Do Specialized Bariatric Multivitamins Lower Deficiencies After Sleeve Gastrectomy?

A Correction to this article was published on 05 December 2019

This article has been updated

Abstract

Background

Vitamin and mineral deficiencies are common after a sleeve gastrectomy (SG). The aim of this study is to examine the effectiveness of a specialized bariatric multivitamin (WLS Optimum) for SG patients on deficiencies compared with a regular multivitamin (MVS) for up to 5 years.

Methods

Data of all patients who underwent a SG procedure in the Catharina Hospital Eindhoven (CZE) between July 2011 and July 2016 were collected and retrospectively analyzed. All patients who completed a preoperative blood test and at least one blood withdrawal during the first operative year were included in this study.

Results

This study included 970 patients; 291 patients in the WLS-user group and 679 patients in the non-WLS-user group. In favor of the user group, significantly less de novo deficiencies were found of vitamin B1 (2 years) and vitamin B6 (two and three), folic acid (1 and 2 years), and vitamin B12 (at 1 year). Binomial logistic regression showed a significant influence of multivitamin supplementation mainly on ferritin; vitamins B1, B6, B12, and D; and folic acid, (all p < 0.05). The total number of de novo deficiencies was significantly reduced during the whole study for all WLS Optimum users.

Conclusions

Vitamin deficiencies are common, and postoperative nutritional management after SG is underestimated. The use of a specialized multivitamin supplement resulted in higher mean serum concentrations and less deficiencies of vitamin B1, folic acid, and vitamin B12. This study shows that SG patients benefit from the specialized multivitamin supplements, but adjustments are required for iron and vitamin B6 content.

This is a preview of subscription content, access via your institution.

Change history

  • 05 December 2019

    The second sentence of the Conclusion section should read as follows.

References

  1. 1.

    Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9945):766–81.

    Article  Google Scholar 

  2. 2.

    Colquitt JL, Picot J, Loveman E, Clegg AJ. Surgery for obesity. The Cochrane Database Syst Rev. 2009;(2):CD003641. https://doi.org/10.1002/14651858.CD003641.pub3.

  3. 3.

    van Rutte PW, Smulders JF, de Zoete JP, et al. Outcome of sleeve gastrectomy as a primary bariatric procedure. Br J Surg. 2014;101(6):661–8.

    Article  Google Scholar 

  4. 4.

    Ali M, El Chaar M, Ghiassi S, Rogers AM. American society for metabolic and bariatric surgery clinical issues committee. American society for metabolic and bariatric surgery updated position statement on sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis. 2017;13(10):1652–7. https://doi.org/10.1016/j.soard.2017.08.007.

    Article  Google Scholar 

  5. 5.

    van Rutte PW, Aarts EO, Smulders JF, et al. Nutrient deficiencies before and after sleeve gastrectomy. Obes Surg. 2014;24(10):1639–46.

    Article  Google Scholar 

  6. 6.

    Boza C, Salinas J, Salgado N, et al. Laparoscopic sleeve gastrectomy as a stand-alone procedure for morbid obesity: report of 1,000 cases and 3-year follow-up. Obes Surg. 2012;22(6):866–71.

    Article  Google Scholar 

  7. 7.

    Brethauer SA, Hammel JP, Schauer PR. Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surgery for obesity and related diseases. 2009;5(4):469–75.

    Article  Google Scholar 

  8. 8.

    Deitel M, Gagner M, Erickson AL, et al. Third International Summit: Current status of sleeve gastrectomy. Surgery for obesity and related diseases. 2011;7(6):749–59.

    Article  Google Scholar 

  9. 9.

    Shi X, Karmali S, Sharma AM, et al. A review of laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg. 2010;20(8):1171–7.

    Article  Google Scholar 

  10. 10.

    Schijns W, Schuurman LT, Melse-Boonstra A, van Laarhoven CJHM, Berends FJ, Aarts EO. Do specialized bariatric multivitamins lower deficiencies after RYGB? Surg Obes Relat Dis. 2018;14(7):1005–12. https://doi.org/10.1016/j.soard.2018.03.029.

