Supplementation recommendations for patients after a Biliopancreatic Diversion with or without Duodenal Switch.

Within 3 years after a Biliopancreatic Diversion (BPD) or BPD with Duodenal Switch (BPD/DS), up to 90% of all patients develop nutritional deficiencies. With this study, Homan and colleagues increase the knowledge needed to develop supplementation recommendations and doses to maintain nutritional health after BDP or BDP/DS.

The need for a tailored food supplement

Prior to this retrospective observational study, there was no multivitamin available tailored to the needs of BPD or BPD/DS patients. Therefore, 34 patients obtained WLS Forte, a multivitamin that effectively prevents deficiencies in Roux-en-Y Gastric Bypass (RYGB) patients. During one year after surgery, nutritional deficiencies were monitored and treated.

Exceptionally high supplementation needed

The doses of vitamin B1, B6, B9 and B12 in WLS Forte were effective in preventing vitamin B deficiencies in BDP or BDP/DS patients. However, 85% of the patients continued to develop new or recurrent deficiencies of vitamin A, vitamin D, iron, calcium or zinc, despite the fact that the supplied multivitamin doses of micronutrients in WLS Forte highly exceeded the standard daily requirements. These results indicate the need for a specialized multivitamin with even higher levels of vitamin A, vitamin D, iron, calcium and zinc, specifically developed for patients after BPD or BPD/DS.

Recommendations

In summary, the authors of the study suggest the following recommendations to prevent nutritional deficiencies among BPD/DS patients:

Nutrient Dose
Iron 100 mg/day for men and postmenopausal women. 200mg/day for premenopausal women.
Vitamin B1 2,75 mg/day
Vitamin B6 980 µg/day
Folic acid 600 µg/day
Vitamin B12 350 µg/day
Vitamin A 50000 IU/week, to be adjusted when needed based on serum levels
Vitamin D 50000 IU/week
Calcium 2000 mg/day, with correction of vitamin D deficiencies
Zinc 440-660 mg/day

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Reference:

Homan J., Schijns W., Aarts E.O., Janssen I.M.C., Berends F.J., de Boer H. (2018) Treatment of Vitamin and Mineral Deficiencies After Biliopancreatic Diversion With or Without Duodenal Switch: a Major Challenge. OBES SURG (2018) 28:234–241

Link to full text: https://link.springer.com/article/10.1007%2Fs11695-017-2841-0

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