scholarly journals Effectiveness of a fortified drink in improving B vitamin biomarkers in older adults: a controlled intervention trial

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Maria Heffernan ◽  
Leanne C. Doherty ◽  
Roberta Hack Mendes ◽  
Michelle Clarke ◽  
Stephanie Hodge ◽  
...  
Keyword(s):  
Older Adults ◽  
Vitamin B12 ◽  
Vitamin B6 ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Serum Vitamin ◽  
B Vitamins ◽  
Serum Folate ◽  
Vitamin Status ◽  
B Vitamin

Abstract Background Older adults are reported to have sub-optimal B vitamin status; targeted food-based solutions may help to address this. The objectives of the OptiAge food intervention study were to develop and investigate the effectiveness of a B vitamin-fortified drink in improving B vitamin biomarkers in older Irish adults with a primary outcome of change in the B vitamin biomarker status. Methods A double-blinded randomised controlled trial was performed in parallel at University College Dublin and Ulster University. Participants aged > 50 years were recruited following screening for exclusion criteria (i.e. taking medications known to interfere with B vitamin metabolism, supplements containing B vitamins, consuming > 4 portions of B vitamin-fortified foods per week or diagnosed with gastrointestinal, liver or pulmonary disease). Recruited participants meeting the inclusion criteria were randomised (by sex and study centre) to receive daily for 16 weeks either B vitamin-fortified or placebo drinks as developed by Smartfish, Norway. Each B vitamin-fortified drink (200 ml) contained 200 µg folic acid, 10 µg vitamin B12, 10 mg vitamin B6 and 5 mg riboflavin, while the placebo was an identical, isocaloric formulation without added B vitamins. Fasting blood samples were collected pre- and post-intervention which were used to measure the primary outcome of change in B vitamin biomarker levels. Results A total of 95 participants were randomised, of which 81 commenced the trial. Of these, 70 completed (37 in the active and 33 in the placebo groups). Intention to treat (ITT) analysis of the B vitamins demonstrated a significant improvement in all B vitamin biomarkers in the active compared to placebo groups: p < 0.01 for each of serum folate, serum vitamin B12 and plasma pyridoxal 5′-phosphate (vitamin B6) and the functional riboflavin biomarker, erythrocyte glutathione reductase activation coefficient (EGRac). Correspondingly, a significant lowering of serum homocysteine from 11.9 (10.3–15.1) µmol/L to 10.6 (9.4–13.0) µmol/L was observed in response to the active treatment (P < 0.001). Similar results were seen in a per-protocol analysis. Conclusions The results demonstrate that a B vitamin-fortified drink was effective in optimising B vitamin status, making this a useful intervention option to improve B vitamin status in older adults. Trial registration ISRCTN, ISRCTN61709781—Retrospectively registered, https://www.isrctn.com/ISRCTN61709781

scholarly journals Effectiveness of a Fortified Drink in Improving B Vitamin Biomarkers in Older Adults: A Controlled Intervention Trial

2021 ◽  
Author(s):  
Maria Heffernan ◽  
Leanne C Doherty ◽  
Roberta Hack Mendes ◽  
Michelle Clarke ◽  
Stephanie Hodge ◽  
...  
Keyword(s):  
Older Adults ◽  
Controlled Trial ◽  
Intervention Strategy ◽  
B Vitamins ◽  
Double Blind ◽  
Intention To Treat ◽  
Vitamin Status ◽  
Randomised Controlled ◽  
B Vitamin ◽  
To Receive

Abstract BackgroundOlder adults are reported to have sub-optimal B vitamin status; targeted food-based solutions may help to address this. The objectives of the OptiAge food intervention study were to develop and investigate the effectiveness of a B vitamin-fortified drink in improving B vitamin biomarkers in older Irish adults with a primary outcome of change in B vitamin biomarker concentrations.MethodsA multicentre double-blind randomised controlled trial was performed in University College Dublin and Ulster University. Participants aged > 50 years were recruited following screening for exclusion criteria i.e. taking medications known to interfere with B vitamin metabolism, supplements containing B vitamins, consuming >4 portions of B-vitamin fortified foods per week or diagnosed with gastrointestinal, liver or pulmonary disease. Recruited participants were randomised with gender and centre as factors in the randomisation to receive either B vitamin-fortified or placebo drinks (developed by Smartfish, Norway) daily for 16 weeks.ResultsA total of 95 participants were randomised, of which 81 commenced the trial. Of these, 70 completed - 37 in the active and 33 in the placebo groups. Intention to treat (ITT) analysis of the B vitamins demonstrated a significant improvement in all B vitamins biomarkers in the active compared to placebo groups (p<0.01 for Folate, Vitamin B12, Vitamin B6, and Riboflavin). A significant lowering of plasma homocysteine from 11.9 (10.3-15.1) µmol/L to 10.6 (9.4-13.0) µmol/L (functional marker of B vitamin status) was also observed in response to the active treatment (P<0.001). Similar results were seen in a per-protocol analysis.ConclusionsThe results demonstrate that a B vitamin-fortified drink was effective in optimising B vitamin status, making this a useful intervention strategy to improve B vitamin status in older adults. Trial registration: ISRCTN, ISRCTN61709781. - Retrospectively registered, https://www.isrctn.com/ISRCTN61709781

