Survey of vitamin and mineral supplementation after gastric bypass and biliopancreatic diversion for morbid obesity

Background: The authors investigated whether practice patterns of bariatric surgeons correlate with published data regarding metabolic deficiencies af ter Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD). Methods: 109 surgeons completed a questionnaire to determine use of supplem ents and frequency of lab tests. Results: Regarding supplements routinely prescribed after RYGB, 96% of surg eons gave multivitamins, 63% gave iron, and 49% gave vitamin B-12. After BP D, 96% of surgeons gave multivitamins, 67% gave iron, 42% gave vitamin B-12 , 97% gave calcium, 63% gave fat-soluble vitamins, and 21% gave protein sup plements. Regarding laboratory tests obtained routinely after RYGB, 95% of surgeons do complete blood counts, 56% do iron determinations, 66% do vitam in B-12 determinations, 58% do folate determinations, 76% do electrolyte de terminations, and 8% test for proteins. After BPD, 96% of surgeons do compl ete blood counts, 80% do iron determinations, 67% do vitamin B-12 determina tions, 71% do folate determinations, 88% do electrolyte determinations, 84% do protein determinations, and 46% test for fat-soluble vitamins. Regardin g frequency of blood tests, after RYGB, 22% of surgeons obtain them after 3 months, 33% after 6 months, and 41% after 12 months; 4% do not routinely o btain postoperative laboratory tests. After BPD, 46% of surgeons obtain the m after 3 months, 33% after 6 months, and 16% after 12 months; one does not obtain laboratory tests. Surgeons estimated these deficiencies after RYGB: 16% iron, 12% vitamin B-12, 14% anemia, 5% protein, and 3% calcium. They e stimated these deficiencies after BPD: 26% iron, 11% vitamin B-12, 21% anem ia, 18% protein, 16% calcium, and 6% fat-soluble vitamins. The estimated in cidence of deficiencies after RYGB was considerably lower than the publishe d incidence. Unnecessary tests were commonly performed (electrolytes after RYGB). Conclusion: Despite wide variations in the performance of laboratory tests and the use of supplements, the practice patterns of most surgeons protect patients from developing severe metabolic deficiencies after RYGB and BPD.