Morbid obesity is a growing problem worldwide and has subsequently resulted in a wide application of bariatric surgery to achieve long-term weight loss and improvement of obesity-related co-morbidities. In spite of these clinical benefits, vitamin deficiencies are common after bariatric surgery; therefore, lifelong multivitamin supplementation (MVS) is recommended. However, patient adherence to MVS intake is generally poor. The aim of this narrative review is to analyse which factors influence the adherence of MVS intake after bariatric surgery. To provide an extensive overview, we will discuss the different factors that influence MVS use in patients who underwent bariatric surgery, but also review the literature on MVS in other patient groups.

Lipoedema is a disorder of adipose tissue that is characterized by abnormal subcutaneous fat deposition, leading to swelling and enlargement of the lower limbs as well as the trunk. This entity is often misdiagnosed as lymphoedema or obesity and, therefore, may be overlooked and missed in patients scheduled for bariatric surgery. Patients with lipoedema who undergo bariatric surgery may have to continue to have extensive lower extremity and trunk adiposity despite adequate weight loss. In this report, we present two patients who had extensive trunk and lower extremity adiposity, one of them before and the other after the bariatric surgery.

Vitamin B12 dosage in multivitamin supplementation in the current literature is quite variable. There is no consensus about the optimal treatment of vitamin B12 deficiency. A systematic literature search on different supplementation regimes to treat perioperative vitamin B12 deficiencies in bariatric surgery was performed. The methodological quality of ten included studies was rated using the Newcastle Ottawa scale and ranged from moderate to good. The agreement between the reviewers was assessed with a Cohen's kappa (0.69). The current literature suggests that 350 μg oral vitamin B12 is the appropriate dose to correct low vitamin B12 levels in many patients. Further research must focus on a better diagnosis of a vitamin B12 deficiency, the optimal dose vitamin B12 supplementation, and clinical relevance next to biochemical data.

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Purpose Lifelong multivitamin supplementation is recommended to prevent nutritional deficiencies. Despite this advice, deficiencies are common which may be due to poor adherence to MVS intake. The aim of this study was to identify which factors affect patient adherence to Multivitamin Supplement (MVS) intake after bariatric surgery. Materials and Methods A 42-item questionnaire was sent to 15,424 patients from four Dutch bariatric center. In total, 4975 patients wanted to participate of which 361 patients were excluded. A total of 4614 patients were included, and MVS users (n=4274, 92.6%) were compared to non-users (n=340, 7.4%). Most patients underwent Roux-en-Y gastric bypass (64.3%) or sleeve gastrectomy (32.3%). Results Seven hundred and ten patients (15.4%) reported inconsistent MVS use and 340 patients (7.4%) did not use any MVS at all. For inconsistent MVS users, most reported reasons included forgetting daily intake (68.3%), gastro-intestinal side effects (25.6%) and unpleasant taste or smell (22.7%), whereas for non-users gastro-intestinal side effects (58.5%), high costs (13.5%) and the absence of vitamin deficiencies (20.9%) were most frequently reported. Overall, 28.5% were dissatisfied about instructions on MVS use, attention paid to MVS use during medical consultation and the extent to which personal preferences were taken into account. Conclusion The attitude of bariatric patients towards MVS use is predominantly negative. It is important to provide accurate information on different options for MVS intake and collect information about patient's personal preferences when prescribing supplements. Improving adherence to MVS intake is challenging and requires implementation of a shared decision-making process, further optimization of MVS formulas and exploring options for reimbursement.

This study shows that all bariatric patients with vitamin B12 levels between 140 and 200 pmol/L benefit clinical and biochemical from vitamin B12 supplementation, regardless the MMA levels.

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