    Article  Google Scholar 

  11. 11.

    Ernst B, Thurnheer M, Schmid SM, et al. Evidence for the necessity to systematically assess micronutrient status prior to bariatric surgery. Obes Surg. 2009;19(1):66–73.

    Article  Google Scholar 

  12. 12.

    Kaidar-Person O, Person B, Szomstein S, et al. Nutritional deficiencies in morbidly obese patients: a new form of malnutrition? Part B: minerals. Obes Surg. 2008;18(8):1028–34.

    Article  Google Scholar 

  13. 13.

    Kaidar-Person O, Person B, Szomstein S, et al. Nutritional deficiencies in morbidly obese patients: a new form of malnutrition? Part A: vitamins. Obes Surg. 2008;18(7):870–6.

    Article  Google Scholar 

  14. 14.

    Damms-Machado A, Friedrich A, Kramer KM, et al. Pre- and postoperative nutritional deficiencies in obese patients undergoing laparoscopic sleeve gastrectomy. Obes Surg. 2012;22(6):881–9.

    Article  Google Scholar 

  15. 15.

    Schweiger C, Weiss R, Berry E, et al. Nutritional deficiencies in bariatric surgery candidates. Obes Surg. 2010;20(2):193–7.

    Article  Google Scholar 

  16. 16.

    Davies DJ, Baxter JM, Baxter JN. Nutritional deficiencies after bariatric surgery. Obes Surg. 2007;17(9):1150–8.

    CAS  Article  Google Scholar 

  17. 17.

    Malinowski SS. Nutritional and metabolic complications of bariatric surgery. Am J Med Sci. 2006;331(4):219–25.

    Article  Google Scholar 

  18. 18.

    Ben-Porat T, Elazary R, Goldenshluger A, et al. Nutritional deficiencies four years after laparoscopic sleeve gastrectomy-are supplements required for a lifetime? Surgery for Obesity and Related Diseases. 2017;13(7):1138–44.

    Article  Google Scholar 

  19. 19.

    Mechanick JI, Kushner RF, Sugerman HJ, et al. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Surgery for Obesity and Related Diseases. 2008;4(5 Suppl):S109–84.

    Article  Google Scholar 

  20. 20.

    Aills L, Blankenship J, Buffington C, et al. ASMBS allied health nutritional guidelines for the surgical weight loss patient. Surgery for Obesity and Related Diseases. 2008;4(5 Suppl):S73–108.

    Article  Google Scholar 

  21. 21.

    Dogan K, Aarts EO, Koehestanie P, et al. Optimization of vitamin suppletion after Roux-en-Y gastric bypass surgery can lower postoperative deficiencies: a randomized controlled trial. Medicine. 2014;93(25):e169.

    CAS  Article  Google Scholar 

  22. 22.

    Homan J, Schijns W, Aarts EO, et al. An optimized multivitamin supplement lowers the number of vitamin and mineral deficiencies three years after Roux-en-Y gastric bypass: a cohort study. Surgery for Obesity and Related Diseases. 2016;12(3):659–67.

    Article  Google Scholar 

  23. 23.

    Heber D, Greenway FL, Kaplan LM, et al. Endocrine and nutritional management of the post-bariatric surgery patient: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2010;95(11):4823–43.

    CAS  Article  Google Scholar 

  24. 24.

    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. Surgery for Obesity and Related Diseases. 2013;9(2):159–91.

    Article  Google Scholar 

  25. 25.

    Parrott J, Frank L, Rabena R, et al. American Society for Metabolic and Bariatric Surgery integrated health nutritional guidelines for the surgical weight loss patient 2016 update: micronutrients. Surgery for Obesity and Related Diseases. 2017;13(5):727–41.

    Article  Google Scholar 

  26. 26.

    Kumar N. Nutritional neuropathies. Neurol Clin. 2007;25(1):209–55.

