{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T06:44:00Z","timestamp":1791960240247,"version":"4.3.4"},"reference-count":41,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2025,11,23]],"date-time":"2025-11-23T00:00:00Z","timestamp":1763856000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly prescribed for people living with obesity and type 2 diabetes due to their efficacy in reducing appetite and body weight. However, by inducing caloric restriction and altering gastrointestinal physiology, GLP-1RAs may predispose patients to nutritional deficiencies. This review aimed to synthesise current evidence on energy, protein, vitamin, and mineral status in GLP-1RA users, and contextualises these findings with metabolic and bariatric surgery (MBS) guidelines. While metabolic and bariatric surgery (MBS) guidelines mandate structured nutritional monitoring, no equivalent frameworks exist for GLP-1RA therapy, highlighting a critical gap that justifies the need for this review. Methods: A narrative review was conducted in three stages: (i) searching PubMed and Embase OVID (August 2025) using MeSH terms and free-text keywords related to GLP-1RAs, micronutrients, and obesity; (ii) screening abstracts and full texts for eligibility; and (iii) synthesising results with comparison to bariatric surgery protocols. Eligible studies included clinical trials, observational cohorts, and reviews reporting nutritional outcomes in GLP-1RA users or describing MBS monitoring guidelines. Results: GLP-1RA therapy consistently reduced caloric intake, with frequent inadequacy of protein intake and occasional sarcopenia. Observational data reported that users developed nutritional deficiencies within 12 months, most commonly vitamin D, followed by thiamine and other B vitamins. Mineral deficiencies, particularly in iron, calcium, magnesium, and potassium, were also observed. Conclusions: GLP-1RAs are associated with clinically relevant risks of protein, vitamin, and mineral deficiencies. The absence of formal monitoring protocols represents an unmet clinical need, and adaptation of surveillance, as seen in MBS, which may help mitigate long-term complications.<\/jats:p>","DOI":"10.3390\/nu17233659","type":"journal-article","created":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T11:47:22Z","timestamp":1763984842000},"page":"3659","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Macronutrient, Micronutrient Supplementation and Monitoring for Patients on GLP-1 Agonists: Can We Learn from Metabolic and Bariatric Surgery?"],"prefix":"10.3390","volume":"17","author":[{"given":"Rhea","family":"Sibal","sequence":"first","affiliation":[{"name":"Faculty of Life Sciences and Medicine, King\u2019s College London, London SE1 1UL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6028-0444","authenticated-orcid":false,"given":"G.","family":"Balamurugan","sequence":"additional","affiliation":[{"name":"Department of Surgery, South Tyneside and Sunderland NHS Foundation Trust, Sunderland SR4 7TP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3603-2085","authenticated-orcid":false,"given":"Jasmine","family":"Langley","sequence":"additional","affiliation":[{"name":"Department of Surgery, South Tyneside and Sunderland NHS Foundation Trust, Sunderland SR4 7TP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yitka","family":"Graham","sequence":"additional","affiliation":[{"name":"Department of Surgery, South Tyneside and Sunderland NHS Foundation Trust, Sunderland SR4 7TP, UK"},{"name":"Helen McArdle Nursing and Care Research Institute, University of Sunderland, Sunderland SR6 0DD, UK"},{"name":"Faculty of Biomedical Sciences, Austral University, Buenos Aires B1406, Argentina"},{"name":"Faculty of Psychology, University of Anahuac, Mexico City 52786, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamal","family":"Mahawar","sequence":"additional","affiliation":[{"name":"Department of Surgery, South Tyneside and Sunderland NHS Foundation Trust, Sunderland SR4 7TP, UK"},{"name":"Helen McArdle Nursing and Care Research Institute, University of Sunderland, Sunderland SR6 0DD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2383","DOI":"10.1007\/s13300-018-0524-z","article-title":"Liraglutide and glycaemic outcomes in the LEADER trial","volume":"9","author":"Zinman","year":"2018","journal-title":"Diabetes Ther."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1834","DOI":"10.1056\/NEJMoa1607141","article-title":"Semaglutide and cardiovascular outcomes in patients with type 2 diabetes","volume":"375","author":"Marso","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/S0140-6736(19)31149-3","article-title":"Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): A double-blind, randomised placebo-controlled trial","volume":"394","author":"Gerstein","year":"2019","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1056\/NEJMoa2032183","article-title":"Once-weekly semaglutide in adults with overweight or obesity","volume":"384","author":"Wilding","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1056\/NEJMoa2206038","article-title":"Tirzepatide once weekly for the treatment of obesity","volume":"387","author":"Jastreboff","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1613","DOI":"10.1002\/oby.24067","article-title":"Nutritional considerations with anti-obesity medications","volume":"32","author":"Almandoz","year":"2024","journal-title":"Obesity"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1159\/000519503","article-title":"Malnutrition in obesity: Is it possible?","volume":"15","author":"Kobylinska","year":"2022","journal-title":"Obes. Facts"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e13087","DOI":"10.1111\/obr.13087","article-title":"British Obesity and Metabolic Surgery Society Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery-2020 update","volume":"21","author":"Parretti","year":"2020","journal-title":"Obes. