Table 3. Prophylactic supplementation after surgery for obesity or surgery for metabolic indications (5).
| SG | RYGB | BPD-DS | |
| Protein (total per day [d]) | >60 g/d | >60 g/d | >90 g/d |
| Folic acid | MVM preparation bid | 600 μg/d | |
| Vitamin B1 | MVM preparation bid, no dose recommendation | ||
| Vitamin B12 | p.o.: 1000 μg/d IM: 1000 – 3000 μg/d every 3 to 6 months |
||
| Vitamin A | MVM preparation bid |
MVM preparation bid |
1–2 × 25 000 IU/d |
| Vitamin D | At least 3000 IU/d, serum concentration >30 ng/mL | ||
| Vitamins E, K | MVM preparation bid, no dose recommendation | ||
| Calcium citrate | 1200 – 1500 mg/d | ||
| Iron sulfate, fumarate, gluconate | MVM preparation bid |
50 mg/d | 2 x 100 mg/d |
| Magnesium citrate | 200 mg/d | ||
| Zinc gluconate, sulfate, acetate |
MVM preparation bid |
MVM preparation bid |
8–15 mg/d |
| Copper gluconate, oxide, sulfate Selenium as sodium selenite |
No recommendation | MVM preparation bid with 2 mg/d of copper |
|
MVM preparation, multivitamin and mineral preparation. A preparation should be chosen that is rich in ?micro?nutrients, in amounts that are within 100% of the RDA (recommended daily allowance).
SG, sleeve gastrectomy; RYGB, proximal Roux-en-Y gastric bypass; BPD-DS, biliopancreatic diversion with duodenal switch.
These recommendations are for the prevention of deficiency states; dose adaptation is necessary for patients with documented deficiency or corresponding symptoms. Regardless of the procedure performed, adequate amounts of MVM cannot be given immediately postoperatively because of the temporary restriction of food intake. Patients who have undergone surgery with techniques that cause more pronounced malabsorption (all distal bypasses with a short common channel or long alimentary and/or biliopancreatic loops) should receive the same type of supplementation as patients who have had a BPD-DS procedure.
There are no data or recommendations on the appropriate duration of prophylactic supplementation after LAGB (laparoscopic adjustable gastric banding) or SG. Patients who have undergone any type of bypass should receive supplementation for life. Depending on the type of surgical procedure and the patient’s nutritional state, adequate intake of macro- and micronutrients may be at least partly achievable.
After LAGB, an MVM preparation qd + 1200–1500 mg calcium + 3000 IU vitamin D are recommended.