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Published in: Obesity Surgery 8/2018

01-08-2018 | Original Contributions

A Randomized Trial of a Novel Chewable Multivitamin and Mineral Supplement Following Roux-en-Y Gastric Bypass

Authors: Jamie Perin, Gregory Prokopowicz, Margaret Furtado, Konstantinos Papas, Kimberley E. Steele

Published in: Obesity Surgery | Issue 8/2018

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Abstract

Background

Vitamin and mineral deficiencies are common following Roux-en-Y gastric bypass (RYGB) and can lead to significant morbidity, but little research on the efficacy of vitamin supplementation regimens exists. We compared the efficacy and tolerability of an investigational versus a standard multivitamin regimen in patients undergoing RYGB.

Methods

Fifty-six patients, aged 18 to 65, were randomized to an investigational versus a standard multivitamin. Plasma levels of vitamins A, B-12, D, E-α, E-β/γ, thiamine, folate, iron, iron-binding capacity, iron saturation, prealbumin, and parathyroid hormone (PTH) were measured at 3 and 6 months postoperatively. Proteins induced by vitamin K absence (PIVKA), beta-carotene, coenzyme Q10, and mixed tocopherols were measured at 3 months postoperatively. Primary outcomes were differences in plasma levels at 3 and 6 months. Secondary outcomes were palatability, ease of use, and adherence.

Results

Twenty-one patients were randomized to the standard regimen and 26 to the investigational multivitamin. Nine were lost to follow-up. At 3 months, plasma levels of PTH were lower (p = 0.042), and levels of vitamin D (p = 0.033), thiamine (p = 0.009), and beta-carotene (p = 0.033) were higher in the investigational multivitamin arm compared to those in the standard regimen arm. Patients receiving the investigational multivitamin reported higher taste satisfaction than those receiving the standard regimen (p = 0.035).

Conclusion

The investigational multivitamin appears to be more effective than a standard multivitamin in maintaining therapeutic levels of clinically relevant vitamins and minerals, and was more palatable. Additional studies should be conducted to confirm these findings and refine the optimal dosing regimen.