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1016\/j.soard.2016.12.018","article-title":"American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient\u20142016 Update: Micronutrients","volume":"13","author":"Parrott","year":"2017","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1159\/000481825","article-title":"Practical recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the post-bariatric surgery medical management","volume":"10","author":"Busetto","year":"2017","journal-title":"Obes. Facts"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2065","DOI":"10.1007\/s00268-016-3492-3","article-title":"Guidelines for perioperative care in bariatric surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations","volume":"40","author":"Thorell","year":"2016","journal-title":"World J. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e253590","DOI":"10.1001\/jamasurg.2025.3590","article-title":"Obesity treatment with bariatric surgery versus GLP-1 receptor agonists","volume":"160","author":"Barrett","year":"2025","journal-title":"JAMA Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2821","DOI":"10.1007\/s12325-021-01710-0","article-title":"Weight loss and maintenance related to the mechanism of action of glucagon-like peptide-1 receptor agonists","volume":"38","author":"Ard","year":"2021","journal-title":"Adv. Ther."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Evenepoel, C., Vandermeulen, G., Luypaerts, A., Vermeulen, D., Lannoo, M., Van der Schueren, B., Buyse, J., and Verbeke, K. (2023). The impact of bariatric surgery on macronutrient malabsorption depends on the type of procedure. Front. Nutr., 9.","DOI":"10.3389\/fnut.2022.1028881"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3453","DOI":"10.1007\/s11695-021-05475-x","article-title":"Fifteen Years After Sleeve Gastrectomy: Weight Loss, Remission of Associated Medical Problems, Quality of Life, and Conversions to Roux-en-Y Gastric Bypass-Long-Term Follow-Up in a Multicenter Study","volume":"31","author":"Felsenreich","year":"2021","journal-title":"Obes. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"100121","DOI":"10.1016\/j.obpill.2024.100121","article-title":"Dietary intake by patients taking GLP-1 and dual GIP\/GLP-1 receptor agonists: A narrative review and discussion of research needs","volume":"11","author":"Christensen","year":"2024","journal-title":"Obes. Pillars"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Johnson, B., Milstead, M., Thomas, O., McGlasson, T., Green, L., Kreider, R., and Jones, R. (2025). Investigating nutrient intake during use of glucagon-like peptide-1 receptor agonist: A cross-sectional study. Front. Nutr., 12.","DOI":"10.3389\/fnut.2025.1566498"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2340","DOI":"10.1111\/dom.15113","article-title":"Effect of the glucagon-like peptide-1 receptor agonist liraglutide, compared to caloric restriction, on appetite, dietary intake, body fat distribution and cardiometabolic biomarkers: A randomized trial in adults with obesity and prediabetes","volume":"25","author":"Silver","year":"2023","journal-title":"Diabetes Obes. Metab."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3725","DOI":"10.1111\/dom.16395","article-title":"The influence of the glucagon-like peptide-1 receptor agonist, liraglutide, on dietary patterns and nutrient intakes in patients with obesity and prediabetes: A secondary analysis of a randomized controlled trial","volume":"27","author":"Richardson","year":"2025","journal-title":"Diabetes Obes. Metab."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"100186","DOI":"10.1016\/j.obpill.2025.100186","article-title":"Nutritional deficiencies and muscle loss in adults with type 2 diabetes using GLP-1 receptor agonists: A retrospective observational study","volume":"15","author":"Butsch","year":"2025","journal-title":"Obes. Pillars"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1007\/s00125-018-4810-0","article-title":"Effects of combined GIP and GLP-1 infusion on energy intake, appetite and energy expenditure in overweight\/obese individuals: A randomised, crossover study","volume":"62","author":"Bergmann","year":"2019","journal-title":"Diabetologia"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Al-Najim, W., Raposo, A., BinMowyna, M.N., and le Roux, C.W. (2025). Unintended Consequences of Obesity Pharmacotherapy: A Nutritional Approach to Ensuring Better Patient Outcomes. Nutrients, 17.","DOI":"10.3390\/nu17111934"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1242","DOI":"10.1111\/dom.12932","article-title":"Effects of once-weekly semaglutide on appetite, energy intake, control of eating, food preference and body weight in subjects with obesity","volume":"19","author":"Blundell","year":"2017","journal-title":"Diabetes Obes. Metab."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1111\/dom.12108","article-title":"The once-daily human GLP-1 analogue liraglutide impacts appetite and energy intake in patients with type 2 diabetes after short-term treatment","volume":"15","author":"Flint","year":"2013","journal-title":"Diabetes Obes. Metab."