Deficiency of fat soluble vitamins after jejunoileal bypass surgery for morbid obesity

Significant vitamin A, E, or 25-hydroxy D deficiency occurred in 76% of 40 patients studied up to 6 years after jejunoileal bypass surgery for morbid obesity. Vitamin A was significantly lower in those who had lost 30% of their initial weight than in those who had lost less weight; however, there was no correlation of vitamin A, E, or D levels, time elapsed since surgery, or with daily intake of vitamins as subnormal values were found despite multivitamin supplementation and consumption of twice the recommended daily allowance of vitamin A. Functional derangement of retinal adaptation to darkness secondary to vitamin A deficiency was found in four of nine stable, healthy patients studied at least 18 months after surgery. There was no linear relationship between vitamin A levels and dark adapted final thresholds or with serum albumin, prothrombin time, or degree of steatorrhea. Three patients with abnormal adapted final thresholds were treated with vitamin A. Total daily intake of up to 65,000 IU of vitamin A daily for several months resulted in normalization of function in all.