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

Abstract

Usage guidelinesPlease refer to the usage guidelines at http://sure.sunderland.ac.uk/policies.html or alternatively contact sure@sunderland.ac.uk. 1 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. 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 T Z 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.

Bariatric Surgery in Obesity: Effects on Gut Microbiota and Micronutrient Status

“…Zinc absorption proceeds in the small bowel through a specific active carrier mechanism that, under normal physiological conditions, is not saturated. If the oral zinc supply increases (e.g., supplementation following BS) [161], zinc uptake also increases up to a maximum level. A diet low in zinc enhances its intestinal absorption, whereas high intakes allow zinc transport through a passive, paracellular pathway [162].…”

“…Hence, bariatric patients are advised to administer these supplements separately. If zinc and copper are taken together, they should be supplemented in an appropriate ratio [161]. Gehrer et al observed a slightly higher post-surgical zinc deficiency 1 year following RYGB (37%) than VSG (34%) [102].…”

“…Another study analyzing micronutrient deficiencies after RYGB and VSG with a 5 year follow-up indicated that serum zinc concentrations were reduced in 25.7% and 12.5% of patients, respectively [163]. Zinc deficiency after RYGB is generally asymptomatic and varies between 8% and 25.7% long-term, when routinely supplemented [161].…”

Micronutrient Deficiencies After Bariatric Surgery: An Emphasis on Vitamins and Trace Minerals

“…Zinc is excreted in feces, and thus diarrhea can worsen zinc deficiency 36 . Up to 50% of patients have presurgical zinc deficiency 65 . Four years after BPD‐DS, a 2‐center report showed that the incidence of zinc deficiency was approximately 50%, as defined by serum zinc level <12 µmol/L 35 , 39 .…”

“…Four years after BPD‐DS, a 2‐center report showed that the incidence of zinc deficiency was approximately 50%, as defined by serum zinc level <12 µmol/L 35 , 39 . On the contrary, Mahawar et al 65 recently reported that clinically relevant zinc deficiency is rare, with only 6 case reports of symptomatic zinc deficiency identified. When present, clinical manifestations of deficiency include frequent infections from impaired immune function, altered taste, frontal alopecia, dry and brittle hair, poor wound healing, and eczematoid dermatitis 18 , 66 .…”