Obesity Surgery

, Volume 26, Issue 10, pp 2469–2474 | Cite as

Micronutrient Supplementation after Biliopancreatic Diversion with Duodenal Switch in the Long Term

  • Philipp NettEmail author
  • Yves Borbély
  • Dino Kröll
Original Contributions



Malabsorptive bariatric surgery requires life-long micronutrient supplementation. Based on the recommendations, we assessed the number of adjustments of micronutrient supplementation and the prevalence of vitamin and mineral deficiencies at a minimum follow-up of 5 years after biliopancreatic diversion with duodenal switch (BPD-DS).


Between October 2010 and December 2013, a total of 51 patients at a minimum follow-up of 5 years after BPD-DS were invited for a clinical check-up with a nutritional blood screening test for vitamins and minerals.


Forty-three of fifty-one patients (84.3 %) completed the blood sampling with a median follow-up of 71.2 (range 60–102) months after BPD-DS. At that time, all patients were supplemented with at least one multivitamin. However, 35 patients (81.4 %) showed either a vitamin or a mineral deficiency or a combination of it. Nineteen patients (44.1 %) were anemic, and 17 patients (39.5 %) had an iron deficiency. High deficiency rates for fat-soluble vitamins were also present in 23.2 % for vitamin A, in 76.7 % for vitamin D, in 7.0 % for vitamin E, and in 11.6 % for vitamin K.


The results of our study show that the prevalence of vitamin and mineral deficiencies after BPD-DS is 81.4 % at a minimum follow-up of 5 years. The initial prescription of micronutrient supplementation and further adjustments during the first follow-up were insufficient to avoid long-term micronutrient deficiencies. Life-long monitoring of micronutrients at a specialized bariatric center and possibly a better micronutrient supplementation, is crucial to avoid a deficient micronutrient status at every stage after malabsorptive bariatric surgery.


Biliopancreatic diversion with duodenal switch Long-term follow-up Vitamin deficiency Mineral deficiency Micronutrient supplementation 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

For this type of study, formal consent is not required.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23(4):427–36.CrossRefPubMedGoogle Scholar
  2. 2.
    Marceau P, Biron S, Marceau S, et al. Long-term metabolic outcomes 5 to 20 years after biliopancreatic diversion. Obes Surg. 2015.Google Scholar
  3. 3.
    Buchwald H. Overview of bariatric surgery. J Am Coll Surg. 2002;194(3):367–75.CrossRefPubMedGoogle Scholar
  4. 4.
    Marceau P, Biron S, Hould FS, et al. Duodenal switch improved standard biliopancreatic diversion: a retrospective study. Surg Obes Relat Dis. 2009;5(1):43–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Topart P, Becouarn G, Salle A, et al. Biliopancreatic diversion requires multiple vitamin and micronutrient adjustments within 2 years of surgery. Surg Obes Relat Dis. 2014;10(5):936–41.CrossRefPubMedGoogle Scholar
  6. 6.
    Bal BS, Finelli FC, Shope TR, et al. Nutritional deficiencies after bariatric surgery. Nat Rev Endocrinol. 2012;8(9):544–56.CrossRefPubMedGoogle Scholar
  7. 7.
    Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring). 2013;21 Suppl 1:S1–S27.CrossRefGoogle Scholar
  8. 8.
    Shankar PM, Boylan M, Sriram K. Micronutrient deficiencies after bariatric surgery. Nutrition. 2010;26(11-12):1031–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Malinowski SS. Nutritional and metabolic complications of bariatric surgery. Am J Med Sci. 2006;331(4):219–25.CrossRefPubMedGoogle Scholar
  10. 10.
    Stein J, Stier C, Raab H, et al. Review article: The nutritional and pharmacological consequences of obesity surgery. Aliment Pharmacol Ther. 2014;40(6):582–609.CrossRefPubMedGoogle Scholar
  11. 11.
    Gletsu-Miller N, Wright BN. Mineral malnutrition following bariatric surgery. Adv Nutr. 2013;4(5):506–17.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Homan J, Betzel B, Aarts EO, et al. Vitamin and mineral deficiencies after biliopancreatic diversion and biliopancreatic diversion with duodenal switch—the rule rather than the exception. Obes Surg. 2015.Google Scholar
  13. 13.
    Gehrer S, Kern B, Peters T, et al. Fewer nutrient deficiencies after laparoscopic sleeve gastrectomy (LSG) than after laparoscopic Roux-Y-gastric bypass (LRYGB)—a prospective study. Obes Surg. 2010;20(4):447–53.CrossRefPubMedGoogle Scholar
  14. 14.
    Sinha N, Shieh A, Stein EM, et al. Increased PTH and 1.25(OH)(2)D levels associated with increased markers of bone turnover following bariatric surgery. Obesity (Silver Spring). 2011;19(12):2388–93.CrossRefGoogle Scholar
  15. 15.
    Topart PA, Becouarn G. Revision and reversal after biliopancreatic diversion for excessive side effects or ineffective weight loss: a review of the current literature on indications and procedures. Surg Obes Relat Dis. 2015.Google Scholar
  16. 16.
    Oria HE, Moorehead MK. Bariatric analysis and reporting outcome system. Obes Surg. 1998;8:487–99.CrossRefPubMedGoogle Scholar
  17. 17.
    Topart P, Becouarn G, Ritz P. Comparative early outcomes of three laparoscopic bariatric procedures: sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch. Surg Obes Relat Dis. 2012;8(3):250–4.CrossRefPubMedGoogle Scholar
  18. 18.
    Risstad H, Søvik TT, Engström M, et al. Five-year outcomes after laparoscopic gastric bypass and laparoscopic duodenal switch in patients with body mass index of 50 to 60: a randomized clinical trial. JAMA Surg. 2015;150(4):352–61.CrossRefPubMedGoogle Scholar
  19. 19.
    Hatizifotis M, Dolan K, Newbury L, et al. Symptomatic vitamin A deficiency following biliopancreatic diversion. Obes Surg. 2003;13(4):655–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Salgado W, Modotti C, Nonino CB. Anemia and iron deficiency before and after bariatric surgery versus intensive medical therapy for diabetes. Surg Obes Relat Dis. 2014;10(1):49–54.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Department of Visceral Surgery and MedicineBern University Hospital and University of BernBernSwitzerland

Personalised recommendations