Cardiomyopathy Associated with Zinc Deficiency after Bariatric Surgery

Abstract

Noncompliance with vitamin and mineral supplement protocol after bariatric surgery may lead to true-elements deficiency. Among them, zinc and selenium deficiencies were closely related to cardiac complications, such as myocardial fibrosis, heart failure, and arrhythmias.

We describe a 30-year-old female, 6 weeks after delivery and 5 years after bariatric surgery, who was admitted to the cardiology department because of dyspnea and clinical evidence of heart failure, as well as an echocardiogram that demonstrated reduced systolic left ventricular function. Standard antifailure regimen shows mild benefit. Zinc supplements added to treatment lead to significant clinical and echocardiographic improvement.

Keywords

cardiomyopathy - congestive heart failure - trace element deficiency - bariatric surgery - parenteral nutrition - morbid obesity - Keshan disease

• References

• 1 Lockitch G, Taylor GP, Wong LT. , et al. Cardiomyopathy associated with nonendemic selenium deficiency in a Caucasian adolescent. Am J Clin Nutr 1990; 52 (03) 572-577
• 2 Iwata A, Morrison ML, Blackwood JE, Roth MB. Selenide targets to reperfusing tissue and protects it from injury. Crit Care Med 2015; 43 (07) 1361-1367
• 3 Levander OA, Beck MA. Interacting nutritional and infectious etiologies of Keshan disease. Insights from coxsackie virus B-induced myocarditis in mice deficient in selenium or vitamin E. Biol Trace Elem Res 1997; 56 (01) 5-21
• 4 Joseph J, Loscalzo J. Selenistasis: epistatic effects of selenium on cardiovascular phenotype. Nutrients 2013; 5 (02) 340-358
• 5 Metes-Kosik N, Luptak I, Dibello PM. , et al. Both selenium deficiency and modest selenium supplementation lead to myocardial fibrosis in mice via effects on redox-methylation balance. Mol Nutr Food Res 2012; 56 (12) 1812-1824
• 6 Boldery R, Fielding G, Rafter T, Pascoe AL, Scalia GM. Nutritional deficiency of selenium secondary to weight loss (bariatric) surgery associated with life-threatening cardiomyopathy. Heart Lung Circ 2007; 16 (02) 123-126
• 7 Gletsu-Miller N, Wright BN. Mineral malnutrition following bariatric surgery. Adv Nutr 2013; 4 (05) 506-517
• 8 Chen J. An original discovery: selenium deficiency and Keshan disease (an endemic heart disease). Asia Pac J Clin Nutr 2012; 21 (03) 320-326
• 9 Loscalzo J. Keshan disease, selenium deficiency, and the selenoproteome. N Engl J Med 2014; 370 (18) 1756-1760
• 10 Lei C, Niu X, Ma X, Wei J. Is selenium deficiency really the cause of Keshan disease?. Environ Geochem Health 2011; 33 (02) 183-188