title: Patient-Reported Adherence to Empiric Vitamin/Mineral Supplementation and Related Nutrient Deficiencies After Roux-en-Y Gastric Bypass.
abstract: Roux-en-Y gastric bypass (RYGB) is associated with nutrient deficiencies, but the optimal supplement regimen remains unclear. We assessed patient-reported adherence to and efficacy of Mayo Clinic's post-RYGB vitamin/mineral supplement protocol and the related incidence of common nutrient deficiencies.
  
  
  
  Data were collected on 287 obese patients who underwent RYGB. Patient-reported supplement adherence was assessed via medication/supplement lists generated by medication reconciliation in hospital dismissal summaries and clinic notes at 6, 12, and 18-36 months postsurgery. Deficiencies were assessed via measurements of hemoglobin, ferritin, 25-hydroxyvitamin D, and vitamins A, E, and B12in the setting of our supplementation protocol.
  
  
  
  Patient-reported adherence to multivitamin/minerals and subcutaneous vitamin B12was sustained in >92 % of patients, correlating with low rates of vitamin A, E, and B12deficiencies (4.9, 0, and 3.7 %, respectively). Rates of calcium supplementation decreased (94.1 to 78.7 %) while rates of vitamin D and iron use increased over time (39.7 to 65.8 and 6.3 to 23.1 %, respectively). At 18-36 months, vitamin D deficiency persisted in 16.2 % of patients, iron deficiency in 6.7 % of women and 17.2 % of men, and anemia in 12.2 % of women and 34.3 % of men.
  
  
  
  Compared to previous reports, we found a lower prevalence of micronutrient deficiencies and excellent patient-reported adherence to a standardized multivitamin/mineral and vitamin B12regimen. Continued prevalence of vitamin D deficiency prompts consideration of standardized vitamin D supplementation after RYGB. Anemia and iron deficiency were observed at lower rates than previously reported, but were more common in men compared to women.
authors.affiliation: Division of Endocrinology, Diabetes, Nutrition, and Metabolism, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA. James.Haleigh@mayo.edu.
authors.forename: Haleigh
authors.initials: H
authors.lastname: James
authors.affiliation: Division of Endocrinology, Diabetes, Nutrition, and Metabolism, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Lorentz
authors.affiliation: Division of Endocrinology, Diabetes, Nutrition, and Metabolism, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
authors.forename: Maria L
authors.initials: ML
authors.lastname: Collazo-Clavell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D003677:Deficiency Diseases / Q000209:etiology / Q000517:prevention & control; D019587:Dietary Supplements; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000209:etiology / Q000517:prevention & control*; D055118:Medication Adherence; D008875:Middle Aged; D008903:Minerals / Q000627:therapeutic use*; D009767:Obesity, Morbid / Q000601:surgery*; D000071066:Patient Reported Outcome Measures; D057566:Self Report; D014815:Vitamins / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D008903:Minerals; D014815:Vitamins
keywords: Nutrient deficiencies; Roux-en-Y gastric bypass; Vitamin/mineral supplement adherence