What is the recommendation for vitamin A supplementation in a patient with a history of Roux-en-Y Gastric Bypass (RYGB) and vitamin A deficiency (hypovitaminosis A)?

From the Guidelines

For a patient with a history of Roux-en-Y gastric bypass (RYGB) and a vitamin A level of 36 mcg/dL, I recommend supplementation with 10,000 IU of vitamin A daily, as suggested by the British Obesity and Metabolic Surgery Society guidelines 1. The supplement should be in a water-miscible or liquid form for better absorption, as noted in the guidelines 1. Treatment should continue indefinitely as RYGB permanently alters nutrient absorption. Key points to consider in management include:

• Monitoring vitamin A levels every 3-6 months initially, then annually once stable, to avoid over-supplementation and toxicity 1.
• Being aware that excessive vitamin A supplementation can cause toxicity, so regular monitoring is essential.
• Recognizing that vitamin A deficiency after RYGB occurs because the procedure bypasses the duodenum and proximal jejunum where fat-soluble vitamins are primarily absorbed, and that reduced intake of vitamin A-rich foods and decreased mixing with pancreatic enzymes contribute to malabsorption 1.
• Prompt treatment is important to prevent complications such as night blindness, dry eyes, and impaired immune function. The British Obesity and Metabolic Surgery Society guidelines suggest that individuals take a complete multivitamin and mineral supplement containing U.K. government dietary recommendations for vitamin A, and consider additional routine oral vitamin A supplementation, especially if symptoms such as deterioration in night vision and dry eyes are present 1. Given the patient's low vitamin A level, supplementation is necessary to prevent further complications and improve quality of life.

From the Research

Vitamin A Supplementation Recommendations

• The provided studies do not specifically address the recommendation for vitamin A supplementation in patients with a history of RYGB and a vitamin A level of 36 mcg/dL.
• However, study 2 mentions that plasma levels of vitamins, including vitamin A, were measured at 3 and 6 months postoperatively in patients undergoing RYGB, but it does not provide specific recommendations for vitamin A supplementation.
• Study 3 reports on the prevalence of vitamin and mineral deficiencies 12 years after RYGB, but it does not provide specific data on vitamin A deficiency or supplementation recommendations.

General Recommendations for Vitamin Supplementation after RYGB

• Study 2 suggests that an investigational multivitamin appears to be more effective than a standard multivitamin in maintaining therapeutic levels of clinically relevant vitamins and minerals after RYGB.
• Study 3 found that adherence to recommended supplements decreases the probability of vitamin and mineral deficiency, but does not eliminate it, 12 years after RYGB.
• Study 4 notes that oral supplement disposition is altered after RYGB, and patients may require indefinite regimens of oral supplementation, but the optimal dosage to confer health benefits while avoiding potential toxicity and tolerability issues remains unknown.

Conclusion is not allowed, and the response should end here.

There are no specific research papers to assist in answering the question about vitamin A supplementation in patients with a history of RYGB and a vitamin A level of 36 mcg/dL.