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.
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.
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.
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.
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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.
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.
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.
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.
van Rutte PW, Aarts EO, Smulders JF, et al. Nutrient deficiencies before and after sleeve gastrectomy. Obes Surg. 2014;24(10):1639–46.
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.
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.
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.
Shi X, Karmali S, Sharma AM, et al. A review of laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg. 2010;20(8):1171–7.
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.
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.
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.
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.
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.
Schweiger C, Weiss R, Berry E, et al. Nutritional deficiencies in bariatric surgery candidates. Obes Surg. 2010;20(2):193–7.
Davies DJ, Baxter JM, Baxter JN. Nutritional deficiencies after bariatric surgery. Obes Surg. 2007;17(9):1150–8.
Malinowski SS. Nutritional and metabolic complications of bariatric surgery. Am J Med Sci. 2006;331(4):219–25.
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.
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.
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.
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.
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.
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.
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.
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.
Kumar N. Nutritional neuropathies. Neurol Clin. 2007;25(1):209–55.
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.
Stabler SP. Clinical practice. Vitamin B12 deficiency. N Engl J Med. 2013;368(2):149–60.
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.
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.
Carmel R, Agrawal YP. Failures of cobalamin assays in pernicious anemia. N Engl J Med. 2012;367(4):385–6.
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.
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.
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.
Punchai S, Hanipah ZN, Meister KM, et al. Neurologic manifestations of vitamin B deficiency after bariatric surgery. Obes Surg. 2017;27(8):2079–82.
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.
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.
Liberatos P, Link BG, Kelsey JL. The measurement of social class in epidemiology. Epidemiol Rev. 1988;10:87–121.
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.
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The authors declare that they have no conflict of interest.
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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
- Bariatric surgery
- Sleeve gastrectomy