The True Story on Deficiencies After Sleeve Gastrectomy: Results of a Double-Blind RCT

Abstract

Background Since a few years, the laparoscopic sleeve gastrectomy (SG) has become the most performed bariatric operation worldwide. However, as with all bariatric procedures, SG also leads to vitamin and mineral deficiencies post-operatively and standard multivitamin supplements are probably not sufficient. Objective The present study evaluates the effectiveness of a specialized multivitamin supplement for SG patients (WLS Optimum 1.0, FitForMe, Rotterdam, the Netherlands), compared to a standard multivitamin supplement (sMVS). Design A double-blind randomized controlled trial was performed. For 12 months, patients in the intervention group received WLS Optimum, containing elevated doses of multiple vitamins and minerals. Patients in the control group were provided with sMVS, containing 100% of the recommended dietary allowance. Results In total, 139 patients were available for analysis (WLS Optimum, n = 69; sMVS, n = 70). Intention-to-treat analyses revealed more folic acid deficiencies and higher serum vitamin B1 levels in the WLS Optimum group. Per protocol analyses showed that in patients using WLS Optimum, serum folic acid and vitamin B1 levels were higher, serum PTH levels were lower, and only one patient (2.6%) was anemic compared to 11 patients (17.5%) using a sMVS (p < 0.05 for all). No differences were found in prevalence of deficiencies for iron, vitamin B12, vitamin D, and other vitamins and minerals. Conclusions This optimized multivitamin supplement only affected serum levels of folic acid, PTH and vitamin B1, and anemia rates compared to a sMVS. There is a clear need to further optimize multivitamin supplementation for SG patients. Besides, noncompliance with multivitamin supplements remains an important issue that should be dealt with. Clinical Trial Registry The study protocol was registered at the clinical trials registry of the National Institutes of Health (ClinicalTrials.gov; identifier NCT01609387).

Micronutrient status in bariatric surgery patients receiving postoperative supplementation per guidelines: Insights from a systematic review and meta‐analysis of longitudinal studies

“…Full‐text review of 355 studies resulted in the exclusion of 273 studies (Figure 1). Among the 82 included studies, 15 were of vitamin B 1 , 18–32 28 of folate, 18–45 42 of vitamin B 12 , 18–59 13 of vitamin A, 18,19,23,25,26,28–30,36,39,55,60,61 11 of vitamin E, 18,19,23,25,26,28,29,61–64 57 of vitamin D, 18,19,21–33,37–39,41,42,45,47,51,52,55,59,61,65–94 42 of calcium,…”

“…Twenty studies 19,24–27,31–34,37,40,42,43,46,48,57,95,101,103,104 presenting post‐bariatric changes in ferritin levels with iron supplementation per guidelines reported that the ferritin levels significantly decreased by 16.42 μg/ml (95% CI, −18.29 to −14.56) at 6–11 months (Table 3). The ferritin levels also decreased at ≥24 months after SG despite supplementation per guidelines (WMD, −54.93 μg/ml; 95% CI, −77.19 to −32.67).…”

Patient adherence to multivitamin supplementation after bariatric surgery: a narrative review

“…Multivitamin supplements (MVSs) are routinely recommended lifelong to prevent vitamin deficiencies (4,(6)(7)(8)(9)(10) . However, vitamin deficiencies are quite common after bariatric surgery despite the use of MVS, which can lead to serious long-term complications (3,(11)(12)(13) . Zarshenas et al reported about an inconsistent adherence of MVS intake after bariatric surgery (5) .…”

“…Zarshenas et al reported about an inconsistent adherence of MVS intake after bariatric surgery (5) . Many other studies have shown that long-term adherence of bariatric patients to MVS intake is poor (10,(12)(13)(14)(15)(16)(17)(18) . However, it is unclear which factors contribute to patient Abbreviations: LRYGB: laparoscopic Roux-en-Y gastric bypass; LSG: Laparoscopic sleeve gastrectomy; MVS: multivitamin supplementation; OAGB/MGB: One Anastomosis/Mini-Gastric Bypass adherence in taking MVS.…”

Design and baseline data in the BAriatic surgery SUbstitution and Nutrition study (BASUN): a 10-year prospective cohort study

“…In Sweden, the same supplement treatment is recommended for RYGB and SG patients postoperatively. A study recently published by Aarts and colleagues confirmed the need for postoperative nutritional management after SG [37] and suggested that larger doses may be required. Earlier studies have focused on nutritional management after malabsorptive surgery [38,39].…”