Treatment of Micronutrient Deficiencies Pre and Post Bariatric Surgery

The goal of this article is to review micronutrient deficiencies in patients with obesity. We will describe the absorption of micronutrients and highlight the risk factors that may exist pre- and post-surgery that contribute to the development of micronutrient deficiency states. Furthermore, we will discuss the process involved in detecting, preventing, and treating micronutrient deficiencies. Pre-bariatric surgery micronutrient deficiencies are commonly due to intake of a high energy, but low micronutrient diet. Deficiencies frequently include vitamin D, folate, vitamin B12, and iron. Post-bariatric surgery micronutrient deficiencies are commonly related to altered absorption in the setting of non-compliance with or intolerance of recommended diets, and frequently include abovementioned deficiencies as well as vitamin A, copper, and zinc deficiencies. All patients should have routine daily supplementation as well as close monitoring for the development of deficiency post-surgery. It is important to understand a patient’s unique risk factors for developing a micronutrient deficiency, and to perform a complete nutritional evaluation to further assess, intervene on, and monitor a patient’s nutritional status throughout their pre- and post-operative course. Treatment of these deficiencies will require a multidisciplinary and multimodal approach involving risk factor modification and supplementation that depends on the severity and duration of the identified deficiency.