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1016\/j.amjmed.2025.01.021","article-title":"Mechanisms of GLP-1 Receptor Agonist-Induced Weight Loss: A Review of Central and Peripheral Pathways in Appetite and Energy Regulation","volume":"138","author":"Moiz","year":"2025","journal-title":"Am. J. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1038\/s41366-018-0143-9","article-title":"Overfed but undernourished: Recognizing nutritional inadequacies\/deficiencies in patients with overweight or obesity","volume":"43","author":"Astrup","year":"2019","journal-title":"Int. J. Obes."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1754","DOI":"10.1210\/jc.2015-3754","article-title":"Long-Term Metformin Use and Vitamin B12 Deficiency in the Diabetes Prevention Program Outcomes Study","volume":"101","author":"Aroda","year":"2016","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Pascual, R.W., Phelan, S., La Frano, M.R., Pilolla, K.D., Griffiths, Z., and Foster, G.D. (2019). Diet Quality and Micronutrient Intake Among Long-Term Weight Loss Maintainers. Nutrients, 11.","DOI":"10.3390\/nu11123046"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2191","DOI":"10.2147\/DMSO.S518912","article-title":"Advances in Perioperative Nutritional Management in Metabolic and Bariatric Surgery","volume":"18","author":"Li","year":"2025","journal-title":"Diabetes Metab. Syndr. Obes."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.soard.2019.10.025","article-title":"Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures\u20142019 update: Cosponsored by American Association of Clinical Endocrinologists\/American College of Endocrinology, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists","volume":"16","author":"Mechanick","year":"2020","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2332","DOI":"10.1007\/s00464-020-07555-y","article-title":"Clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) on bariatric surgery: Update 2020 endorsed by IFSO-EC, EASO and ESPCOP","volume":"34","author":"Antoniou","year":"2020","journal-title":"Surg. Endosc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"37","DOI":"10.4240\/wjgs.v9.i2.37","article-title":"Enhanced recovery after surgery: Current research insights and future direction","volume":"9","author":"Abeles","year":"2017","journal-title":"World J. Gastrointest. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1007\/s00268-021-06394-9","article-title":"Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations: A 2021 Update","volume":"46","author":"Stenberg","year":"2022","journal-title":"World J. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Humi\u0119cka, M., Sawicka, A., K\u0119dzierska, K., Binda, A., Jaworski, P., Tarnowski, W., and Jankowski, P. (2025). Prevalence of Nutrient Deficiencies Following Bariatric Surgery-Long-Term, Prospective Observation. Nutrients, 17.","DOI":"10.3390\/nu17162599"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1007\/s00423-024-03422-9","article-title":"Long-term prevalence of vitamin deficiencies after bariatric surgery: A meta-analysis","volume":"409","author":"Chen","year":"2024","journal-title":"Langenbeck\u2019s Arch. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"464","DOI":"10.4239\/wjd.v8.i11.464","article-title":"Bariatric surgery and long-term nutritional issues","volume":"8","author":"Lupoli","year":"2017","journal-title":"World J. Diabetes"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Bertoni, L., Valentini, R., Zattarin, A., Belligoli, A., Bettini, S., Vettor, R., Foletto, M., Spinella, P., and Busetto, L. (2021). Assessment of Protein Intake in the First Three Months after Sleeve Gastrectomy in Patients with Severe Obesity. Nutrients, 13.","DOI":"10.3390\/nu13030771"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1016\/j.clnesp.2020.06.007","article-title":"3Bariatric surgery affects obesity-related protein requirements","volume":"40","author":"Guillet","year":"2020","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e70834","DOI":"10.1002\/fsn3.70834","article-title":"Effect of Dietary Patterns on Long-Term Weight Maintenance of Patients After Sleeve Gastrectomy","volume":"13","author":"Zheng","year":"2025","journal-title":"Food Sci. Nutr."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Mozaffarian, D., Agarwal, M., Aggarwal, M., Alexander, L., Apovian, C.M., Bindlish, S., Bonnet, J., Butsch, W.S., Christensen, S., and Gianos, E. (Am. J. Lifestyle Med., 2025). Nutritional Priorities to Support GLP-1 Therapy for Obesity: A Joint Advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and the Obesity Society, Am. J. Lifestyle Med., epub ahead of print.","DOI":"10.1177\/15598276251344827"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"100205","DOI":"10.1016\/j.obpill.2025.100205","article-title":"Application of nutrition interventions with GLP-1 based therapies: A narrative review of the challenges and solutions","volume":"16","author":"Fitch","year":"2025","journal-title":"Obes. Pillars"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/23\/3659\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T11:58:30Z","timestamp":1763985510000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/23\/3659"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,23]]},"references-count":41,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["nu17233659"],"URL":"https:\/\/doi.org\/10.3390\/nu17233659","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,23]]}}}