---
type: source
title: "Micronutrient and Nutritional Deficiencies Associated With GLP-1 Receptor Agonist Therapy: A Narrative Review"
author: "Urbina et al., PubMed (2026)"
url: https://pubmed.ncbi.nlm.nih.gov/41549912/
date: 2026-01-01
domain: health
secondary_domains: []
format: research-paper
status: processed
processed_by: vida
processed_date: 2026-04-11
priority: high
tags: [GLP-1, micronutrient, deficiency, nutrition, vitamin-D, iron, calcium, protein, sarcopenia, monitoring, 2026]
extraction_model: "anthropic/claude-sonnet-4.5"
---

## Content

Narrative review of micronutrient and nutritional deficiencies associated with GLP-1 receptor agonist therapy. Published 2026 (per PubMed listing). Also published in PDF via third-party host (waltersport.com).

**Documented deficiencies:**

*Vitamin D:*
- Most common deficiency: 7.5% at 6 months, 13.6% at 12 months

*Iron:*
- Approximately 64% of GLP-1RA users consumed less than the estimated average requirement for iron
- Highest prevalence: women and individuals undergoing aggressive caloric restriction
- Intestinal iron absorption dropped markedly after 10 weeks of semaglutide (prospective pilot, n=51)

*Calcium:*
- 72% of GLP-1RA participants consumed below the recommended dietary allowance for calcium

*Protein:*
- 58% did not meet recommended protein intake targets

*Other deficiencies (from large cohort, n=461,382):*
- 22% developed nutritional deficiencies within 12 months of starting GLP-1 treatment
- Vitamin D: 13% by 12 months
- Iron, B vitamins, zinc, selenium also documented

**Mechanism:** GLP-1 suppresses appetite broadly — patients eat less food overall, not just less fat. Delayed gastric emptying may also alter micronutrient absorption. The deficiency risk is compounded in patients who already have low baseline micronutrient levels (common in obesity, food insecurity).

**Implementation gap:** 92% of patients had not visited a dietitian in the 6 months prior to GLP-1 prescription — the nutritional risk is accumulating without professional monitoring.

## Agent Notes

**Why this matters:** This is the most comprehensive quantitative summary of GLP-1 micronutrient deficiency epidemiology. The 22% nutritional deficiency rate at 12 months in the large cohort (n=461,382) means this is affecting roughly 1 in 5 GLP-1 users — at the current US scale of millions of prescriptions, this is a population-level nutritional safety signal that is not being systematically monitored.

**What surprised me:** Iron: 64% of GLP-1 users consuming below estimated average requirement for iron. This isn't a niche edge case — it's the majority of GLP-1 users. The calcium figure (72% below RDA) is similarly alarming. These are not rare adverse events; they are the statistical expectation for GLP-1 users who don't receive nutritional support.

**What I expected but didn't find:** Data specifically on GLP-1 users who are food-insecure or SNAP recipients — how does the micronutrient deficiency profile compare in this subpopulation? The research exists on the general GLP-1 user population but not specifically on low-income or food-insecure subgroups.

**KB connections:**
- Directly supports and quantifies the OMA/ASN/ACLM advisory's nutritional monitoring recommendations (archived separately)
- Creates a specific quantitative basis for the SNAP + GLP-1 double-jeopardy claim: if 64% of all GLP-1 users are iron-deficient, and SNAP-eligible individuals already have higher baseline micronutrient deficiency rates, the combined rate in food-insecure GLP-1 users likely exceeds 80%
- Connects to [[GLP-1 pharmacotherapy follows a continuous-treatment model]] — adds a nutritional safety dimension to the continuous-treatment problem

**Extraction hints:**
- Claim candidate: "GLP-1 receptor agonist therapy is producing a nutritional deficiency epidemic at population scale: 22% of users develop nutritional deficiencies within 12 months, 64% consume below estimated average iron requirement, and 72% consume below calcium RDA — while 92% receive no dietitian support"
- The intersection with food insecurity is the novel angle: baseline micronutrient deficiency is higher in low-income/food-insecure populations, making GLP-1-induced deficiency a compounding risk in exactly the population with highest metabolic disease burden
- The iron deficiency finding (intestinal absorption drops markedly at 10 weeks) is particularly concerning for women of reproductive age on GLP-1s

**Context:** Published 2026. The paper was pre-published via a third-party host (waltersport.com) in January 2026, suggesting it was in press/just accepted at publication time. Represents the leading edge of GLP-1 nutritional safety monitoring research.

## Curator Notes

PRIMARY CONNECTION: [[GLP-1 receptor agonists are the largest therapeutic category launch in pharmaceutical history but their chronic use model makes the net cost impact inflationary]]
WHY ARCHIVED: Quantifies the population-scale nutritional safety signal for GLP-1 therapy with specific deficiency rates; the 22% deficiency rate at 12 months in 461K patients is actionable evidence for a new claim
EXTRACTION HINT: Focus on the scale: 22% in 461K patients is a large-sample confirmation, not a small-study signal. The iron and calcium figures (64%, 72%) are majority-of-users deficiencies, not edge cases. This should generate a claim about the public health burden of GLP-1 nutritional deficiency.
