title: Can Composite Nutritional Supplement Based on the Current Guidelines Prevent Vitamin and Mineral Deficiency After Weight Loss Surgery?
abstract: BACKGROUND
  Nutritional deficiencies occur after weight loss surgery. Despite knowledge of nutritional risk, there is little uniformity of postoperative vitamin and mineral supplementation. The objective of this study was to evaluate a composite supplement based on the clinical practice guidelines proposed in 2008 regarding vitamin and mineral supplementation after Roux-en-Y gastric bypass. The composite included iron (Fe) and calcium as well.
  
  
  METHODS
  A retrospective chart review of 309 patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) was evaluated for the development of deficiencies in iron and vitamins A, B1, B12, and D. Patients were instructed to take a custom vitamin and mineral supplement that was based on society-approved guidelines. The clinical practice guidelines were modified to include 1600 international units (IU) of vitamin D3 instead of the recommended 800 IU.
  
  
  RESULTS
  The compliant patients' deficiency rates were significantly lower than those of the noncompliant patients for iron (p = 0.001), vitamin A (p = 0.01), vitamin B12 (p ≈ 0.02), and vitamin D (p < 0.0001). Women's menstrual status did not significantly influence the development of iron deficiency.
  
  
  CONCLUSIONS
  Use of a composite based on guidelines proposed by the AACE, TOS, and the ASMBS appears to be effective for preventing iron and vitamins A, B1, B12, and D deficiencies in the LRYGB patients during the first postoperative year. Separation of calcium and Fe does not need to be mandatory. Even with simplification, compliance is far from universal.
authors: New Life Center for Bariatric Surgery, Knoxville, TN, USA.
authors: Stephen G
authors: SG
authors: Boyce
authors: Department of Surgery, Northshore-LIJ-Lenox Hill Hospital, 100 E 77th Street, New York, NY, 10075, USA.
authors: Richie
authors: R
authors: Goriparthi
authors: New Life Center for Bariatric Surgery, Knoxville, TN, USA.
authors: Jennifer
authors: J
authors: Clark
authors: New Life Center for Bariatric Surgery, Knoxville, TN, USA.
authors: Krystal
authors: K
authors: Cameron
authors: Department of Surgery, Northshore-LIJ-Lenox Hill Hospital, 100 E 77th Street, New York, NY, 10075, USA. mroslin@nshs.edu.
authors: Mitchell S
authors: MS
authors: Roslin
mesh_terms: D000328:Adult; D001361:Avitaminosis / Q000209:etiology / Q000517:prevention & control*; D019587:Dietary Supplements; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D008903:Minerals / Q000627:therapeutic use*; D009767:Obesity, Morbid / Q000601:surgery*; D011184:Postoperative Period; D012189:Retrospective Studies; D014815:Vitamins / Q000627:therapeutic use*; D015431:Weight Loss / Q000502:physiology*
chemical_list: D008903:Minerals; D014815:Vitamins
keywords: Gastric bypass; Nutritional guidelines; Vitamin supplementation; Weight loss surgery