Effects of standard v. very long Roux limb Roux-en-Y gastric bypass on nutrient status: a 1-year follow-up report from the Dutch Common Channel Trial (DUCATI) Study

Abstract

Laparoscopic Roux-en-Y gastric bypass (RYGB) is considered the ‘gold standard’ for surgical treatment of morbid obesity. It is hypothesised that reducing the length of the common limb positively affects the magnitude and preservation of weight loss but may also impose a risk of malnutrition. The aim of this study was to compare patients’ nutrient and vitamin deficiencies in standard RYGB with a very long Roux limb RYGB (VLRL-RYGB). This study was part of the multicentre randomised controlled trial (Dutch Common Channel Trial), including 444 patients undergoing an RYGB or a VLRL-RYGB. Laboratory results, use of multivitamin supplements and reoperations were collected at baseline and 1 year postoperative. Primary outcome measure was nutrient deficiency after 1 year postoperative. Secondary outcome measure was the reoperation rate due to malabsorption. In total, 227 patients underwent RYGB and 196 patients underwent VLRL-RYGB. Most common deficiencies at 1 year postoperative were ferritin (17·2–18·2 %), Fe (23·4–35·6 %), K (7·4–15·2 %), vitamin B12 (9·0–9·9 %) and vitamin D (22·7–34·5 %). Patients undergoing VLRL-RYGB had slightly but significantly lower levels of Ca, Fe and vitamin D compared with those undergoing RYGB at 1 year postoperative, but significantly higher levels of folic acid and Na. Reoperation rates due to malabsorption were not significantly different between RYGB (2/227, 0·9 %) and VLRL-RYGB (7/196, 3·6 %) (P = 0·088). We concluded that patients undergoing VLRL-RYGB had significantly lower levels of Ca, Fe and vitamin D compared with those undergoing RYGB at 1 year postoperative, but higher levels of folic acid and Na. Reoperation rates did not differ. Close monitoring on nutrient deficiencies should be performed in patients undergoing VLRL-RYGB.

Standard versus distal Roux-en-Y gastric bypass in patients with BMI 50–60 kg/m2: 5-year outcomes of a double-blind, randomized clinical trial

“…A shorter common channel may have resulted in greater weight loss, but probably with a risk of severe malabsorption, as previously shown for distal RYGB 29 . The Dutch DUCATI randomized trial 30 , 31 of standard versus distal RYGB with a common channel of 100 cm may shed further light on this.…”

The effect of a duodenal-jejunal bypass liner on lipid profile and blood concentrations of long chain polyunsaturated fatty acids

“…However, these surgical procedures also carry risks of increased morbidity and mortality [11,12]. In addition, one side effect of surgical procedures that aim to reduce nutrient absorption is impaired availability of essential micronutrients [13,14].…”

“…This would make dietary sources of these longer chain PUFAs even more important. Since essential nutrient deficiency following malabsorptive bariatric operations is common [13,14], we sought to investigate the effects of DJBL therapy on circulating concentrations of EFAs and other bioactive PUFAs. We hypothesised that circulating concentrations of these fatty acids would be lower after DJBL treatment than following an alternative weight loss intervention that did not involve restricting nutrient absorption.…”

Dietary Recommendations for Bariatric Patients to Prevent Kidney Stone Formation

“…Finally, a higher intake of potassium provided by fruits and vegetables may also be of help due to the alkaline load [97]. According to Leeman et al [98], potassium deficiency is very frequent after RYGB procedures, and a recent study showed a decrease of 45.6% on fiber intake after RYGB, reflecting the smaller amount of plant-based food consumption (fruits, vegetables, cereals and legumes), which corresponds to the main source of potassium [99]. Albeit there is no specific recommendation on potassium intake after BS, the RDA for adults is of 120 mEq/day [100].…”