scholarly journals Modulation of the Homocysteine-Betaine Relationship by Methylenetetrahydrofolate Reductase 677 C->T Genotypes and B-Vitamin Status in a Large-Scale Epidemiological Study

2007 ◽  
Vol 92 (4) ◽  
pp. 1535-1541 ◽  
Author(s):  
Pål I. Holm ◽  
Steinar Hustad ◽  
Per Magne Ueland ◽  
Stein Emil Vollset ◽  
Tom Grotmol ◽  
...  
Keyword(s):  
Vitamin B12 ◽  
Vitamin B6 ◽  
Large Scale ◽  
Methylenetetrahydrofolate Reductase ◽  
Population Based ◽  
Serum Folate ◽  
Vitamin B2 ◽  
Cross Sectional ◽  
Vitamin Status ◽  
B Vitamin

Abstract Context: Betaine is formed from the essential nutrient choline or is supplied from the diet. It serves as a substrate in the betaine-homocysteine methyltransferase reaction and thereby provides methyl groups for the homocysteine-methionine cycle, which is regulated by enzymes dependent on folate, vitamin B12, riboflavin (vitamin B2), or vitamin B6. Objective: We investigated how betaine affected total homocysteine (tHcy) concentration within the frame of variable B-vitamin status and according to the methylenetetrahydrofolate reductase (MTHFR) 677C-&gt;T genotype. Design/Setting/Patients: This is a population-based study with a cross-sectional design. It includes 10,601 healthy men and women aged 50–64 yr. Outcome Measures: Plasma samples were analyzed for tHcy, betaine, choline, dimethylglycine, riboflavin, and vitamin B6, whereas folate and vitamin B12 were analyzed in serum. Results: Betaine was a strong determinant of plasma tHcy in subjects with low serum folate and the MTHFR TT genotype. The association was further strengthened at low levels in the circulation of the other B-vitamins (B2, B6, and B12). Thus, in subjects with the combination of serum folate in the lowest quartile, low vitamin B2, B6, and B12 status, and the MTHFR TT genotype, the difference in tHcy (mean, 95% confidence interval) across extreme plasma betaine quartiles was 8.8 (1.3–16.2) μmol/liter. Conclusion: Betaine may thus be an important one-carbon source, particularly in MTHFR 677 TT subjects with inadequate B-vitamin status.

scholarly journals Hyperglycemia and Metformin Use Are Associated With B Vitamin Deficiency and Cognitive Dysfunction in Older Adults

2019 ◽  
Vol 104 (10) ◽  
pp. 4837-4847 ◽  
Author(s):  
Kirsty M Porter ◽  
Mary Ward ◽  
Catherine F Hughes ◽  
Maurice O’Kane ◽  
Leane Hoey ◽  
...  
Keyword(s):  
Older Adults ◽  
Vitamin B12 ◽  
Cognitive Dysfunction ◽  
Vitamin B6 ◽  
Vitamin Deficiency ◽  
Community Dwelling ◽  
Metformin Treatment ◽  
Fortified Foods ◽  
B Vitamin ◽  
The Impact

