 1 iron showed a significant association with hair loss ( P = 0.013). A cutoff point was established in 115 (odds ratio, 4; P = 0.006). All the patients but two reporting hair loss presented addition levels under 115. This variable showed sensibility 88 per cent, specificity 84 per cent, positive predictive value 79 per cent, and negative predictive value 91 per cent to predict hair loss. Hair loss is a frequent condition after sleeve gastrectomy. In most cases, iron and zinc levels are within the normal range. The variable addition (zinc 1 iron) is a good predictor of hair loss. Patients with addition levels below 115 are fourfold more susceptible to present hair loss. In these cases, zinc supplements achieve the stop of hair loss in most cases.

Effect of Bariatric Surgery on Weight Loss, Nutritional Deficiencies, Postoperative Complications and Adherence to Dietary and Lifestyle Recommendations: A retrospective cohort study from Bahrain

“…9,16 Among these, hair loss is one of the most commonly reported and is related to rapid weight loss and deficiencies of iron, zinc and other micronutrients. 28 In the present study, the prevalence of hair loss was 59.5%, a rate which is in line with that reported by other researchers (40-60%); however, Goldenshluger et al observed a greater frequency of hair loss in MGB patients compared to those who underwent SG, while the opposite was true in the present study. 29 This may be related to the higher number of SG patients included in the current study and the fact that 55.3% had undergone the surgery between 1-2 years previously, a time when weight loss is commonly rapid in bariatric surgery patients.…”

Bariatric surgery – a dermatologic perspective

“…Indeed those females with a more severe hair loss after BS had lower values of zinc and iron, demanding for substitution. And there is a second type of temporary alopecia seen shortly after BC caused by protein deficiency …”

Comparison of Oral Iron Supplement Formulations for Normalization of Iron Status Following Roux-EN-y Gastric Bypass Surgery: a Randomized Trial

“…Iron plays a critical role in the body, and this sheds light into the signs and symptoms that manifest when an individual is iron deficient. The clinical consequences of iron deficiency in bariatric surgery patients have been shown to negatively impact quality of life (13) and include general fatigue, weakness, cold intolerance, anemia, hair loss, pica, and cognitive impairments in concentration, attention and memory (14)(15)(16)(17). Because of issues such as a lack of monitoring and screening, reduced dietary intake of bioavailable iron, poor compliance to prophylactic iron supplementation, and poor response to treatment, bariatric surgery patients who develop iron deficiency often remain undiagnosed and untreated (1).…”