title: Nutrient Deficiency 10 Years Following Roux-en-Y Gastric Bypass: Who's Responsible?
abstract: Monitoring and prevention of long-term nutrient deficiency after laparoscopic Roux-en-Y gastric bypass (LRYGB) remains ill defined due to limited surgical follow-up after bariatric surgery. This study compared nutrient supplementation as well as surgeon and primary care physician (PCP) follow-up between patients with short-term versus long-term follow-up.
  
  
  
  All patients undergoing LRYGB at a single institution in 2004 (long-term group, n = 281) and 2012-2013 (short-term group, n = 149) were evaluated. Prospectively collected database, electronic medical record (EMR) review and telephone survey were used to obtained follow-up for both cohorts. Multivariate logistic regression was used to assess factors independently predicting multivitamin use.
  
  
  
  Complete follow-up was achieved in 172 (61 %) long-term and 107 (72 %) short-term patients. We demonstrate a significant difference (p < 0.0001) in time since last surgeon follow-up (13.3 ± 7.8 vs 86.9 ± 39.9 months) for the long-term group with no difference in PCP follow-up, (3.1 ± 4.3 vs 3.7 ± 3.4). Nutrient supplementation was higher in the short-term group, including multivitamin (70.3 vs 58.9 %, p < 0.05), iron (84.2 vs 67.1 %, p = 0.02), and calcium (49.5 vs 32.9 %, p = 0.01). After adjusting for interval since surgery, %EBMI and current comorbidities logistic regression (c = 0.797) demonstrated shorter time since last surgeon visit was independently predictive of multivitamin use (p = 0.001).
  
  
  
  While it appears patients prefer to follow-up with their PCP, this study reveals a large disparity in malnutrition screening and nutrient supplementation following LRYGB. Therefore, implementation of multidisciplinary, best-practice guidelines to recognize and prevent malnutrition is paramount in the management of this growing population of high-risk patients.
authors.affiliation: Department of Surgery, University of Virginia, Box 800709, Charlottesville, VA, 22903, USA.
authors.forename: J Hunter
authors.initials: JH
authors.lastname: Mehaffey
authors.affiliation: Department of Internal Medicine, University of Virginia, Charlottesville, VA, USA.
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Mehaffey
authors.affiliation: Department of Surgery, University of Virginia, Box 800709, Charlottesville, VA, 22903, USA.
authors.forename: Mathew G
authors.initials: MG
authors.lastname: Mullen
authors.affiliation: Department of Surgery, University of Virginia, Box 800709, Charlottesville, VA, 22903, USA.
authors.forename: Florence E
authors.initials: FE
authors.lastname: Turrentine
authors.affiliation: Department of Kinesiology, University of Virginia, Charlottesville, VA, USA.|Division of Endocrinology & Metabolism, University of Virginia, Charlottesville, VA, USA.
authors.forename: Steven K
authors.initials: SK
authors.lastname: Malin
authors.affiliation: Department of Surgery, University of Virginia, Box 800709, Charlottesville, VA, 22903, USA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Schirmer
authors.affiliation: Department of Internal Medicine, University of Virginia, Charlottesville, VA, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Wolf
authors.affiliation: Department of Surgery, University of Virginia, Box 800709, Charlottesville, VA, 22903, USA. pth2f@virginia.edu.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Hallowell
mesh_terms: D000328:Adult; D000359:Aftercare; D050110:Bariatric Surgery / Q000009:adverse effects; D001774:Blood Chemical Analysis; D015897:Comorbidity; D003430:Cross-Sectional Studies; D019587:Dietary Supplements / Q000706:statistics & numerical data*; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy; D016015:Logistic Models; D008297:Male; D044342:Malnutrition / Q000209:etiology* / Q000517:prevention & control; D018977:Micronutrients / Q000008:administration & dosage*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D014815:Vitamins
chemical_list: D018977:Micronutrients; D014815:Vitamins
keywords: Bariatric surgery; Follow-up; Gastric bypass; Long-term complications; Nutrient deficiency