title: An optimized multivitamin supplement lowers the number of vitamin and mineral deficiencies three years after Roux-en-Y gastric bypass: a cohort study.
abstract: BACKGROUND
  Vitamin and mineral deficiencies are common after Roux-en-Y gastric bypass (RYGB) surgery. In particular, inadequate serum concentrations of ferritin and vitamin B12 have been found in 11% and 23% (respectively) of patients using a standard multivitamin supplement (sMVS) 1 year after RYGB.
  
  
  OBJECTIVE
  To evaluate the effectiveness and safety of Weight Loss Surgery (WLS) Forte® (a pharmaceutical-grade, optimized multivitamin supplement) compared with an sMVS and a control group (nonuser) 3 years after RYGB.
  
  
  METHODS
  General hospital specialized in bariatric surgery.
  
  
  METHODS
  A follow-up cohort study of a triple-blind randomized, controlled clinical trial.
  
  
  RESULTS
  At baseline 148 patients were enrolled (74 [50%] in the sMVS group and 74 [50%] in the WLS Forte group). After a mean follow-up of 36 months, 11 (7%) patients were lost to follow-up, of whom 2 were secondary to death. At the end of the study, 11 (17%) patients in the WLS Forte and 17 (24%) in the sMVS group stopped using a supplement. In addition, 64 (47%) patients were using WLS Forte and 45 (33%) patients a sMVS. Patient characteristics and follow-up length were comparable between the groups. Significantly more patients were diagnosed with anemia (16% versus 3% [P = .021]), a ferritin deficiency (14% versus 3% [P = .043]), and a zinc deficiency (8% versus 0% [P = .033]) in the sMVS group compared with WLS Forte. Five patients developed a vitamin B12 deficiency while using WLS Forte, versus 15 of sMVS users (P = .001). No adverse events occurred that were related to supplement use.
  
  
  CONCLUSIONS
  At 3 years postoperative of RYGB, an optimized multivitamin supplement (WLS Forte) was more effective in reducing anemia and ferritin, vitamin B12, and zinc deficiencies compared with a standard supplement and control.
authors.affiliation: Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands. Electronic address: jhoman@rijnstate.nl.
authors.forename: Jens
authors.initials: J
authors.lastname: Homan
authors.affiliation: Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
authors.forename: Wendy
authors.initials: W
authors.lastname: Schijns
authors.affiliation: Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
authors.forename: Edo O
authors.initials: EO
authors.lastname: Aarts
authors.affiliation: Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Cees J H M
authors.initials: CJHM
authors.lastname: van Laarhoven
authors.affiliation: Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
authors.forename: Ignace M C
authors.initials: IMC
authors.lastname: Janssen
authors.affiliation: Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
authors.forename: Frits J
authors.initials: FJ
authors.lastname: Berends
mesh_terms: D000328:Adult; D001361:Avitaminosis / Q000517:prevention & control*; D019587:Dietary Supplements; D005260:Female; D005293:Ferritins / Q000172:deficiency; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000517:prevention & control; D009767:Obesity, Morbid / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control; D014131:Trace Elements / Q000172:deficiency*; D014815:Vitamins / Q000008:administration & dosage*
chemical_list: D014131:Trace Elements; D014815:Vitamins; D005293:Ferritins
keywords: Bariatric surgery; Deficiency; Dietary supplements; Gastric bypass; Malnutrition; Minerals; Vitamins