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Post-op vitamin deficiency

Study: need to identify patients with vitamin deficiency

At the five-year follow-up, patients had significant increases in folic acid, vitamins B-6, vitamin B-12 , vitamin C and vitamin A

Norwegian researchers have revealed that a five-year follow-up study of roux-en-y gastric bypass patients has revealed that levels of certain vitamins increased while others remained the same as before surgery. The increases may be because patients took their supplements and ate better, but also because their vitamin concentrations before surgery may have been poor, explained lead author Dr Eirik Aaseth from Oslo University Hospital, Norway. Previous studies have found an elevated risk of vitamin deficiency following gastric bypass, and these new findings should encourage patients to take their supplements, he added.

The researchers retrospectively followed 441 patients through medical records and estimated changes in vitamin concentrations using linear mixed models that adjusted for age and sex. Their results were published in the European Journal of Clinical Nutrition.

Using a retrospectively maintained database the researchers retrospectively followed 441 patients of patients undergoing roux-en-y gastric bypass at their tertiary care hospital from July 2004 to May 2008. Data on vitamin concentrations and patient-reported intake of dietary supplements were collected up to July 2012. Linear mixed models were used to estimate changes in vitamin concentrations during follow-up, adjusting for age and sex. All patients were recommended daily oral multivitamin, calcium/vitamin D and iron supplements and three-monthly intramuscular B-12 after surgery.

From the 443 patients operated with gastric bypass, 441 (99.5%) patients with one or more measurements of vitamin concentrations (75.1% women; mean age 41.5 years, mean body mass index 46.1 kg/m2 at baseline) were included in the study. At five years after surgery, the patients' estimated mean vitamin concentrations were either significantly higher (vitamin B-6, folic acid, vitamin B-12, vitamin C and vitamin A) or not significantly different (thiamine, 25-hydroxyvitamin D and lipid-adjusted vitamin E) compared with before surgery.

Use of multivitamin, calcium/vitamin D and vitamin B-12 supplements was reported by 1–9% of patients before surgery, 79–84% of patients at one year and 52–83% of patients five years after surgery. At the five-year follow-up, patients had significant increases in folic acid (from 15.9 nmol/l before surgery to 23.1 nmol/l), vitamins B-6 (from 33.1 to 43.3 nmol/l), vitamin B-12 (from 364 to 547 pmol/l), vitamin C (from 46 to 59.7 mmol/l) and vitamin A (from 1.68 to 1.80 mcmol/l).

Concentrations of thiamine, 25-hydroxyvitamin D and lipid-adjusted vitamin E were not changed compared to levels before surgery.

Dr Aaseth stressed that some patients will not have increased vitamin concentrations. "Identify at-risk individuals for vitamin deficiency, e.g. persistent vomiting the first weeks after surgery - thiamine deficiency," he advised.

Additional authors of the study were M W Fagerland, A-M Aas, S Hewitt, H Risstad, J Kristinsson, T Bøhmer, T Mala and E T Aasheim. 

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