Trial Registration

www.​clinicaltrials.​gov under identifier NCT01475617
Appendix
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Literature
1.
go back to reference Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25(10):1822–32.CrossRefPubMed Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25(10):1822–32.CrossRefPubMed
2.
go back to reference Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes—5-year outcomes. N Engl J Med. 2017;376(7):641–51.CrossRefPubMedPubMedCentral Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes—5-year outcomes. N Engl J Med. 2017;376(7):641–51.CrossRefPubMedPubMedCentral
3.
go back to reference Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366(17):1577–85.CrossRefPubMed Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366(17):1577–85.CrossRefPubMed
4.
go back to reference Perrone F, Bianciardi E, Ippoliti S, et al. Long-term effects of laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass for the treatment of morbid obesity: a monocentric prospective study with minimum follow-up of 5 years. Updat Surg. 2017;69(1):101–7.CrossRef Perrone F, Bianciardi E, Ippoliti S, et al. Long-term effects of laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass for the treatment of morbid obesity: a monocentric prospective study with minimum follow-up of 5 years. Updat Surg. 2017;69(1):101–7.CrossRef
5.
go back to reference Zhang Y, Wang J, Sun X, et al. Laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass for morbid obesity and related comorbidities: a meta-analysis of 21 studies. Obes Surg. 2015;25(1):19–26.CrossRefPubMed Zhang Y, Wang J, Sun X, et al. Laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass for morbid obesity and related comorbidities: a meta-analysis of 21 studies. Obes Surg. 2015;25(1):19–26.CrossRefPubMed
6.
go back to reference Dogan K, Homan J, Aarts EO, de Boer H, van Laarhoven CJ, Berends FJ. Long-term nutritional status in patients following Roux-en-Y gastric bypass surgery. Clinical nutrition (Edinburgh, Scotland) 2017. Dogan K, Homan J, Aarts EO, de Boer H, van Laarhoven CJ, Berends FJ. Long-term nutritional status in patients following Roux-en-Y gastric bypass surgery. Clinical nutrition (Edinburgh, Scotland) 2017.
7.
go back to reference Borg CM, le Roux CW, Ghatei MA, et al. Progressive rise in gut hormone levels after Roux-en-Y gastric bypass suggests gut adaptation and explains altered satiety. Br J Surg. 2006;93(2):210–5.CrossRefPubMed Borg CM, le Roux CW, Ghatei MA, et al. Progressive rise in gut hormone levels after Roux-en-Y gastric bypass suggests gut adaptation and explains altered satiety. Br J Surg. 2006;93(2):210–5.CrossRefPubMed
8.
go back to reference Kellum JM, Kuemmerle JF, O'Dorisio TM, et al. Gastrointestinal hormone responses to meals before and after gastric bypass and vertical banded gastroplasty. Ann Surg. 1990;211(6):763–70. discussion 770-761CrossRefPubMedPubMedCentral Kellum JM, Kuemmerle JF, O'Dorisio TM, et al. Gastrointestinal hormone responses to meals before and after gastric bypass and vertical banded gastroplasty. Ann Surg. 1990;211(6):763–70. discussion 770-761CrossRefPubMedPubMedCentral
9.
go back to reference le Roux CW, Welbourn R, Werling M, et al. Gut hormones as mediators of appetite and weight loss after Roux-en-Y gastric bypass. Ann Surg. 2007;246(5):780–5.CrossRefPubMed le Roux CW, Welbourn R, Werling M, et al. Gut hormones as mediators of appetite and weight loss after Roux-en-Y gastric bypass. Ann Surg. 2007;246(5):780–5.CrossRefPubMed
10.
go back to reference Peterli R, Steinert RE, Woelnerhanssen B, et al. Metabolic and hormonal changes after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy: a randomized, prospective trial. Obes Surg. 2012;22(5):740–8.CrossRefPubMedPubMedCentral Peterli R, Steinert RE, Woelnerhanssen B, et al. Metabolic and hormonal changes after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy: a randomized, prospective trial. Obes Surg. 2012;22(5):740–8.CrossRefPubMedPubMedCentral
11.
go back to reference Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring, Md). 2013;21(Suppl 1):S1–27.CrossRef Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring, Md). 2013;21(Suppl 1):S1–27.CrossRef
12.
go back to reference Kothari SN, Borgert AJ, Kallies KJ, Baker MT, Grover BT. Long-term (>10-year) outcomes after laparoscopic Roux-en-Y gastric bypass. Surgery for obesity and related diseases: official journal of the American Society for Bariatric Surgery 2016. Kothari SN, Borgert AJ, Kallies KJ, Baker MT, Grover BT. Long-term (>10-year) outcomes after laparoscopic Roux-en-Y gastric bypass. Surgery for obesity and related diseases: official journal of the American Society for Bariatric Surgery 2016.
13.
go back to reference Obeid A, Long J, Kakade M, et al. Laparoscopic Roux-en-Y gastric bypass: long term clinical outcomes. Surg Endosc. 2012;26(12):3515–20.CrossRefPubMed Obeid A, Long J, Kakade M, et al. Laparoscopic Roux-en-Y gastric bypass: long term clinical outcomes. Surg Endosc. 2012;26(12):3515–20.CrossRefPubMed
14.
go back to reference Roust LR, DiBaise JK. Nutrient deficiencies prior to bariatric surgery. Current opinion in clinical nutrition and metabolic care. 2017;20(2):138–44.PubMed Roust LR, DiBaise JK. Nutrient deficiencies prior to bariatric surgery. Current opinion in clinical nutrition and metabolic care. 2017;20(2):138–44.PubMed
15.
go back to reference Lefebvre P, Letois F, Sultan A, et al. Nutrient deficiencies in patients with obesity considering bariatric surgery: a cross-sectional study. Surg Obes Relat Dis Off J Am Soc Bariatric Surg. 2014;10(3):540–6.CrossRef Lefebvre P, Letois F, Sultan A, et al. Nutrient deficiencies in patients with obesity considering bariatric surgery: a cross-sectional study. Surg Obes Relat Dis Off J Am Soc Bariatric Surg. 2014;10(3):540–6.CrossRef
16.
go back to reference Schiavo L, Scalera G, Pilone V, De Sena G, Capuozzo V, Barbarisi A. Micronutrient deficiencies in patients candidate for bariatric surgery: a prospective, preoperative trial of screening, diagnosis, and treatment. Int J Vit Nutr Res Internationale Zeitschrift fur Vitamin- und Ernahrungsforschung Journal international de vitaminologie et de Nutrition 2016:1–8. Schiavo L, Scalera G, Pilone V, De Sena G, Capuozzo V, Barbarisi A. Micronutrient deficiencies in patients candidate for bariatric surgery: a prospective, preoperative trial of screening, diagnosis, and treatment. Int J Vit Nutr Res Internationale Zeitschrift fur Vitamin- und Ernahrungsforschung Journal international de vitaminologie et de Nutrition 2016:1–8.
18.
go back to reference Dogan K, Aarts EO, Koehestanie P, et al. Optimization of vitamin suppletion after Roux-en-Y gastric bypass surgery can lower postoperative deficiencies: a randomized controlled trial. Medicine. 2014;93(25):e169.CrossRefPubMedPubMedCentral Dogan K, Aarts EO, Koehestanie P, et al. Optimization of vitamin suppletion after Roux-en-Y gastric bypass surgery can lower postoperative deficiencies: a randomized controlled trial. Medicine. 2014;93(25):e169.CrossRefPubMedPubMedCentral
19.
go back to reference Shankar P, Boylan M, Sriram K. Micronutrient deficiencies after bariatric surgery. Nutrition (Burbank, Los Angeles County, Calif). 2010;26(11–12):1031–7.CrossRef Shankar P, Boylan M, Sriram K. Micronutrient deficiencies after bariatric surgery. Nutrition (Burbank, Los Angeles County, Calif). 2010;26(11–12):1031–7.CrossRef
Metadata
Title
A Randomized Trial of a Novel Chewable Multivitamin and Mineral Supplement Following Roux-en-Y Gastric Bypass
Authors
Jamie Perin
Gregory Prokopowicz
Margaret Furtado
Konstantinos Papas
Kimberley E. Steele
Publication date
01-08-2018
Publisher
Springer US
Published in
Obesity Surgery / Issue 8/2018
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-018-3177-0

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