*3.6.3 Selenium*

Selenium is absorbed in the duodenum and proximal jejunum and it is an essential element that provides an important part of the multifunctional selenoproteins that are important for health [41]. Selenium deficiency has been associated with cardiomyopathy, immune system dysfunction and infertility in men. Since RYGB results in the bypass of the duodenum and upper jejunum, micronutrient deficiencies such as selenium are common after this procedure. The prevalence of selenium deficiency post LSG is 7.1% and post RYGB is 3.8% [26]. A case report described a 40 year-old woman that presented with symptoms of heart failure nine months after RYGB which was confirmed by echocardiography and cardiac markers [42]. The patient was diagnosed with selenium-deficient cardiomyopathy, and she had complete resolution of her symptoms after 3 months of oral selenium [42].
