Nutrient Deficiency 10 Years Following Roux-en-Y Gastric Bypass: Who’s Responsible?

Abstract

Objective(s) 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. Methods 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. Results 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). Conclusions 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.

Metabolic surgery and iron homeostasis

“…To further complicate matters, the prevalence of other micronutrient deficiencies is increasing, and major limitations of perioperative nutritional care are common, including lack of preoperative screening, failure to provide supplements, poor patient compliance with supplementation, patient reluctance to take iron supplements because of unpleasant gastrointestinal side effects, major gaps in surgical and nutritional follow‐up, and lack of specialized nutritional care after surgery . Considered together, these findings reflect a growing problem and an opportunity for quality improvement in metabolic surgery.…”

“…Regular follow‐up and specialized care in the bariatric programme have been shown to reduce the prevalence of anaemia 10 years after metabolic surgery . Preliminary evidence suggests that long‐term nutritional care in the metabolic surgery programme is superior to care provided by primary care providers with outside specialists …”

Personalized Nutrition for Management of Micronutrient Deficiency—Literature Review in Non-bariatric Populations and Possible Utility in Bariatric Cohort

“…People who have bariatric surgery, short gut syndrome, long-term vegetarian, or vegan diets can potentially develop vitamin B12 deficiency [ 56 ]. While vitamin B12 level can be normal at baseline, it is often found to be lower in individuals after bariatric surgery [ 57 , 58 ]. Nutritional parameters were compared preoperatively and at similar periods postoperatively among patients undergoing malabsorptive procedures [ 59 ].…”

“…People who have bariatric surgery, short gut syndrome, long-term vegetarian, or vegan diets can potentially develop vitamin B12 deficiency [56]. While vitamin B12 level can be normal at baseline, it is often found to be lower in individuals after bariatric surgery [57,58].…”

The Use of Multivitamin/Multimineral Supplements: A Modified Delphi Consensus Panel Report

“…144 Although most patients receive postbariatric-surgery MVMS and report improvements in their nutritional status and prevention of anemia, there is a large disparity in the prevalence of this practice. 145,146 Furthermore, MVMS may not provide adequate nutritional support, 147 and individual supplements at higher doses may be necessary for certain individuals.…”