Patient-Reported Adherence to Empiric Vitamin/Mineral Supplementation and Related Nutrient Deficiencies After Roux-en-Y Gastric Bypass

• Published in: Obesity surgery 2016-11, Vol.26 (11), p.2661-2666
• Main Authors: James, Haleigh, Lorentz, Paul, Collazo-Clavell, Maria L.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Bypass; Clinical Protocols; Deficiency Diseases - etiology; Deficiency Diseases - prevention & control; Dietary Supplements; Female; Gastric Bypass - adverse effects; Gastrointestinal surgery; Humans; Male; Malnutrition - etiology; Malnutrition - prevention & control; Medication Adherence; Medicine; Medicine & Public Health; Middle Aged; Minerals; Minerals - therapeutic use; Nutrients; Obesity; Obesity, Morbid - surgery; Original Contributions; Patient Reported Outcome Measures; Self Report; Surgery; Vitamins; Vitamins - therapeutic use; Young Adult
• ISSN: 0960-8923; 1708-0428
• DOI: 10.1007/s11695-016-2155-7

Background Roux-en-Y gastric bypass (RYGB) is associated with nutrient deficiencies, but the optimal supplement regimen remains unclear. We assessed patient-reported adherence to and efficacy of Mayo Clinic’s post-RYGB vitamin/mineral supplement protocol and the related incidence of common nutrient deficiencies. Methods Data were collected on 287 obese patients who underwent RYGB. Patient-reported supplement adherence was assessed via medication/supplement lists generated by medication reconciliation in hospital dismissal summaries and clinic notes at 6, 12, and 18–36 months postsurgery. Deficiencies were assessed via measurements of hemoglobin, ferritin, 25-hydroxyvitamin D, and vitamins A, E, and B 12 in the setting of our supplementation protocol. Results Patient-reported adherence to multivitamin/minerals and subcutaneous vitamin B 12 was sustained in >92 % of patients, correlating with low rates of vitamin A, E, and B 12 deficiencies (4.9, 0, and 3.7 %, respectively). Rates of calcium supplementation decreased (94.1 to 78.7 %) while rates of vitamin D and iron use increased over time (39.7 to 65.8 and 6.3 to 23.1 %, respectively). At 18–36 months, vitamin D deficiency persisted in 16.2 % of patients, iron deficiency in 6.7 % of women and 17.2 % of men, and anemia in 12.2 % of women and 34.3 % of men. Conclusion Compared to previous reports, we found a lower prevalence of micronutrient deficiencies and excellent patient-reported adherence to a standardized multivitamin/mineral and vitamin B 12 regimen. Continued prevalence of vitamin D deficiency prompts consideration of standardized vitamin D supplementation after RYGB. Anemia and iron deficiency were observed at lower rates than previously reported, but were more common in men compared to women.