Zinc Deficiency and Bariatric Surgery

Zinc deficiency is common after bariatric surgery as the main absorption sites such as duodenum and proximal jejunum are being bypassed and also the deficiency rates may vary depending on the type of surgery. After surgery, reduced stomach acid which is essential for zinc bioavailability, reduced protein intake, food intolerance and impaired zinc absorption may worsen the situation and may lead to zinc deficiency [30, 31]. In addition, regular iron and calcium supplementation can also contribute to insufficient zinc absorption [32, 33]. Zinc deficiency can also be associated with pregnancy and can lead to reduced birth weight, preterm delivery and congenital abnormalities and can induce hypertension in the mother [34-36].

A recent retrospective study showed that patients (n=272) who underwent RYGB, LSG and BPD-DS, 99 % had zinc deficiency preoperatively [31]. Studies at 2 years follow up after RYGB reported 20-35 % and Sleeve with 18-34 % and higher deficiency rates were found with BPD (74-91 %) with serum or plasma zinc levels [15, 37, 38]. It was found that, zinc deficiency persisted in patients even after 5 years follow up with 12.5 % after sleeve, 21-33 % after RYGB and 45 % after BPD. Rojas et al. stated that at 6 months, post bariatric surgery patients have an increased hair loss with lower intakes of zinc and iron requiring monitoring and supplementation [39].

Zinc Recommendation After Bariatric Surgery

Liver (beef, chicken, lamb, pork), red meat (beef, lamb, pork), sea foods like crab, lobsters, oysters and scallops, wheat germ, spinach, pumpkin, sesame and squash seeds, cashew nuts, mushrooms, chick peas, lentils, black beans, tofu, and whole grains are good dietary sources of zinc.

Copper and zinc compete for the same transport mechanism, so the excess of one might determine the deficiency of the other. Hence post bariatric patients should be advised oral zinc gluconate or acetate to provide 8-15 mg of zinc and 1 mg of copper for each 8-15 mg of zinc given.

The recommended Dietary Allowance for Zinc




RDA* (India) [18]

12 mg

10 mg

RDA*(US) [19]

11 mg

8 mg

RNI**(UK) [20]

11.3 mg

14.8 mg

NRV***(Australia/New Zealand) [21]

14 mg

8 mg

RDA* recommended dietary allowances, RNI** reference nutrient intake, NRV*** nutrient reference value

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