ABSTRACT
Trace elements and vitamins play an essential role in homeostasis and biochemical processes needed for life, such as cellular utilization of oxygen, DNA reproduction, and maintaining cell membrane integrity. Deficiencies may present with specific syndromes, or a spectrum of clinical presentations, from malaise and loss of appetite to severe infections and heart failure.1 While access to proper nutrition is necessary, also important are the amounts of the different nutrients ingested by food choices made, and that absorption proceeds in a suitable fashion.2 There are few studies examining preoperative and postoperative nutritional status in morbidly obese patients opting for metabolic surgery, and the reported prevalence of nutritional deficiencies varies widely due to differences in definitions of deficiency, patient populations, surgical techniques, supplement protocols, and lengths and completion of patient follow-up.3,4
We have entered a new era in clinical gastroenterology, one in which malnutrition and malabsorption are by-products of metabolic surgery. Although much research has been done on short-term and long-term effects of bariatric surgery on weight loss, less is known about its long-term clinical and nutritional consequences of changes in the gastrointestinal anatomy and physiology. This also refers to the change in the quantity and quality of diet, which results in vitamin and mineral deficiencies.3 The latency period of overt and subclinical symptoms differs, depending on the micronutrient in question, and we have to consider the relatively young age of some of our patients, as the postoperative course may take over a period of several decades.5
