Evaluation of the professional practices of specialized obesity centers on the strategy of vitamin B12 follow-up and supplementation after obesity surgery

• Published in: Nutrition clinique et métabolisme 2022-11, Vol.36 (4), p.279-284
• Main Authors: Pisaroni, Hugo, Vastel, Elise, Coulbault, Laurent, Thibault, Ronan, Piquet, Marie-Astrid
• Format: Article
• Language: English
• Subjects: Carence; Chirurgie bariatrique; Deficiency; Intramusculaire; Intramuscular; Obesity surgery; Oral; Per os; Vitamin B12; Vitamine B12
• ISSN: 0985-0562; 1768-3092
• DOI: 10.1016/j.nupar.2022.09.003

Vitamin B12 deficiency is frequent after obesity surgery. The goal of this study was to establish the current practices in specialized obesity centers in terms of dosage, supplementation, and management of B12 deficiency after obesity surgery. In 2021, a survey has been sent to the 37 French specialized obesity centers to perform an assessment of the physician professional practices relating to B12 supplementation after obesity surgery. Forty-one responses were collected from 29 centers, representing a response rate of 78%. All physicians routinely monitored plasma B12 in the postoperative period. The first intent route of B12 supplementation after obesity surgery was mainly: oral, then intramuscular, then subcutaneous, with respectively 38 (93%), 9 (22%), and 3 responses (7%). The preferred prescription for prevention of B12 deficiency, used as long-term maintenance therapy, was 1mg per week, orally (n=21; 51%). The other schemes used for that purpose were rare and specific to a single center. In case of B12 deficiency, the two most used therapeutic schemes were 1mg per day orally for 15 days (n=8; 20%) and 1mg intramuscular per week for 1 month (n=4; 10%). This assessment of the current physician professional practices revealed a diversity in the practices of B12 supplementation after obesity surgery, with a trend to favor the oral route. This is due to the lack of evidence and clear-cut recommendations. A comparative randomized study would help to identify the best route and posology for B12 supplementation after obesity surgery. La carence en vitamine B12 est fréquente après chirurgie de l’obésité. L’objectif de cette étude était de déterminer les pratiques actuelles en centre spécialisé de l’obésité en termes de dosage, supplémentation, et prise en charge d’un déficit ou d’une carence en B12 après chirurgie de l’obésité. En 2021, une évaluation des pratiques professionnelles portant sur la supplémentation en B12 en post-chirurgie bariatrique des patients a été réalisée auprès des médecins nutritionnistes de 37 centres spécialisés de l’obésité (CSO) français. Parmi les 41 réponses collectées provenant de 29 centres, soit un taux de réponse de 78 %, le suivi du dosage de la B12 en post-opératoire était toujours utilisé en routine. La voie de supplémentation en B12 envisagée en première intention après chirurgie bariatrique était majoritairement orale, puis intramusculaire, puis sous cutanée, avec respectivement 38 (93 %), 9 (22 %), et 3 réponses (7 %).