Which population is at a higher risk for copper deficiency?

January 2, 2026 •

4 min read

According to research from the Linus Pauling Institute, while dietary copper insufficiency is uncommon, certain groups face elevated risks due to factors beyond diet. These at-risk individuals include premature infants, those with malabsorption disorders, and people who have undergone specific gastrointestinal surgeries.

Quick Summary

Several groups are prone to copper deficiency, including premature infants, those with malabsorption issues, bariatric surgery patients, and individuals with excessive zinc intake or the genetic Menkes disease. Early identification of these risks is crucial for mitigating potential health complications.

Key Points

Bariatric Surgery Patients: Significant alterations to the digestive tract after weight loss surgeries can severely impair copper absorption, leading to long-term deficiency risks.
Excessive Zinc Supplement Users: High doses of zinc compete with copper for absorption, causing a secondary deficiency. This includes individuals using excessive zinc supplements or zinc-containing denture creams.
Infants and Premature Babies: Low birth weight and prematurity can result in reduced copper stores, increasing vulnerability during periods of rapid growth.
Patients with Malabsorption Conditions: Gastrointestinal diseases like celiac disease, Crohn's disease, and cystic fibrosis can compromise intestinal function and inhibit proper copper absorption.
Individuals on Prolonged Parenteral Nutrition: Patients receiving intravenous feeding for long durations without adequate copper supplementation are at risk of deficiency.
Menkes Disease Patients: This rare, inherited genetic disorder directly disrupts copper transport and distribution in the body, causing severe and systemic deficiency.
Advanced Liver Disease Patients: Some studies indicate that copper deficiency is more common in those with advanced cirrhosis and is linked to a higher mortality risk.

Understanding Copper Deficiency

Copper is a vital trace mineral essential for many bodily functions, including nerve function, immune system health, and red blood cell formation. A deficiency, also known as hypocuperemia, can lead to serious health problems, such as anemia, neutropenia, neurological issues, and weakened bones. While rare in healthy individuals with balanced diets, several specific populations are highly susceptible due to underlying health conditions, medical procedures, or genetic factors.

Primary Populations at Elevated Risk

Several distinct groups are particularly vulnerable to inadequate copper levels, often due to issues with absorption rather than simple dietary intake. These populations warrant careful monitoring to prevent deficiency-related health complications.

Infants and Children

Infants represent a highly susceptible population for copper deficiency, particularly those who are born prematurely or with a low birth weight. They have a lower accumulation of prenatal copper stores and are reliant on milk for their copper intake. Issues can arise in several scenarios:

Premature and low-birth-weight infants: These babies have underdeveloped copper reserves, increasing their risk, especially during periods of rapid growth.
Infants recovering from malnutrition: Children with severe protein or calorie malnutrition are also at a higher risk.
Exclusive cow's milk formula: Feeding an infant exclusively with non-fortified cow's milk formula can lead to deficiency, as it is a poor source of copper compared to breast milk.
Menkes disease: This rare, X-linked genetic disorder causes severe copper malabsorption and improper distribution within the body. Infants with Menkes disease experience progressive neurodegeneration and typically have very low serum copper levels.

Individuals with Gastrointestinal Conditions

Problems affecting the gastrointestinal tract can significantly hinder the body's ability to absorb copper, even if dietary intake is adequate. This includes several malabsorptive syndromes and conditions.

Celiac disease: The intestinal damage caused by celiac disease can interfere with nutrient absorption, making individuals with this condition more likely to develop a copper deficiency.
Crohn's disease: As a chronic inflammatory bowel disease, Crohn's can impair nutrient absorption along the digestive tract.
Cystic fibrosis: This genetic disorder affects the body's ability to absorb fat-soluble vitamins and minerals, including copper.
Chronic diarrhea: Prolonged periods of diarrhea can lead to accelerated copper loss from the body.

Medical and Surgical Risk Factors

Certain medical interventions and practices can dramatically increase the risk of copper deficiency by affecting the digestive system's architecture and nutrient absorption capacity.

