title: Long-term evolution of nutritional deficiencies after gastric bypass: an assessment according to compliance to medical care.
abstract: OBJECTIVE
  To study long-term nutritional deficits based on adherence to a standardized nutritional care after gastric bypass (GBP).
  
  
  BACKGROUND
  Long-term prospective data on nutritional complications after GBP are missing. It is not known whether severe deficiencies are prevented by standard multivitamin supplementation and what parameters are influenced by patient adherence to nutritional care.
  
  
  METHODS
  One hundred forty-four consecutive subjects from our prospective database (90% women, initial body mass index: 48 ± 15 kg/m2, age: 43 ± 10 years) who underwent GBP more than 3 years before the study were assessed. Multivitamins were systematically prescribed after GBP, and additional supplements were introduced if deficiencies were recorded during follow-up. We identified a group of 66 compliant subjects who attended yearly medical visits and a group of 32 noncompliant subjects who were recalled because they had not attended any visit for more than 2 years.
  
  
  RESULTS
  Weight loss was 42 ± 14 kg at 3 years or later. The number of nutritional deficits per subject was 3.2 ± 2.3 before surgery and did not significantly increase between 1 and 3 years or later after GBP (3.4 ± 2.0 and 3.5 ± 2.3, respectively). However, specific nutritional deficits occurred despite long-term multivitamin supplementation, including vitamins B1, B12, and D and iron. Noncompliant subjects had more deficits than compliant subjects (4.2 ± 1.9 vs 2.9 ± 2.0 deficits per patient, P < 0.01) and the number of deficits correlated with the time from last visit (r = 0.285, P < 0.01).
  
  
  CONCLUSIONS
  Lifelong medical care is required to maintain a good nutritional status after GBP. Monitoring of nutritional parameters is necessary to add supplementation for deficits that are not prevented by multivitamin preparations.
authors.affiliation: *Explorations Fonctionnelles †Service de Chirurgie ‡Service de Biochimie, Centre de référence de l'Obésité, Hôpital Louis Mourier (AP-HP), Colombes, and Faculté Xavier Bichat, Université Denis Diderot, PRES Sorbonne Paris cité, Paris, France §Service de Biochimie, Hôpital Bichat (AP-HP), Paris ¶Service de Diabétologie, Hôtel Dieu de Paris (AP-HP) and Faculté Paris Descartes, PRES Sorbonne Paris cité, Paris, France.
authors.forename: Séverine
authors.initials: S
authors.lastname: Ledoux
authors.forename: Daniela
authors.initials: D
authors.lastname: Calabrese
authors.forename: Catherine
authors.initials: C
authors.lastname: Bogard
authors.forename: Thierry
authors.initials: T
authors.lastname: Dupré
authors.forename: Benjamin
authors.initials: B
authors.lastname: Castel
authors.forename: Simon
authors.initials: S
authors.lastname: Msika
authors.forename: Etienne
authors.initials: E
authors.lastname: Larger
authors.forename: Muriel
authors.initials: M
authors.lastname: Coupaye
mesh_terms: D000328:Adult; D015992:Body Mass Index; D019587:Dietary Supplements; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000209:etiology / Q000517:prevention & control*; D009752:Nutritional Status; D018529:Nutritional Support / Q000379:methods*; D009767:Obesity, Morbid / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D011446:Prospective Studies; D013997:Time Factors; D015431:Weight Loss