Factors Affecting Patient Adherence to Multivitamin Intake After Bariatric Surgery: a Multicentre Survey Study from the Patient’s Perspective

Abstract

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.

Nutritional Deficiencies 3 Years After Sleeve Gastrectomy Can Be Limited by a Specialized Multivitamin Supplement

“…This is in line with other research on adherence to supplementation regimes after bariatric surgery with (self-reported) compliance rates ranging between 37 and 93% up to 5 years post-surgery [7,14,15,[17][18][19][20]. Besides commonly reported barriers as gastro-intestinal side effects, bad taste/smell/size, and high cost [13,15,19], some patients believe that their diet provides sufficient micronutrients and therefore do not feel the need to use MVS [15,19]. This is concerning as we found that about 66% of the non-users in this study presented with one or more nutrient deficiencies during follow-up, whereas this was only about 30% in the groups that used a specialized MVS.…”

“…Over time, supplement use varied and adherence to MVS declined with less than half of the participants consistently using the same MVS throughout follow-up and the percentage of non-users increasing up to 24% at 3 years after SG. This is in line with other research on adherence to supplementation regimes after bariatric surgery with (self-reported) compliance rates ranging between 37 and 93% up to 5 years post-surgery [7,14,15,[17][18][19][20]. Besides commonly reported barriers as gastro-intestinal side effects, bad taste/smell/size, and high cost [13,15,19], some patients believe that their diet provides sufficient micronutrients and therefore do not feel the need to use MVS [15,19].…”

“…This in line with a study of Dagan et al including 77 SG patients that showed that adherence to multivitamin supplementation Table 4 Prevalence of deficiencies at baseline (T0), after the 12-month intervention period (T12), and at 24 and 36 months of follow-up (T24, T36) for the four groups Data are presented as frequencies (percentages) MVS multivitamin supplement, sMVS standard multivitamin supplement, MCV mean corpuscular volume, PTH parathyroid hormone 1 Elevated PTH levels 2 Corrected for albumin levels (total calcium − (0.025 × albumin) + 1) Different letters denote significant differences between groups (P < 0.05) at 12 months was significantly associated with higher serum levels of hemoglobin, iron, folic acid, and vitamins B12 and D [14]. As with the general adherence to medical follow-up visits after bariatric surgery, compliance with post-surgery supplementation protocols tends to decrease with time from surgery [7,[13][14][15][16]. As a result, nutritional status may worsen over time.…”

“…However, the effectiveness of such specialized MVS on the longer term after SG is still unknown. In addition to this, compliance to supplementation regimes appears to be poor after bariatric surgery and a part of the patients discontinue the use of (specialized) MVS several years after surgery [13][14][15][16]. Research reporting on nutritional status of nonusers of MVS following SG is limited.…”

A smartphone application to improve adherence to vitamin and mineral supplementation after bariatric surgery

“…Identifying individual barriers is necessary to improve adherence. In a recent study by Smelt et al, the most common reasons for poor adherence or non-persistence were difficulty in remembering to use supplements, gastrointestinal side effects, unpleasant taste or smell, high costs, and the absence of vitamin deficiencies in blood tests [17].…”