Table 2.

Pre and post-operative vitamin deficiencies, screening and supplementation ⁶⁹

Vitamin/Mineral	Screening	Preoperative Deficiency	LAGBY	RYGBδ	BPD/DSΔ
B1(Thiamine)	Serum thiamin	15–29%, more common in African Americans and Hispanics	Rare, but it may occur with all procedures. Consider daily supplementation in first 6m
B6(Pyidoxine)	Pyidoxal-5′-phosphate	Unknown	Rare	Rare	Rare
B12 (Cobalamin)	Serum B12	10–13%, may occur in elderly patients and those taking H2 and PPIs	_	Common (12–33%) IM 1000 μg/mo or PO 350–500 μg/d Begin 0–3 mon after surgery	_
Folate	RBC folate	Uncommon	Rare	Rare	Rare
Iron	Ferritin Fe/TIBC	9–16% of adult women in general population are deficient	_	Common (20–49%). Menstruating women and super obese patients (≥50%). Minimum addition 18–27 mg/d elemental. May add Vit C supplement Begin on day 1 after surgery	Minimum addition 18–27 mg/d elemental. May add Vit C supplement Begin on day 1 after surgery.
Vitamin A	Plasma Retinol	Uncommon	Rare	Rare	Common (50%) after 1y Up to (70%) at 4 y. PO 10.000 IU/d. Begin 2–4 w after
Calcium	Serum calcium	Common		_	Common (≥50%) after 1y PO Calcium Citrate 1500–1700 mg/d
Vitamin D	25(OH)D	60–70%		Occasionally. May give 1000 IU/d. Begin 2–4 w after	Common after 1y. PO 2000 IU/d. Begin 2–4 w after
Vitamin E	α-Tocopherol	Uncommon	Rare	Rare	Rare
Vitamin K	PT	Uncommon	_	_	Common after 1 y. PO 300 μg/d
ZincΛ	Plasma Zinc	Uncommon	_	Occasionally	Common after 1 y.
Protein	Serum albumin, pre-albumin, total protein	Uncommon	Occasionally (10–20%)	Occasionally (10%)	Occasionally (10–20%)

^YA high-potency vitamin containing 100% and 200%^δΔ of daily value for at least 2/3 of nutrients is recommended daily.

^ΛPatients should be cautioned that exogenous zinc consumption may impair copper absorption.

LAGB Laparoscopic adjustable gastric band, RYGB Roux-en-Y gastric bypass, BPD/DS biliopancreatic diversion/duodenal switch, Fe Iron, TIBC Total Iron Binding Capacity, IM Intramuscular, PO By mouth, Vit Vitamin, IU International Units