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American Journal of Clinical Nutrition, Vol. 88, No. 4, 1176, October 2008
© 2008 American Society for Nutrition

LETTER TO THE EDITOR

Nutritional deficiencies after Roux-en-Y gastric bypass can be prevented by standard multivitamin supplementation

Séverine Ledoux

Explorations Fonctionnelles
Centre de Référence de l'Obésité
Hôpital Louis Mourier
92700 Colombes and Faculté Xavier Bichat
78018 Paris
France
E-mail: severine.ledoux{at}lmr.aphp.fr

Etienne Larger

INSERM U833
Chaire de Médecine Expérimentale
Collège de France
75005 Paris
France

Dear Sir:

In a recent issue of the Journal, Gasteyger et al (1) report that nutritional deficiencies are common after Roux-en-Y (RY) gastric bypass and occur despite supplementation with the standard multivitamin preparation. This study is interesting because it shows what type of supplements are prescribed in clinical practice, but the data do not allow one to conclude that multivitamin supplementation cannot correct the deficiencies.

Indeed this study has many pitfalls. First, it is a retrospective study that included only 50% of the surgical cohort, and the reasons for excluding patients are not clear to the reader. Second, biological assessments of nutritional deficiencies are not reported in the manuscript: the author state that supplements were given as soon as the value measured was below the lower value of the reference range. However, if a specific substitution was started, the patient was considered deficient for the rest of the follow-up period. There was no systematic reevaluation of the need for that specific substitution during follow-up. Thus, at the end of follow-up, the diagnosis of deficiencies relied only on the prescription of supplement, with no attempt to ascertain the continued need of the prescription, although this was at the heart of the conclusion of the study. Third, the presurgical nutritional status of the patients is not reported, although it is well known that nutritional deficiencies are common in obese populatione before surgery, and are frequently untreated, as confirmed by our data (2, 3) and by a recent article published in the Journal (4). Thus, nutritional deficiencies recorded after surgery cannot be attributed solely to surgery. Fourth, there was no index of adherence to supplementation.

We recently conducted a prospective evaluation of the same variables in patients who had undergone either adjustable gastric banding or RY gastric bypass (3). The gastric bypass patients received systematic supplementation with a standard multivitamin preparation. We confirmed that nutritional deficiencies were frequent before surgery. Some were worsened by gastric bypass, including vitamin B-12. Overall, nutritional deficiencies, which were systematically assessed by laboratory investigations, were not increased by surgery in patients with a good index of adherence to multivitamin supplementation.

Therefore, our study, which was conducted with an adequate, prospective design, does not support the conclusion of Gasteyger et al that multivitamin supplementation cannot correct nutritional deficiencies after gastric bypass.

ACKNOWLEDGMENTS

No conflicts of interest were reported.

REFERENCES

  1. Gasteyger C, Suter M, Gaillard RC, Giusti V. Nutritional deficiencies after Roux-en-Y gastric bypass for morbid obesity often cannot be prevented by standard multivitamin supplementation. Am J Clin Nutr 2008;87:1128–33.[Abstract/Free Full Text]
  2. Ledoux S, Msika S, Moussa F, et al. Comparison of nutritional consequences of conventional therapy of obesity, adjustable gastric banding, and gastric bypass. Obes Surg 2006;8:1041–9.
  3. Coupaye M, Puchaux K, Bogard C, et al. Nutritional consequences of adjustable gastric banding and gastric bypass: a one-year prospective study. Obes Surg (Epub ahead of print 10 June 2008).
  4. Aasheim ET, Hofsø D, Hjelmesæth J, Birkeland KI, Bøhmer T. Vitamin status in morbidly obese patients: a cross-sectional study. Am J Clin Nutr 2008;87:362–9.[Abstract/Free Full Text]




This Article
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