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Multivitamin noncompliance associated with nutritional deficiencies after Roux-en-Y gastric bypass

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February 13, 2017

Adults with obesity and type 2 diabetes who undergo Roux-en-Y gastric bypass surgery and do not adhere to multivitamin therapy are more likely to exhibit nutritional deficiencies, including low iron, vitamin B12 and vitamin D levels, during long-term follow-up vs. those who are compliant with multivitamin use, according to recent findings.

“Due to alterations in the gastrointestinal tract after a [Roux-en-Y gastric bypass] procedure, patients are prone to develop nutritional deficiencies,” Kemal Dogan, MD, of the department of surgery at Rijnstate Hospital in Arnhem, the Netherlands, and colleagues wrote. “These deficiencies can lead to serious hematological, neurological and musculoskeletal complications. Most reported vitamin and mineral deficiencies are for iron, vitamin B12, folate, vitamin D and calcium. Although there are numerous reports on deficiencies after [Roux-en-Y gastric bypass], most only have a limited follow-up period, and long-term follow-up studies are scarce.”

In a retrospective study, Dogan and colleagues analyzed data from 51 adult patients with type 2 diabetes (58.8% women; mean age, 48 years) who underwent laparoscopic Roux-en-Y gastric bypass between 2000 and 2008 for severe obesity (BMI > 35 kg/m²) or morbid obesity (BMI > 40 kg/m²). Regular follow-up occurred at 2, 3, 6, 9, 12, 18 and 24 months, and annually thereafter; mean follow-up period after surgery was 81.4 months. Patients provided blood samples at follow-up. Primary outcomes were serum iron, vitamin B12 and vitamin D deficiencies; secondary outcomes included deficiencies of other vitamins and minerals and compliance with multivitamin use. Patients were stratified by multivitamin compliance.

Within the cohort, 68.6% of patients were still taking vitamin supplements as of their last follow-up visit; 31.4% were noncompliant. Researchers found that iron deficiency was more common in noncompliant patients vs. compliant patients (56.3% vs. 25.7%; P = .034), as was vitamin B12 deficiency (25% vs. 11.4%; P = .46) and vitamin D deficiency (75% vs. 45.7%; P = .07). Overall deficiencies in the cohort for iron, vitamin B12 and vitamin D were 35.3%, 15.7% and 54.9%, respectively.

Researchers also found that patients experiencing successful weight reduction (n = 25) were more likely to be multivitamin compliant vs. patients who did not experience successful weight loss (n = 10). Patients with an excess weight loss of at least 50% had higher mean vitamin D levels vs. patients with an excess weight loss of less than 50% (P = .027), but there were no between-group differences for other vitamins and minerals.

“Although optimal regimes are not yet available, multivitamin supplementation, individualized for patients, should be implemented on a permanent basis for all patients after [Roux-en-Y gastric bypass],” the researchers wrote. “New criteria to optimize such supplementation therapies should be researched. Bariatric surgeons, endocrinologists and general practitioners should be committed to strict, lifelong follow-up.” by Regina Schaffer

Disclosure: The researchers report no relevant financial disclosures.

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