Associations of Bariatric Interventions With Micronutrient and Endocrine Disturbances

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Abstract
While effective at inducing substantial and durable weight loss, bariatric procedures are recognized to predispose patients to vitamin and mineral deficiencies.1-4 The prevailing notion is that the extent and spectrum of these deficits are contingent on the physiological and anatomical alterations imposed by the different types of bariatric procedures.5-11 Procedures that achieve weight loss predominantly through restriction of meal accommodation capacity (known as restrictive procedures) are thought to be associated with milder micronutrient deficiencies that occur in tandem with reduced food intake. In contrast, interventions with a malabsorptive component (known as malabsorptive procedures) are thought to be associated with more profound and focal nutritional deficits and metabolic derangements, as they entail bypassing alimentary tract segments involved in the absorption of specific dietary nutrients. For example, the duodenum and proximal jejunum serve as critical absorption sites for trace elements, such as zinc, copper, and calcium,1,2 and also contain free fatty-acid receptors that modulate cholecystokinin secretion and hence affect absorption of fat-soluble vitamins (eg, A, D, E, and K).12

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