An Investigation of Elevated Serum Copper Levels Following Bariatric Surgery

Bariatric surgery alters physiology and dietary absorption, which may influence trace metal homeostasis. Copper (Cu), an essential micronutrient linked to inflammation and obesity and has been found to be elevated in a pre-surgery bariatric patient population. This study followed the cohort and evaluated changes in serum Cu after bariatric surgery and identified demographic, metabolic, and biochemical factors associated with elevated post-surgery Cu.

We performed a retrospective cohort study involving electronic health record (EHR) data from 523 bariatric surgery patients at University Medical Center-New Orleans (2018-2024). The analysis included preoperative and 12- to 24-month postoperative Cu measurements and covariates related to Cu metabolism. Serum Cu levels were analyzed as continuous variables and categorized as elevated (≥ 140 mcg/dl). Quantile and logistic regression models were utilized.

Participants were predominantly female (93.8%) and Black (69.2%), with a median age of 40.9 years. The median Cu level decreased from 142.1 mcg/d pre-surgery to 128.0 mcg/dl post-surgery; however, 30.8% of participants continued to have levels ≥ 140 mcg/dl. In adjusted models, higher post-surgical Cu levels were associated with pre-surgical Cu (p < 0.001), body mass index (BMI) (p = 0.003), zinc ( p = 0.002), and Black race (p = 0.005). Black patients were 2.37 more likely to have elevated post-surgical Cu compared to White patients.

Elevated Cu levels persisted in approximately one-third of patients up to two years following surgery, with a higher prevalence observed among Black individuals. Additional research on factors associated with elevated Cu and racial differences are needed.