    Article  Google Scholar 

  27. 27.

    Smelt HJ, Smulders JF, Said M, et al. Improving bariatric patient aftercare outcome by improved detection of a functional vitamin B12 deficiency. Obes Surg. 2016;26(7):1500–4.

    CAS  Article  Google Scholar 

  28. 28.

    Stabler SP. Clinical practice. Vitamin B12 deficiency. N Engl J Med. 2013;368(2):149–60.

    CAS  Article  Google Scholar 

  29. 29.

    Gasteyger C, Suter M, Gaillard RC, et al. Nutritional deficiencies after Roux-en-Y gastric bypass for morbid obesity often cannot be prevented by standard multivitamin supplementation. Am J Clin Nutr. 2008;87(5):1128–33.

    CAS  Article  Google Scholar 

  30. 30.

    Smelt HJM, Pouwels S, Said M, Smulders JF. Neuropathy by folic acid supplementation in a patient with anaemia and an untreated cobalamin deficiency: a case report. Clin Obes. 2018;8(4):300–4. https://doi.org/10.1111/cob.12254.

    CAS  Article  Google Scholar 

  31. 31.

    Carmel R, Agrawal YP. Failures of cobalamin assays in pernicious anemia. N Engl J Med. 2012;367(4):385–6.

    CAS  Article  Google Scholar 

  32. 32.

    Aarts E, van Groningen L, Horst R, et al. Vitamin D absorption: consequences of gastric bypass surgery. Eur J Endocrinol. 2011;164(5):827–32.

    CAS  Article  Google Scholar 

  33. 33.

    Chakhtoura MT, Nakhoul N, Akl EA, et al. Guidelines on vitamin D replacement in bariatric surgery: Identification and systematic appraisal. Metab Clin Exp. 2016;65(4):586–97.

    CAS  Article  Google Scholar 

  34. 34.

    Chakhtoura MT, Nakhoul NN, Shawwa K, et al. Hypovitaminosis D in bariatric surgery: a systematic review of observational studies. Metab Clin Exp. 2016;65(4):574–85.

    CAS  Article  Google Scholar 

  35. 35.

    Punchai S, Hanipah ZN, Meister KM, et al. Neurologic manifestations of vitamin B deficiency after bariatric surgery. Obes Surg. 2017;27(8):2079–82.

    Article  Google Scholar 

  36. 36.

    Cupa N, Schulte DM, Ahrens M, et al. Vitamin B6 intoxication after inappropriate supplementation with micronutrients following bariatric surgery neurologic manifestations of vitamin B deficiency after bariatric surgery. Eur J Clin Nutr. 2015;69(7):862–3.

    CAS  Article  Google Scholar 

  37. 37.

    Navarro M, Wood RJ. Plasma changes in micronutrients following a multivitamin and mineral supplement in healthy adults. J Am Coll Nutr. 2003;22(2):124–32.

    CAS  Article  Google Scholar 

  38. 38.

    Liberatos P, Link BG, Kelsey JL. The measurement of social class in epidemiology. Epidemiol Rev. 1988;10:87–121.

    CAS  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Hendrika J. M. Smelt.

Ethics declarations

The study protocol was approved by the National Medical Ethics Review Committee of the Radboud University Medical Center (protocol number 2017-3412) and Local Ethical Committee of the CZE (protocol number nWMO2017-45), and was conducted in concordance with the principles of the Declaration of Helsinki.

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval Statement

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

Informed Consent Statement

Does not apply

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Smelt, H.J.M., van Loon, S., Pouwels, S. et al. Do Specialized Bariatric Multivitamins Lower Deficiencies After Sleeve Gastrectomy?. OBES SURG 30, 427–438 (2020). https://doi.org/10.1007/s11695-019-04191-x

Download citation

Keywords

  • Obesity
  • Bariatric surgery
  • Sleeve gastrectomy
  • Vitamin
  • Mineral
  • Deficiency
  • Specialized
  • Multivitamin
  • Supplementation