Only 38.9% of respondents routinely prescribe multivitamin supplementation
Vegetarian bariatric patients in East and South-East Asia are an under-recognized patient cohort at risk of micronutrient deficiencies, according to a survey of Asian surgeons by Asia-Pacific Metabolic and Bariatric Surgery Society (APMBSS). The study authors noted that current literature on micronutrient deficiency in this cohort is scarce, particularly in East and South-East Asian, and that there is a knowledge gap among regional surgeons in long-term nutritional assessment and management.
The paper, ‘Bariatric Surgery in Vegetarians: Asia-Pacific Metabolic and Bariatric Surgery Society (APMBSS) survey of Asian surgeon experience’, published in the Asian journal of Surgery, surveyed 56 surgeons (from 138 eligible surgeon members, response rate of 40.6%) regarding their practices and experiences with the vegetarian population (20-question survey). A majority of respondents (36, 80%) worked at a public hospital facility and nine (20%) from a private hospital facility. The distribution of respondents was as follows:
- 21 (46.7%) from China
- 15 (33.3%) from Hong Kong (China)
- three (6.6%) from Japan
- two (4.4%) from Taiwan;
- and one (2.2%) each from Korea, Malaysia, Singapore and Brunei (there were no respondents from Indonesia, Iran, India, Philippines, or Thailand)
Nearly half of the respondents (n=22, 48.9%) noticed vegetarian patients (all types) in their case volume. The majority of respondents (n=38, 84%) noted a vegetarian prevalence of 0.1–5%. Only three respondents (6.7%) from China and Hong Kong reported a vegetarian prevalence of 5.1–10% in their case volume. Twenty-three respondents (51.1%) reported there to be no vegetarian patients within their cases.
More respondents (n=30, 66.7%) identified vegetarian patients were more likely to be female. The makeup of vegetarian patients was Type 4 (lacto-ovo-vegetarian, socially referred to as vegetarian, those that do not eat animal flesh/meat but still consume dairy and eggs, n=13, 37.1%), followed by both Type 1 (vegan, abstains from eating any animal products) and Type 2 (lacto-vegetarian, abstains from any animal products except dairy products, n=8, 22.8% each) and Type 3 (ovo-vegetarian, abstains from animal products except for eggs, n=7, 20.1%).
The reasons for that eating choices were for religious and or health (n=20, 66.7%) reasons, ethical (n=3, 10%) and environmental (n=2, 6.7%) concerns. A majority (n=13, 76.5%) reported patients would continue their vegetarian diet post-operatively.
Micronutrient deficiency status
Almost 60% (n=10) of respondents were unsure of the micronutrient deficiency status among their vegetarian population and a majority of respondents (n=8, 53.3%) reported their vegetarian patients either did not consume multivitamins/vitamin supplements or that they were unsure of the supplement status. Of those (n=7, 41.2%) that reported dietary supplementation, it was at 50–80% of patients.
Some 17.6% (n=3) of respondents that noted mineral deficiency, a range of Iron (10–50%) and Folic acid (5–60%) deficiency was noted. Respondents were unsure of Iron (n=8, 47.1%), Vitamin B12 (n=10, 58.8%), Vitamin D (n=10, 58.8%), Zinc (n=11, 64.7%) and Folic acid (n=10, 58.8%) deficiency status of these patients. Only 38.9% of respondents routinely prescribe multivitamin supplementation.
“This study represents the perspectives of surgeons, rather than patient experience. Moreover, lack of respondent from India, Indonesia, Iran, and Malaysia where the vegetarian population is high, which make this study mainly represent East-Asian population, rather than the entire Asia–Pacific region,” the authors noted. “However, APMBSS supported and distributed this questionnaire and with a high response rate (40.6%), this captures the regional surgeon experience. This supports the development of the literature on Asian vegetarian bariatric patients.”
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