Variations in oral vitamin and mineral supplementation following bariatric gastric bypass surgery: a national survey.
BACKGROUND
Bariatric surgery (including gastric bypass) is associated with long-term deficiencies in vitamins and minerals, which may have deleterious effects on physiology. The American Association of Clinical Endocrinologists' (AACE) guidelines regarding post-operative vitamin supplementation have recently been endorsed by the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Supplements have cost implications. Non-branded multivitamins may have similar compositions to branded multivitamins, but at a lower cost. This study assesses multivitamin supplementation following bariatric gastric bypass in England against AACE guidelines. It also examines the composition and cost of branded and non-branded multivitamins.


METHODS
Micronutrient amounts in common multivitamin preparations were obtained from product literature. Costs were collected from a standard retailer. To determine vitamin prescribing patterns, the 37 NHS hospitals performing bariatric gastric bypasses in England were contacted. Practice was assessed against AACE guidelines.


RESULTS
All non-branded multivitamins met AACE guidelines for composition. Most had similar compositions to branded multivitamins, and all were cheaper. There was no standard practice regarding post-operative supplementation among the 35 responding hospitals. Only 7/35 (20%) hospitals followed the guidance for two-tablet doses of multivitamins. Immediately post-operatively, 25/35 (71%) hospitals administered calcium carbonate and vitamin D (none recommended calcium citrate, as recommended by AACE to improve absorption), and only 9/35 (26%) hospitals recommended iron to all patients.


CONCLUSIONS
Most non-branded multivitamins are lower cost alternatives to branded multivitamins, with similar compositions. The AACE recommendation for two-tablet doses of multivitamins is not being met by most English centres. Calcium and iron supplementation is also inadequate.
Department of Bariatric Surgery, Ashford and St. Peter's Hospitals NHS Foundation Trust, Guildford Road, Chertsey, Surrey, KT16 0PZ, UK, matthew.dunstan@doctors.org.uk.
Matt J D
MJ
Dunstan
Emma J
EJ
Molena
Kumaran
K
Ratnasingham
Anna
A
Kamocka
Natasha C
NC
Smith
Samer
S
Humadi
Shashi
S
Irukulla
D000284:Administration, Oral; D000328:Adult; D019587:Dietary Supplements; D004739:England; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D007501:Iron / Q000008:administration & dosage; D008297:Male; D018977:Micronutrients / Q000172:deficiency; D008903:Minerals / Q000008:administration & dosage*; D009767:Obesity, Morbid / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology / Q000601:surgery*; D011183:Postoperative Complications / Q000097:blood / Q000517:prevention & control; D011184:Postoperative Period; D014815:Vitamins / Q000008:administration & dosage* / Q000032:analysis
D018977:Micronutrients; D008903:Minerals; D014815:Vitamins; D007501:Iron