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Author Notes:

Correspondence: Dr N Gletsu-Miller, Department of Surgery, Emory University School of Medicine, 1364 Clifton Road, H130 Atlanta, GA 30322, USA. ngletsu@emory.edu.

Adeola T Ayeni, MD assisted with clinical research coordination of the study participants and Amareshwar Chiruvella, MD assisted with data collection.

We graciously thank all the study participants.

The authors declare no conflict of interest.


Research Funding:

This work was supported by National Institute of Health Grants R03 DK067167 and R21 DK 075745 (to NGM), K24 RR023356 (to TRZ), RO1 HD 39078 and a National Research Initiative Grant 2006-35200-17378 from the USDA National Institute for Food and Agriculture (to JRP), the General Clinical Research Center Grant M01 RR00039 and the Atlanta Clinical and Translational Science Institute Grant UL1 RR025008 and the International Copper Association.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Endocrinology & Metabolism
  • Nutrition & Dietetics
  • copper deficiency
  • bariatric surgery
  • nutritional complications
  • ZINC

Incidence and prevalence of copper deficiency following roux-en-y gastric bypass surgery


Journal Title:

International Journal of Obesity


Volume 36, Number 3


, Pages 328-335

Type of Work:

Article | Post-print: After Peer Review


Introduction and Objectives:The frequency of copper deficiency and clinical manifestations following roux-en-y gastric bypass (RYGB) surgery is not yet clear. Objectives were to determine the prevalence and incidence of copper deficiency in patients who have undergone RYGB.Design and Methods:We sought to determine the number of RYGB patients undergoing medical and nutritional follow-up visits at the Emory Bariatric Center who experienced copper deficiency and associated hematological and neurological complaints (n=136). Separately, in patients followed longitudinally before and during 6 and 24 months following RYGB surgery, we obtained measures of copper status (n16). Systemic blood cell counts and measures of copper, zinc and ceruloplasmin were determined using standardized assays in reference laboratories including atomic absorption spectrometry and immunoassays.Results:Thirteen patients were identified to have copper deficiency suggesting a prevalence of copper deficiency of 9.6%, and the majority of these had concomitant complications including anemia, leukopenia and various neuro-muscular abnormalities. In the longitudinal study, plasma copper concentrations and ceruloplasmin activity decreased over 6 and 24 months following surgery, respectively (P<0.05), but plasma zinc concentrations did not change. A simultaneous decrease in white blood cells was observed (P<0.05). The incidence of copper deficiency in these subjects was determined to be 18.8%.Conclusions:The prevalence and incidence of copper deficiency following RYGB surgery was determined to be 9.6% and 18.8%, respectively, with many patients experiencing mild-to-moderate symptoms. Given that copper deficiency can lead to serious and irreversible complications if untreated, frequent monitoring of the copper status of RYGB patients is warranted.

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