AbstractContextEmerging evidence suggests that deficiencies of folate-related B vitamins can arise with metformin treatment and are independently linked with cognitive dysfunction, a comorbidity of diabetes.ObjectiveTo determine the impact of hyperglycemia and metformin use on relevant B vitamin biomarkers and cognitive outcomes in older adults.Setting and ParticipantsCommunity-dwelling older adults (74.1 ± 8.3 years, n = 4160) without dementia, recruited to the Trinity, Ulster and Department of Agriculture cohort study in 2008 to 2012, were classified as normoglycemic (n = 1856) or hyperglycemic, based on HbA1c ≥5.7% (39 mmol/mol), either with (n = 318) or without (n = 1986) metformin treatment.Main Outcome MeasuresBiomarkers of folate, vitamin B12, vitamin B6, and riboflavin were measured. Cognitive assessments included the Repeatable Battery for Assessment of Neuropsychological Status (RBANS) and the Frontal Assessment Battery (FAB).ResultsMetformin use was associated with higher risk of deficiency of vitamin B12 (combined B12 index ≤−1; OR 1.45; 95% CI, 1.03 to 2.02) and vitamin B6 (plasma pyridoxal 5-phosphate <30.0 nmol/L; OR 1.48; 95% CI, 1.02 to 2.15). Fortified foods when eaten regularly had a positive impact on all relevant B vitamin biomarkers, even with hyperglycemia. After adjustment for relevant covariates, metformin use was associated with an increased risk of cognitive dysfunction as assessed with the RBANS (OR 1.36; 95% CI, 1.03 to 1.80) and FAB (OR 1.34; 95% CI, 1.03 to 1.74).ConclusionsUse of metformin by older adults is associated with poorer cognitive performance; B vitamin deficiency may be implicated. Fortified foods can optimize B vitamin status and may be beneficial for maintaining better cognitive health in older people with or at risk for diabetes.

scholarly journals B-VITAMIN THERAPY FOR KIDNEY TRANSPLANT RECIPIENTS LOWERS HOMOCYSTEINE AND IMPROVES SELECTIVE COGNITIVE OUTCOMES IN THE RANDOMIZED FAVORIT ANCILLARY COGNITIVE TRIAL

2017 ◽  
pp. 1-8
Author(s):  
T.M. Scott ◽  
G. Rogers ◽  
D.E. Weiner ◽  
K. Livingston ◽  
J. Selhub ◽  
...  
Keyword(s):  
Vitamin B12 ◽  
Kidney Transplant ◽  
Vitamin B6 ◽  
Cognitive Outcomes ◽  
High Dose ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Vitamin Status ◽  
Vitamin Therapy ◽  
B Vitamin

Background: Objectives: Elevated plasma total homocysteine (tHcy) is associated with increased risk of cardiovascular disease, stroke and dementia. Results of clinical trials using B-vitamins to reduce the cognitive risks attributed to tHcy have been inconsistent. The high prevalence of both hyperhomocysteinemia and cognitive impairment among kidney transplant recipients makes them an important population in which to evaluate the effect of lowering homocysteine on cognitive function. We therefore evaluated whether B-vitamin therapy to lower tHcy would prevent cognitive-decline in a cohort of stable kidney transplant recipients. Design: The study was a longitudinal ancillary of the FAVORIT trial, a randomized, placebo-controlled multi-site trial of high-dose B vitamins to reduce cardiovascular and cerebrovascular events in clinically stable kidney transplant recipients with elevated tHcy. Participants: 584 participants from 18 sites across North America. Intervention: The intervention consisted of a daily multivitamin containing high-doses of folate (5.0 mg), vitamin B12 (1.0 mg) and vitamin B6 (50 mg). The placebo consisted of a daily multi-vitamin containing no folate and recommended daily allowances of vitamins B12 and B6 (0 mg folate; 2.0 µg vitamin B12; 1.4 mg vitamin B6). Measurements: Annual neuropsychological assessment for up to 5 years (mean 3.3 years) using a standardized test battery. Efficacy was analyzed on an intention-to-treat basis using end-of-trial data. Subgroup analyses included stratification for baseline plasma B-vitamin and tHcy concentrations. Results: At baseline, cognitive impairment was common with 61% of participants falling more than one standard deviation below published norms for at least one cognitive test. Fewer than 1% of participants had insufficient plasma folate < 5 ng/ml or vitamin B12 < 148 pmol/L. However, 44.6% had plasma B6 concentrations < 30 nmol/L. At follow-up, processing speed and memory scores were modestly but significantly better in the B-vitamin supplement group than in controls (p≤0.05). There was no interaction between baseline tHcy, B-vitamin status and treatment on the cognitive outcomes. Conclusions: High-dose B-vitamin supplementation provided modest cognitive benefit for kidney transplant recipients with elevated baseline tHcy. Since nearly all participants were folate and vitamin B12 sufficient at baseline, the potential cognitive benefits of folate and B12 supplementation in individuals with poor B-vitamin status remains to be determined.

scholarly journals Detectable Unmetabolized Folic Acid, and Sufficient Folate and Vitamin B12 Concentrations Are Evident in Canadian Children with Sickle Cell Disease

