Adherence to vitamin supplementation following adolescent bariatric surgery

Abstract

Adolescents with extreme obesity, who have undergone bariatric surgery, must adhere to many lifestyle and nutritional recommendations, including multivitamin therapy. Little is know about multivitamin adherence following adolescent bariatric surgery. The present study aims to document self-reported and electronically-monitored adherence to multivitamins, determine convergence between self-report and electronic monitoring adherence for multivitamins, and identify barriers to multivitamin adherence for adolescents who have undergone bariatric surgery. The study used a prospective, longitudinal observational design to assess subjective (self-reported) and objective (electronic monitors) multivitamin adherence in a cohort of 41 adolescents (Mean age = 17.1±1.5; range=13–19) who have undergone bariatric surgery at Cincinnati Children's Hospital Medical Center. Mean adherence as derived from electronic monitoring for the entire 6-month study period was 29.8% ± 23.9. Self-reported adherence was significantly higher than electronically monitored adherence across both the 1 and 6-month assessment points (z = 4.5, p< 0.000 and z = 4.0, p< 0.0001, respectively). Forgetting and difficulty swallowing multivitamins were the two primary barriers identified. While there are no established data regarding best practice for multivitamins following bariatric surgery, high rates of non-adherence to multivitamin therapy were observed in adolescents who had undergone bariatric surgery with forgetting and difficulty swallowing pills as reported barriers to adherence. These high rates of non-adherence to multivitamin therapy should be considered when devising treatment and family education pathways for adolescents considering weight loss surgery.

Age-appropriate and acceptable paediatric dosage forms: Insights into end-user perceptions, preferences and practices from the Children’s Acceptability of Oral Formulations (CALF) Study

“…Nevertheless, evidence has shown that children as young as 3 years old are able to swallow conventional tablets and capsules (Nahirya-Ntege et al, 2012, Kaplan et al, 2010, Czyzewski et al, 2000. On the other hand, older children and adolescents have reported swallowing difficulties, including as a barrier to adherence in chronic conditions (Hansen et al, 2008, Polaha et al, 2008, Hommel and Baldassano, 2010, Modi et al, 2013. The present study highlights 185 that while age is a critical factor, other aspects such as health background are also important characteristics to consider.…”

Comparison of self-report and electronic monitoring of 6MP intake in childhood ALL: a Children’s Oncology Group study

“…Some examples include pediatric inflammatory bowel disease (intake of prescribed oral 6MP/ azathioprine 90% by parent or patient interview vs 36% by pill count), 11 adolescent bariatric surgery (postoperative oral multivitamin 88.4% by self-report vs 37.4% by electronic monitoring), 12 HIVinfected children or youth (antiretroviral medication 100% by selfreport vs 75.4% by electronic monitoring), 13 and pediatric asthma (inhaled steroid 80% by self-report or parent report vs 50% by electronic monitoring).…”

“…Self-report is a convenient and inexpensive method for monitoring 6MP intake in the clinic, but literature in the non-oncology setting indicates that self-report is subject to overreporting. [11][12][13][14] The accuracy of self-reported 6MP intake during maintenance therapy for childhood ALL is not known. In this study, we address this issue by directly comparing self-report to electronic monitoring of 6MP intake and identifying predictors of overreporting of 6MP intake in a racially and geographically diverse cohort of children with ALL during the maintenance phase of therapy.…”

Assessing Micronutrient Adherence after Bariatric Surgery: An Exploratory Study

“…Modi et al studied short-term adherence to multivitamin in 41 adolescent patients with Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in a prospective observational study over a 6-month period. The mean self-reported adherence rate was 88.4% and 78.6% at the 1-and 6-month postoperative clinic visits, respectively, whereas the electronic monitoring system that captured the number and time of bottle opening logged an adherence rate of 37.4% and 27.1% during the same time intervals [5]. Similar studies have not been conducted in adult bariatric patients.…”