title: Vitamin and Mineral Deficiencies After Biliopancreatic Diversion and Biliopancreatic Diversion with Duodenal Switch--the Rule Rather than the Exception.
abstract: BACKGROUND
  Malabsorptive bariatric procedures, like the biliopancreatic diversion (BPD) and BPD with duodenal switch (BPD/DS), have excellent results in terms of weight loss. However, these malabsorptive techniques are associated with severe malnutrition and vitamin deficiencies. The aim of this study was to evaluate the vitamin and mineral status after BPD and BPD/DS in the long term.
  
  
  METHODS
  All patients who underwent BPD or BPD/DS were selected and invited for an additional follow-up (FU) visit, including blood sampling for vitamin and mineral levels.
  
  
  RESULTS
  Forty patients completed the blood sampling with a median FU of 42 (range 12-90) months. At that time, all patients used some kind of supplementation. However, 93 % of all patients were diagnosed with a deficiency. There were no significant differences in mean serum level vitamins and minerals between BPD and BPD/DS. Forty-three per cent of the patients were anaemic, and 40 % had an iron deficiency (ID). High deficiency rates for fat-soluble vitamins were present: vitamin A in 28 %, vitamin D in 60 %, vitamin E in 10 % and vitamin K in 60 % of the patients. Hypervitaminosis was found in 43 % of the patients for vitamin B1 and in 50 % for vitamin B6.
  
  
  CONCLUSIONS
  High numbers of vitamin and mineral deficiencies were found after BPD and BPD/DS despite vitamin supplementation. Anaemia, ID and deficiencies for fat-soluble vitamins are frequently diagnosed. Repeated monitoring is necessary to detect deficiencies at an early stage. Taking all of this into consideration, a stringent multivitamin supplementation regimen should be implemented after malabsorptive procedures.
authors.affiliation: Department of Surgery, Rijnstate Hospital, Postal number 1190, 6800 TA, Arnhem, The Netherlands, jhoman@rijnstate.nl.
authors.forename: Jens
authors.initials: J
authors.lastname: Homan
authors.forename: Bark
authors.initials: B
authors.lastname: Betzel
authors.forename: Edo O
authors.initials: EO
authors.lastname: Aarts
authors.forename: K
authors.initials: K
authors.lastname: Dogan
authors.forename: Kees J H M
authors.initials: KJ
authors.lastname: van Laarhoven
authors.forename: Ignace M C
authors.initials: IM
authors.lastname: Janssen
authors.forename: Frits J
authors.initials: FJ
authors.lastname: Berends
mesh_terms: D000328:Adult; D000740:Anemia / Q000209:etiology*; D001361:Avitaminosis / Q000209:etiology*; D015904:Biliopancreatic Diversion / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D013831:Thiamine / Q000097:blood; D025101:Vitamin B 6 / Q000097:blood
chemical_list: D025101:Vitamin B 6; D013831:Thiamine