Table 1.

Suggested pre/postoperative screening & preventive supplementation for select micronutrients after bariatric surgery^30,75

	B1	Iron	Vit D	B12⁷⁶	Folate	Vit A	Trace Minerals (Zinc, Copper)
Preop Screening	High Risk only	All	All	High Risk only	No	High Risk only	No
Postop Screening	All (6mo, 1y, annually)	All (3,6,9 mo,1y, annually)	All (3mo, 6mo, 1y, annually)	All (6mo, 1y, annually)	All (6mo, 1y, annually)	High Risk only	High Risk only
Lab Test	Whole blood thiamin	Ferritin + ESR + Iron Panel	25-OH Vit D	B12 level (screen) or Methylmalonic acid	RBC or Serum Folate	Retinol Level + Retinol Binding Protein	Zinc Level; Serum Copper + Ceruloplasmin
Risk Factors for Deficiency	Diuretics; acid blockers; vomiting; poor oral intake; poor vitamin intake; alcohol abuse	Menstruation; low intake of animal protein; preop iron deficiency; intraoperative bleeding; poor vitamin adherence; acid blockers	S/p gastric bypass; low dietary intake; poor vitamin adherence; antiepileptics, systemic glucocorticoids, acid blockers; preop Vit D deficiency	Vegan/strict vegetarian diet; acid blockers; poor vitamin adherence	Low dietary intake; poor vitamin adherence; phenytoin, methotrexate, sulfasalazine, trimethoprim; oral contraceptives; alcohol abuse	S/p gastric bypass; any condition/ medication associated with fat malabsorption	S/p gastric bypass; poor vitamin adherence; high zinc to copper supplement ratio (> 15mg zinc:1mgCu)
*Standard Postop Preventive Supplementation (dose and duration)*	50–100 mg/d x 6mo	45–60mg elemental iron/d titrated to normal range ferritin Indefinite	3,000 IU D3/d titrated to a 25(OH) level >30ng/mL Indefinite	Sublingual 1,000ug/d OR 3,000ug IM injection q6 months Indefinite	Female (child bearing potential): 800–1,000ug/d Male: 400–800ug/d Indefinite	5,000–10,000 IU/d Indefinite	Zinc: SG: 8–11mg/d RYGB: 8-22mg/d Copper: SG: 1mg/d RYGB: 2mg/d Indefinite

ESR = erythrocyte sedimentation rate | SG = sleeve gastrectomy | RYGB = Roux-en-Y Gastric Bypass