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1100-1100
Author(s):  
Brock Williams ◽  
Heather McCartney ◽  
Yvonne Lamers ◽  
Suzanne Vercauteren ◽  
John Wu ◽  
...  
Keyword(s):  
Folic Acid ◽  
Sickle Cell Disease ◽  
Vitamin B12 ◽  
Sickle Cell ◽  
Vitamin B6 ◽  
Serum Folate ◽  
High Dose ◽  
Cell Disease ◽  
Median Serum ◽  
B Vitamin

Abstract Objectives Canadian children with sickle cell disease (SCD) are routinely supplemented with high-dose folic acid (1 mg/d), synthetic folate, due to increased erythrocyte production and turn-over in the disease. Folate also plays a vital role in one-carbon metabolism. Impairments in this folate-dependent mechanism can also occur due to secondary B-vitamin (vitamin B2, B6 and B12) deficiencies. The study objective was to determine B-vitamin status in Canadian children with SCD. Methods Serum and plasma samples from children diagnosed with SCD were obtained from BC Children's Hospital BioBank (Vancouver, Canada). Samples were analyzed for folate, vitamin B6, and related metabolites using electrospray ionization-liquid chromatography-tandem mass spectrometry. Vitamin B12 concentrations were analyzed using chemiluminescent immunoassay. World Health Organization cut-offs were used to determine deficiencies of folate (&lt;10 nmol/L) and vitamin B12 (&lt;150 pmol/L), and European Food Safety Authority Panel cut-offs were used for vitamin B6 (&lt;30 nmol/L pyridoxal 5’-phosphate; PLP). Medians with interquartile ranges (IQR) are presented. Results Six individuals (50% male; SCD type: Hgb SS n = 3, Hgb SC n = 2, HbSβ,0-Thal n = 1) were included. Median age of participants was 15 (9, 18) years. Half (50%) of participants were prescribed hydroxyurea (median dose: 21(14, 30) mg/kg/d), and all participants were prescribed 1 mg/d folic acid (adherence data not available). Median serum folate was 55.4 (43.1, 71.9) nmol/L, with levels 3 to 15 times above the cut-off for deficiency. Unmetabolized folic acid (UMFA), unused folic acid in circulation, was detected in all six participants. All participants were vitamin B12 sufficient, with median plasma vitamin B12 of 325 (288, 411) nmol/L. The majority (n = 5; 83%) had sufficient B6 status, with median serum PLP of 39 (36.9, 44.2) nmol/L. Conclusions In this pilot project, there was limited evidence of B-vitamin deficiencies among Canadian children with SCD. Serum folate levels exceeded the cut-off for deficiency by 3 to 15 times, with all participants having detectable levels of UMFA. A randomized clinical trial re-assessing the routine practice of high-dose folic acid supplementation in children with SCD is warranted. Funding Sources Thrasher Research Fund and Rare Disease Foundation.

scholarly journals Effect of metformin on serum level of vitamin B12 and folate in patients of type-2 diabetes mellitus

2021 ◽  
Vol 8 (7) ◽  
pp. 922
Author(s):  
Rajesh Meena ◽  
Ramesh Kumar ◽  
Atul Meena ◽  
Om Prakash Meena ◽  
Lokesh Meena ◽  
...  
Keyword(s):  
Vitamin B12 ◽  
Controlled Trial ◽  
Serum Vitamin ◽  
Serum Folate ◽  
High Dose ◽  
Folate Level ◽  
Baseline Serum ◽  
Before And After ◽  
Genetic And Environmental Factors

Background: Several types of DM are caused by a complex interaction of genetic and environmental factors. Depending on the etiology of the DM, factors contributing to hyperglycaemia include- reduced insulin secretion, decreased glucose utilization, and increased glucose production.Objective of the current study was to study the effect of metformin on the level of vitamin B12 and folate in patients of type 2 DM.Methods: This is hospital based study before and after metformin therapy randomized controlled trial was conducted in medicine ward of M. B. hospital, Udaipur. Baseline serum vitamin B12 and folate level of all patients were measured and treatment with metformin 500 mg twice a day was given for 6 months. After 6 months serum vitamin B12 and folate level of all patients were re-evaluated.Results: There was a significant positive correlation (r=0.824, p<0.001) between decrease in vitamin B12 and decrease in folate level after metformin treatment. When analysis for change in vitamin B12 is compared with change in MCV values after 6 months, negative correlation (r=-0.08, p>0.05) was obtained. A non significant correlation (r=-0.08, p>0.05) with change in level of serum folate and change in MCV values or haemoglobin level was obtained.Conclusions: Low serum vitamin B12 level is associated with longer duration and higher dose of metformin use. Routine determination of vitamin B12 level in patients with type 2 DM on high dose of metformin and those with prolonged use of metformin might help in identifying patients that would benefit from vitamin B12 supplements.

