Pragmatic strategy for vitamin and micronutrient supplementation after metabolic and bariatric surgery

Nutritional deficiencies are frequent after metabolic and bariatric surgery (MBS) and systematic addition of vitamin B12, iron, calcium, and vitamin D to standard multivitamin tablets is recommended. However, there are still uncertainties because supporting data are few and compliance with a large number of tablets is low.

To assess the need for additional supplements using a supplementation based on biological assays after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG).

Consecutive patients (N = 313: 179 RYGB/134 SG; 86% women, mean age 44.1 ± 10.3 years, Body mass index 43.5 ± 6.6 kg/m²) who underwent a nutritional assessment, before and at 6, 12, and 36 months after MBS, were studied. Multivitamin tablets were systematically prescribed after MBS, and additional supplements were introduced following a standardized protocol in the case of deficiency.

University Hospital, France.

Although the number of patients taking additional supplements increased by more after RYGB than after SG (58.7% vs 43.3%, P < .01), the mean number of deficits did not increase and was similar at 3 years (3.7 vs 3.4, Ns). The frequency of nutritional symptoms was also similar after both procedures, the most common being hair loss, while neurological symptoms were unusual and mild. Anemia was infrequent, but secondary hyperparathyroidism was frequent after RYGB (23% vs 9% after SG, P < .01).

A personalized supplementation strategy adapted to biological parameters, in patients followed regularly up to 3 years after MBS, may reduce the number of nutritional supplements without increasing the number of deficiencies. However, vigilance must be maintained, particularly regarding bone and neurological risks.