Integrated health article Altered plasma response to zinc and iron tolerance test after Roux-en- Y gastric bypass

Background: The duodenum and proximal jejunum are excluded after Roux-en- Y gastric bypass but these intestinal sites are where iron and zinc are most absorbed. Therefore, they are among the nutrients whose digestive and absorptive process can be impaired after surgery. The aim of the present study was to investigate the iron and zinc plasma response to a tolerance test before and after bariatric surgery. The study was performed at Sao Paulo University School of Medicine of Ribeirao Preto, Brazil. Methods: In a longitudinal paired study, 9 morbidly obese women (body mass index $40 kg/m 2 ) under- went an iron and zinc tolerance test before and 3 months after surgery. The iron and zinc levels were determined at 0, 1, 2, 3, and 4 hours after a physiologic unique oral dose. The mineral concentrations in the plasma and 24-hour urine sample were assayed using an atomic absorption spectrophotometer. The anthro- pometric measurements and 3-day food record were also evaluated. A linear mixed model was used to compare the plasma concentration versus interval after the oral dose, before and after surgery. Results: The pre- and postoperative test results revealed a significantly lower plasma zinc response (P ,.01) and a delayed response to iron intake after surgery. The total plasma iron concentration area, during the 4 hours, was not different after surgery ( P..05). The 24-hour urinary iron and zinc excretion did not differ between the pre- and postoperative phases. Conclusion: The present data showed a compromised response to the zinc tolerance test after gastric bypass surgery, suggesting an impaired absorption of zinc. More attention must be devoted to zinc nutritional status after surgery. (Surg Obes Relat Dis 2011;xx:xxx.) © 2011 American Society for Metabolic and Bariatric Surgery. All rights reserved.