Progressive Zinc and Iron Deficiency Following Bariatric Surgery in Iraqi Patients: A 12-Month Pilot Study

Background: Obesity is a global pandemic, and the Middle East, particularly Iraq, faces a high burden of this condition. Bariatric surgery, such as Laparoscopic Sleeve Gastrectomy (LSG), is the most effective treatment, but it carries a significant risk of micronutrient deficiencies, notably zinc and iron, which are implicated in common post-operative complications, such as hair loss. While this association is well-documented in Western and Asian cohorts, there is a critical lack of localized data from the Iraqi patient population. This pilot study aimed to investigate changes in serum zinc and iron status over a 12-month period in a group of Iraqi patients following bariatric surgery, providing localized evidence to optimize post-operative nutritional protocols. Methods: A total of 15 morbidly obese patients (mean BMI 46.0 ± 4.0 kg/m², mean age 42.0 ± 7.5 years) undergoing bariatric procedures (mini-gastric bypass, RYGB, and SG) at Al-Batool Hospital, Najaf, Iraq, were included. Serum zinc and iron levels were measured preoperatively and at 3-, 6-, and 12-months post-operation. The prevalence of deficiency was determined using established reference values. Results: Both zinc and iron serum levels declined progressively post-surgery. The prevalence of zinc deficiency increased from 13.3% preoperatively to a peak of 33.3% at 6 months. Similarly, iron deficiency rose steadily from 20.0% preoperatively to 46.7% at 12 months. While changes in mean levels and deficiency prevalence were not statistically significant over time (P>0.05), a numerical trend toward higher deficiency rates was observed in female patients and in those with a higher preoperative BMI. Conclusion: Bariatric surgery significantly exacerbates the already high prevalence of zinc and iron deficiencies in Iraqi patients. The progressive increase in deficiency rates, particularly for iron, underscores the critical need for rigorous, lifelong nutritional monitoring and aggressive, targeted supplementation protocols to mitigate the risk of associated complications in this specific patient cohort.