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Multivitamin supplementation

Clear need to optimise multivitamin supplementation for sleeve patients

WLS Optimum 1.0 only affected serum levels of folic acid, PTH and vitamin B1, and anaemia rates compared to a sMVS

There is a clear need to further optimise multivitamin supplementation for patients who have had a sleeve gastrectomy, according to the results from a randomised controlled study carried by researchers from Vitalys Clinic and Rijnstate Hospital, Arnhem and Wageningen University, Wageningen, The Netherlands.

The result were published in the paper, ‘The True Story on Deficiencies After Sleeve Gastrectomy: Results of a Double-Blind RCT’, featured in Obesity Surgery, that sought to evaluate the effectiveness of a specialised multivitamin supplement for sleeve gastrectomy patients (WLS Optimum 1.0 developed by FitForMe), compared to a standard multivitamin supplement (sMVS). The investigators reported that WLS Optimum 1.0 only affected serum levels of folic acid, PTH and vitamin B1, and anaemia rates compared to a sMVS.

The trial included 139 patients - 69 patients received WLS Optimum and 70 patients received sMVS. The demographics of both groups were similar at baseline for age, gender, weight and BMI deficiencies, although dyslipidaemia was three times higher in the sMVS group compared to the WLS Optimum group (p=0.047).

Pre-operative deficiencies and mean serum levels at baseline were similar between the groups (with vitamin D (76.1%), phosphate (34.1%) and albumin (12.2%) the most common.

At 12 months, weight loss was similar in both groups with the mean BMI 32.7 in the WLS Optimum group and 33.8 in the sMVS group, and patients using WLS Optimum showed 70.5±22.7 %EWL and 31.3±8.6 %TWL, compared to 68.5±23.2 %EWL and 30.5±8.4 %TWL for patients using sMVS (p>0.05 for all).

Significantly more patients in the WLS Optimum group were deficient for folic acid: ten patients (14.5%) vs two patients (2.9%) in the sMVS group (p=0.016). However, no differences were found in prevalence of anaemia or deficiencies for iron, vitamin B12, vitamin D and other vitamins and minerals.

Elevated serum B1 and B6 levels were found in 11 (18.0%) and 20 patients (32.8%) using WLS Optimum and 5 (7.9%) and 13 patients (20.6%) using sMVS (p > 0.05). For PTH, elevated serum levels were more frequent - but not significant (p=0.060) - in the sMVS group (11 patients, 15.7%) compared to the WLS Optimum group (4 patients, 5.8%).

At 12 months, mean serum PTH levels were significantly lower in patients using WLS Optimum (3.2±1.7pmol/L) compared to the group using a sMVS (p=0.026). One patient (2.6%) using WLS Optimum was anaemic, compared to 11 of the patients (17.5%) using a sMVS (p=0.029), no other significant differences were found for other vitamins and minerals.

Only 44 from 69 patients (63.8%) reported using the WLS Optimum supplement after six months, which decreased to 38 patients (55.1%) after 12 months - nausea was cited as the main reason for discontinuation.

The researchers advised that a specialised multivitamin supplement for SG patients should at least contain higher doses of elementary iron, vitamin B12, vitamin D, vitamin B1, and zinc to prevent nutritional deficiencies post-operatively.

“This indicates that there is a clear need to further optimise multivitamin supplementation for sleeve patients. These supplements should contain higher doses of elementary iron, folic acid, vitamin B12, vitamin D, vitamin B1, and zinc to prevent deficiencies post-operatively,” the authors concluded. “However, caution is needed to prevent oversupplementation as we found that most of the recommended doses for WLS preventative supplements according to the ASMBS guideline might be overestimated. Besides, non-compliance with multivitamin supplements was frequently encountered. More research is needed to identify which factors affect (non-)compliance and how this can be improved.”

To access this paper, please click here

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