Nutritional deficiencies and bone metabolism after endobarrier in obese type 2 patients with diabetes


Endobarrier® is a minimally invasive, reversible endoscopic treatment for obesity. It provokes malabsorption along 60 cm of the small intestine, which can contribute to the development of vitamin deficiencies and to changes in bone mineral density (BMD). To determine the prevalence of nutrient deficiencies, changes in body composition and BMD during the first year after Endobarrier® placement. Twenty-one patients with type 2 diabetes met inclusion criteria. Levels of vitamins, micro and macronutrients were assessed prior and at 1, 3 and 12 months post-operatively. DEXA was performed before and 12 months after implant. Nineteen patients completed the 12 months follow-up. Vitamin D deficiency was the most prevalent finding before Endobarrier® implant. The percentage of patients with severe deficiency decreased from 19 to 5% at 12 months after supplementation. Microcytic anaemia was initially present in 9.5% of patients and increased to 26.3% at 12 months. Low ferritin and vitamin B12 levels were observed in 14.2 and 4.8% of patients before the implant and worsened to 42 and 10.5%. Low concentrations of magnesium and phosphorus were also common but improved along the study. A significant but not clinically relevant decrease in BMD of 4.14 ± 4.0% at the femoral neck was observed at 12 months without changes in osteocalcin levels. Vitamin deficiencies are common after Endobarrier® implant. It is therefore important to screen patients prior to and at regular intervals after the implant, and to encourage adherence to diet counselling and supplementation.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.


  1. 1.

    Schouten R, Rijs CS, Bouvy ND, Hameeteman W, Koek GH, Janssen IM, et al. A multicenter, randomized efficacy study of the EndoBarrier Gastrointestinal Liner for presurgical weight loss prior to bariatric surgery. Ann Surg. 2010;251:236–43.

    Article  Google Scholar 

  2. 2.

    Vilarrasa N, de Gordejuela AG, Casajoana A, Duran X, Toro S, Espinet E, et al. Endobarrier® in grade i obese patients with long-standing type 2 diabetes: role of gastrointestinal hormones in glucose metabolism. Obes Surg. 2017;27:569–77.

    Article  Google Scholar 

  3. 3.

    Rohde U, Hedbäck N, Gluud LL, Vilsbøll T, Knop FK. Effect of the EndoBarrier Gastrointestinal Liner on obesity and type 2 diabetes: a systematic review and meta-analysis. Diabetes Obes Metab. 2016;18:300–5.

    CAS  Article  Google Scholar 

  4. 4.

    American Diabetes Association. Standards of medical care in diabetes 2017. Diabetes Care. 2017;40:S57–63.

    Article  Google Scholar 

  5. 5.

    Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient-2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity. 2013;21:S1–27.

    CAS  Article  Google Scholar 

  6. 6.

    McColl KE. Effect of proton pump inhibitors on vitamins and iron. Am J Gastroenterol. 2009;104:S5–9.

    CAS  Article  Google Scholar 

  7. 7.

    Earthman CP, Beckman LM, Masodkar K, Sibley SD. The link between obesity and low circulating 25-hydroxyvitamin D concentrations: considerations and implications. Int J Obes. 2012;36:387–96.

    CAS  Article  Google Scholar 

  8. 8.

    Kurstjens S, de Baaij JH, Bouras H, Bindels RJ, Tack CJ, Hoenderop JG. Determinants of hypomagnesemia in patients with type 2 diabetes mellitus. Eur J Endocrinol. 2017;176:11–9.

    CAS  Article  Google Scholar 

  9. 9.

    Haglin L, Lindblad Å, Bygren LO, Hypophosphataemia in the metabolic syndrome. Gender differences in body weight and blood glucose. Eur J Clin Nutr. 2001;55:493

    CAS  Article  Google Scholar 

  10. 10.

    Kim HJ, Koo HS, Kim YS, Kim MJ, Kim KM, Joo NS, et al. The association of testosterone, sex hormone-binding globulin, and insulin-like growth factor-1 with bone parameters in Korean men aged 50 years or older. J Bone Miner Metab. 2016;1:1–7.

    Google Scholar 

Download references


The authors thank Dr. Kenneth McCreath for helpful discussions on the manuscript.

Author information



Corresponding author

Correspondence to Nuria Vilarrasa.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest. Nuria Vilarrasa is the recipient of grants “Ajuts per a projectes de recerca clínica de l’Hospital Universitari de Bellvitge (2011-PR143/11)” and of project “PI11/01960 and PI14/01997” funded by Instituto de Salud Carlos III and co-funded by European Union (ERDF, “A way to build Europe”).

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Vilarrasa, N., Fabregat, A., Toro, S. et al. Nutritional deficiencies and bone metabolism after endobarrier in obese type 2 patients with diabetes. Eur J Clin Nutr 72, 1447–1450 (2018).

Download citation

Further reading


Quick links