Prevention and management of nutritional deficiencies after Roux-en-Y Gastric Bypass

The Roux-en-Y Gastric Bypass (RYGB) is commonly associated with nutritional deficiencies and requires life-long supplementation. To bring guidance into nutritional healthcare for this patient group, a literature review was conducted. This review lead to a guideline on the approach to prevention and management of nutritional deficiencies after RYGB.

Recommendations for supplementation after RYGB

The review found that the prevention strategy for every RYGB patient should include a multivitamin containing at least 200% of the daily recommended value, 400 mcg of folic acid and 18 mg of iron. Furthermore, vitamin A, vitamin B12, vitamin D, calcium, zinc and copper should be supplemented in a dosage tailored to the RYGB patients’ specific needs. For a complete overview of the deficiency prevalence after RYGB and the supplementation advice for deficiency prevention, see table 1.

Monitoring on deficiencies and compliance is needed

Some bariatric patients may require additional supplementation of one or more vitamins and minerals. Patients should therefore be monitored carefully and frequently. To ensure optimal prevention and treatment of nutritional deficiencies, patients should be made aware of the importance of proper nutrition and compliance with supplementation.

Table 1: Prevalence and advice for nutritional deficiencies after RYGB

Nutrients Deficiency prevalence Supplementation advice for deficiency prevention
Vitamin B12 26-70% 1000 mcg orally or sublingually
Folate 9-38%, higher prevalence among pregnant women 800-1000 mccg
Iron 6-52%, higher prevalence among menstruating or pregnant women 36-65 mg, higher doses for menstruating women and people at risk for anemia
Thiamine 1% 3 mg
Calcium 10% 2 years post-op 1.700-2.000 mg from both diet and supplementation
Vitamin D 50-80% 1.000-2.000 IU
Vitamin A 11% 10.000-25.000 IU
Zinc 36% More research needed to identify the optimal supplementation dose
Copper 18,8% No current recommendations

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Reference:

Levinson, R., Silverman, J.B., Catella, J.G. et al. (2013) Pharmacotherapy prevention and management of nutritional deficiencies post Roux-en-Y gastric bypass. OBES SURG (2013) 23: 992. https://doi.org/10.1007/s11695-013-0922-2

Link to full text: https://link.springer.com/article/10.1007%2Fs11695-013-0922-2

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