GLP-1 Agonists Linked to Increased Nutritional Deficiencies, Reveals Research
USA: A study published in Obesity Pillars has revealed that individuals taking GLP-1 receptor agonists (GLP-1RAs) experienced higher rates of nutritional deficiencies — 12.7% within six months and 22.4% within a year of treatment. Vitamin D deficiency was the most common. Among 461,382 mostly type 2 diabetes patients, researchers emphasized the need for routine nutritional screening and closer collaboration among physicians, dietitians, and nutrition specialists to improve patient outcomes.
The research, conducted by Dr. W. Scott Butsch and colleagues from the Cleveland Clinic Bariatric and Metabolic Institute, USA, examined nutritional risks among adults receiving GLP-1RA therapy. These medications, including semaglutide and other agents, are increasingly prescribed for diabetes management and chronic weight reduction. While they are highly effective in promoting weight loss, they can also lead to loss of lean muscle mass and potential nutrient deficiencies — a growing concern among healthcare professionals.
The investigators performed a retrospective, observational study using de-identified claims data from more than 461,000 adults newly prescribed GLP-1RAs between July 2017 and December 2021. Participants had no previous diagnoses of nutritional deficiency. While most had type 2 diabetes (80.5%), the analysis also included individuals with type 1 diabetes, prediabetes, or obesity. A secondary, propensity-matched analysis compared GLP-1RA users with a similar group of non-users treated with metformin alone.
The study led to the following findings:
- Nutritional deficiencies were identified in 12.7% of patients within six months of starting GLP-1RA therapy.
- The rate of nutritional deficiencies increased to 22.4% within twelve months of treatment.
- Vitamin D deficiency was the most common, affecting 7.5% of patients at six months and 13.6% at one year.
- Patients who had at least one dietitian visit within the first six months were more likely to be diagnosed with a deficiency or related complication, likely due to improved detection and reporting.
The researchers noted that these findings emphasize the need for clinicians to routinely monitor nutritional parameters in patients using GLP-1RAs. Since weight loss from these drugs primarily reduces fat mass but can also lead to muscle loss, nutritional assessment should be an essential part of ongoing care. They recommended that physician nutrition specialists, dietitians, and other nutrition care providers play a key role in evaluating and managing these patients.
While the large sample size added strength to the findings, the authors noted key limitations. The study relied on insurance claims data, capturing only documented and billed deficiencies. Information on supplement use, diet, and physical activity was unavailable, and as an observational analysis, it could not confirm a direct causal link between GLP-1RA use and nutritional deficiencies.
The study concluded that over one in five adults developed a nutritional deficiency within a year of starting GLP-1RA therapy. The authors highlighted that deficiencies are often underdiagnosed, and the accompanying muscle loss observed in earlier trials further supports the need for nutritional guidance. They suggested that timely nutrition therapy emphasizing adequate protein, fiber, and micronutrient intake could help preserve muscle mass and optimize overall health.
Future research, the team noted, should focus on developing clear clinical guidelines for monitoring and managing nutritional status in patients undergoing GLP-1RA therapy to ensure both safe and effective treatment outcomes.
Reference:
Scott Butsch, W., Sulo, S., Chang, A. T., Kim, J. A., Kerr, K. W., Williams, D. R., Hegazi, R., Panchalingam, T., Goates, S., & Heymsfield, S. B. (2025). Nutritional deficiencies and muscle loss in adults with type 2 diabetes using GLP-1 receptor agonists: A retrospective observational study. Obesity Pillars, 15, 100186. https://doi.org/10.1016/j.obpill.2025.100186
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