Optimization of Vitamin Suppletion After Roux-En-Y Gastric Bypass Surgery Can Lower Postoperative Deficiencies

Abstract

Iron, vitamin B12, and folic acid deficiencies are among the most common deficiencies occurring after laparoscopic Roux-en-Y gastric bypass (LRYGB). The present study evaluates the effectiveness of a specially designed multivitamin supplement (WLS Forte, FitForMe, Rotterdam, the Netherlands) specifically developed for LRYGB patients.A triple-blind, randomized, 12-month study was conducted comparing WLS forte with a standard multivitamin supplement (sMVS) containing approximately 100% of the recommended daily allowance (RDA) for iron, vitamin B12, and folic acid. WLS Forte contains vitamin B12 14000% RDA, iron 500% RDA, and folic acid 300% RDA.In total, 148 patients (74 in each group) underwent a LRYGB procedure. Baseline characteristics were similar for both groups. Per protocol analysis demonstrated that sMVS treatment was associated with a decline in ferritin (−24.4 ± 70.1 μg/L) and vitamin B12 (−45.9 ± 150.3 pmol/L) over 12 months, whereas in WLS Forte patients, ferritin remained stable (+3.2 ± 93.2 μg/L) and vitamin B12 increased significantly (+55.1 ± 144.2 pmol/L). The number of patients developing ferritin or vitamin B12 deficiency was significantly lower with WLS Forte compared with sMVS (P < 0.05). Iron deficiency (ID) was reduced by 88% after WLS Forte compared with sMVS. Adverse events related to supplement use did not occur.An optimized multivitamin supplement is safe and reduces the development of iron and vitamin B12 deficiencies after LRYGB.

Nutritional Deficiencies in Patients after Roux-en-Y Gastric Bypass and Sleeve Gastrectomy during 12-Month Follow-Up

“…Kwon et al claims that supplementation of only selected micronutrients (vitamin B 12 and iron) may not always be sufficient in deficient patients [36]. Customised supplementation formula compared to a standard multivitamin product in RYGB cohort may lead to improved reduction of nutritional deficiencies [37]. From our perspective, it may be difficult to accurately assess the efficiency of supplementation regimen due to unknown patients' compliance; therefore, we suggest both general and specific…”

Bariatric Surgery in Obesity: Effects on Gut Microbiota and Micronutrient Status

“…This prevents capture of vitamin B 12 from dietary sources and determines loss of food contact with intrinsic factor (IF)-producing cells, leading to cobalamin malabsorption and deficiency [120,121]. Disrupted IF secretion is currently considered the main driver of the post-surgical B 12 deficiency [121,122]. A 2017 small-scale study, involving 20 patients submitted to RYGB, proposed that, besides IF, other molecules involved in the vitamin B 12 metabolism may be involved in the pathogenesis of its postoperative deficiency.…”

“…In spite of indirect improvement of cobalamin absorption following mixed bariatric procedures, studies show a greater incidence of vitamin B 12 deficit after RYGB compared to VSG [123]. Vitamin B 12 deficiency is reported in 37-50% of gastric bypass patients [122] and, respectively, in 10-20% of patients that underwent VSG [104]. The authors argue that after restrictive BS, although TCN 1 synthesis may be inhibited, exposure of food at the entire intestinal surface area results in local IF production, with B 12 gut transport by IF being less disrupted [121].…”

Micronutrient supplementation in gastric bypass surgery: prospective study on inflammation and iron metabolism in premenopausal women

“…The minerals presented in the formula were chelated into an amino acid (glycine). The micronutrient supplementation of 2 RDAs (26) was suggested to be given daily for RYGB surgery in two doses (11,(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). Adequate Intake (AI) (26) was used when the RDA was not established for the micronutrient (except for calcium).…”

“…Bariatric surgery, especially RYGB surgery, induces a process of nutritional deficiencies that affect food intake and micronutrient absorption (23,24). With these conditions, micronutrient supplementation is indicated to maintain normalized iron levels and prevent anemia (2,11).…”