title: Predictors of Vitamin Adherence After Bariatric Surgery.
abstract: Vitamin supplementation in bariatric aftercare is essential to prevent nutrient deficiencies; however, rates of vitamin adherence have been as low as 30 % 6 months post-surgery. Preliminary literature suggests non-adherence to prescribed treatments can be linked to demographic and psychological factors. We aimed to determine the relationship between these factors to vitamin adherence in post-bariatric surgery patients.
  
  
  
  A total of 92 bariatric patients were assessed 6 months post-surgery. Patients were administered a questionnaire collecting demographic information, psychological scores, and self-reported adherence. Nutrient deficiencies were analyzed through serum vitamin levels measured 3 and 6 months after surgery. Wilcoxon rank-sum and chi-square tests were used for analysis.
  
  
  
  Non-adherence was associated with male sex and full-time employment (p = 0.027, p = 0.015). There were no differences with respect to living situation, education level, or relationship type. Non-adherent patients did not have significantly higher scores for generalized anxiety, depressive symptoms, or avoidant behaviors. However, non-adherent patients displayed greater attachment anxiety than their adherent counterparts (p = 0.0186). Non-adherence was also associated with lower vitamin B12 levels 6 months post-surgery (p = 0.001).
  
  
  
  Male gender and full-time work have previously been shown to be associated with non-adherence. This is the first study to demonstrate that attachment anxiety is associated with poor multivitamin adherence in the post-surgical bariatric population. This result is concordant with recent literature that has demonstrated attachment anxiety is associated with poor adherence to dietary recommendations in bariatric patients 6 months postoperatively. Presurgical screening for attachment anxiety could facilitate early interventions to promote better bariatric aftercare in this group.
authors.affiliation: Toronto Western Bariatric Surgery Program, University Health Network, University of Toronto, 399 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada.
authors.forename: Supreet
authors.initials: S
authors.lastname: Sunil
authors.affiliation: Toronto Western Bariatric Surgery Program, University Health Network, University of Toronto, 399 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada.
authors.forename: Vincent A
authors.initials: VA
authors.lastname: Santiago
authors.affiliation: Toronto Western Bariatric Surgery Program, University Health Network, University of Toronto, 399 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Gougeon
authors.affiliation: Toronto Western Bariatric Surgery Program, University Health Network, University of Toronto, 399 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada.
authors.forename: Katie
authors.initials: K
authors.lastname: Warwick
authors.affiliation: Toronto Western Bariatric Surgery Program, University Health Network, University of Toronto, 399 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada.|Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada.
authors.forename: Allan
authors.initials: A
authors.lastname: Okrainec
authors.affiliation: Toronto Western Bariatric Surgery Program, University Health Network, University of Toronto, 399 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada.|Centre for Mental Health, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada.
authors.forename: Raed
authors.initials: R
authors.lastname: Hawa
authors.affiliation: Toronto Western Bariatric Surgery Program, University Health Network, University of Toronto, 399 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada. sanjeev.sockalingam@uhn.ca.|Centre for Mental Health, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada. sanjeev.sockalingam@uhn.ca.|Toronto General Hospital, University Health Network, 200 Elizabeth Street, Room 8EN-228, Toronto, Ontario, M5G 2C4, Canada. sanjeev.sockalingam@uhn.ca.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Sockalingam
mesh_terms: D000328:Adult; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D050110:Bariatric Surgery / Q000379:methods / Q000534:rehabilitation*; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D004032:Diet; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009748:Nutrition Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D009767:Obesity, Morbid / Q000097:blood / Q000453:epidemiology / Q000534:rehabilitation / Q000601:surgery*; D010349:Patient Compliance / Q000706:statistics & numerical data; D011184:Postoperative Period; D011379:Prognosis; D057566:Self Report; D011795:Surveys and Questionnaires; D014815:Vitamins / Q000627:therapeutic use*
chemical_list: D014815:Vitamins
keywords: Adherence; Bariatric surgery; Obesity; Vitamins