Bariatric surgery: Procedures such as gastric bypass or gastrectomy fundamentally alter the digestive system, bypassing the duodenum where most copper is absorbed. Patients can develop severe deficiency years after surgery if not properly monitored and supplemented.
Excessive zinc supplementation: High doses of zinc interfere directly with copper absorption by increasing the production of a protein called metallothionein, which binds to and prevents copper uptake. This can occur from long-term use of zinc supplements or zinc-containing dental creams.
Prolonged parenteral nutrition: Individuals receiving total parenteral nutrition (TPN) for extended periods are at risk if their IV solutions do not contain adequate copper.

Comparison of Common Risk Groups

To illustrate the diverse causes and risks, the following table compares key populations vulnerable to copper deficiency:


Risk Group	Primary Cause of Deficiency	Onset of Symptoms	Primary Health Impacts
Bariatric Surgery Patients	Reduced absorption due to stomach and intestinal bypass.	Delayed; can take years for severe symptoms to appear.	Anemia, neutropenia, and severe neurological deficits.
Individuals with High Zinc Intake	Competitive inhibition of copper absorption in the intestines.	Varies, depending on dose and duration of zinc use.	Anemia, neutropenia, and peripheral neuropathy.
Menkes Disease Infants	Genetic defect (ATP7A) causing severe copper malabsorption.	Early infancy (2-4 months).	Severe developmental and neurological delays, kinky hair.
Malabsorption Syndrome Patients	Intestinal damage from diseases like celiac or Crohn's.	Gradual, dependent on severity and chronicity of the underlying disease.	Anemia, neutropenia, and gastrointestinal issues.

Diagnosis and Prevention

Diagnosing copper deficiency can be challenging due to its varied and non-specific symptoms, which can mimic other conditions like vitamin B12 deficiency. Diagnosis typically involves a review of the patient's history, diet, and medication/supplement use, followed by blood tests to measure serum copper and ceruloplasmin levels.

Treatment involves addressing the root cause and providing copper supplementation, either orally or intravenously in severe cases. In instances of excess zinc, discontinuation of the supplement is critical.

Prevention is key, especially for high-risk individuals. This includes regular monitoring and prophylactic supplementation for bariatric surgery patients and those on long-term TPN. Promoting a balanced diet rich in copper-containing foods like organ meats, nuts, seeds, and shellfish is also important for the general population.

Conclusion

While a rare occurrence in the general healthy population, specific groups face a significantly higher risk for copper deficiency. These include infants with inherited disorders like Menkes disease, premature babies, and individuals with malabsorptive issues caused by gastrointestinal surgeries or conditions such as celiac and Crohn's disease. Additionally, excessive zinc intake from supplements can directly induce a deficiency. Early identification and management of these risk factors are crucial for preventing potentially irreversible neurological damage and other serious health complications. Awareness among both patients and healthcare providers is paramount for timely diagnosis and intervention.

Who is at a higher risk for copper deficiency?

Frequently Asked Questions

The most common causes of acquired copper deficiency are malabsorption due to bariatric or other gastrointestinal surgeries, and excessive, long-term zinc intake from supplements or dental creams.

High zinc intake increases the production of metallothionein, a protein that binds copper and prevents it from being absorbed in the intestines. Zinc and copper compete for absorption, and excess zinc can effectively block copper uptake.

Yes, especially premature and low-birth-weight infants who have lower copper stores at birth. Infants with certain rare genetic disorders like Menkes disease are also severely deficient.

Yes. Celiac disease causes damage to the lining of the small intestine, which is where copper is absorbed. This intestinal malabsorption can lead to a deficiency over time.

Symptoms can include anemia that doesn't respond to iron supplements, fatigue, frequent infections due to low white blood cell count (neutropenia), and neurological problems like numbness, tingling, and poor coordination.

Diagnosis typically involves a patient history review, physical exam, and blood tests to measure serum copper and ceruloplasmin levels. The diagnosis is often complex as symptoms can mimic other conditions.

Yes, in many cases, especially with acquired deficiency, it can be reversed with copper supplements and dietary changes. However, neurological damage may be partially irreversible, emphasizing the need for early diagnosis.