scholarly journals Correlates of plasma homocysteine, cysteine and cysteinyl-glycine in respondents in the British National Diet and Nutrition Survey of Young People Aged 4–18 Years, and a comparison with the Survey of People Aged 65 Years and Over

2002 ◽  
Vol 87 (1) ◽  
pp. 71-79 ◽  
Author(s):  
C. J. Bates ◽  
M. A. Mansoor ◽  
Jan Gregory ◽  
Kristina Pentieva ◽  
Ann Prentice
Keyword(s):  
Young People ◽  
Disease Risk ◽  
Serum Vitamin ◽  
Public Health Intervention ◽  
Serum Folate ◽  
Vitamin B ◽  
Nutrition Survey ◽  
Vitamin Status ◽  
Risk Indices ◽  
B Vitamin

Plasma total homocysteine (tHcy), cysteine and cysteinyl-glycine were measured in a representative sample of 922 young people aged 4–18 years, participating in the National Diet and Nutrition Survey in mainland Britain in 1997. Both tHcy and cysteine increased markedly with age; cysteinyl-glycine less so. Neither tHcy nor cysteine differed between genders; cysteinyl-glycine was higher in males. tHcy concentrations were lowest in the winter; cysteine and cysteinyl-glycine varied only slightly with season. In respondents aged >15 years, tHcy was higher in smokers, but in respondents aged 7–11 years, tHcy was higher in those whose mothers smoked. tHcy was inversely correlated with serum folate, serum vitamin B12and vitamin B6status, but neither cysteine nor cysteinyl-glycine shared these relationships. The relationships between tHcy and B-vitamin status indices ran parallel with those of the 65 years and over survey, but at much lower tHcy concentrations for any given B-vitamin concentration. Age-adjusted tHcy was not correlated with anthropometric indices, blood pressure, haematology, plasma creatinine, urea or cholesterol, but was directly correlated with fasting triacylglycerol. We conclude that disease-risk indices, like tHcy and perhaps cysteine, if established during early life, may be modulated by diet and lifestyle, thereby providing an opportunity for public health intervention.

Comparative Review of the Thiochrome, Microbial and Protozoan Analyses of B-Vitamins

1978 ◽  
Vol 41 (9) ◽  
pp. 730-738 ◽  
Author(s):  
MICHAEL N. VOIGT ◽  
RONALD R. EITENMILLER
Keyword(s):  
Vitamin B12 ◽  
Pantothenic Acid ◽  
Extraction Methods ◽  
Food Samples ◽  
B Vitamins ◽  
Vitamin Status ◽  
Comparative Review ◽  
Specific Stimulation ◽  
B Vitamin ◽  
Vitamin Analysis

A comparative review of the specificities of various B-vitamin analysis methods is presented. Methods of vitamin analysis employing protozoa, viz. Tetrahymena and Ochromonas, are compared to the commonly used methods of vitamin assay, including officially accepted methods. Since 1968 the protozoan techniques have routinely been used to evaluate clinical vitamin status. This is due to their more mammalian-like response to the various forms of the vitamins that occur in natural materials. Protozoa have more developed ingestive and digestive systems than bacteria and yeast, which allow them to respond to conjugated forms of the vitamins (e.g. thiamin pyrophosphate and folic acid polyglutamates). Also, fewer problems are encountered with non-specific stimulation (e.g. fatty acid stimulation of the Lactobacillus casei assay for riboflavin or the sparing of the vitamin B12 requirement of Lactobacillus leichmannii by deoxyribosides). Application of the protozoan methods to analysis of foods indicate significantly lower levels of biotin and vitamin B12 than official methods, while significantly higher levels of riboflavin, vitamin B6, niacin and pantothenic acid are found in low-acid foods. This review also summarizes extraction methods for the B-vitamins from food samples and indicates the importance of enzymatic hydrolysis in extract preparation.

scholarly journals Genetically predicted circulating B vitamins in relation to digestive system cancers

2021 ◽  
Author(s):  
Shuai Yuan ◽  
Paul Carter ◽  
Mathew Vithayathil ◽  
Siddhartha Kar ◽  
Amy M. Mason ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Vitamin B12 ◽  
Vitamin B6 ◽  
Digestive System ◽  
Elevated Serum ◽  
Serum Vitamin ◽  
Serum Folate ◽  
Mendelian Randomisation ◽  
Uk Biobank ◽  
Digestive System Cancer

Abstract Background Folate, vitamin B6 and vitamin B12 have been associated with digestive system cancers. We conducted a two-sample Mendelian randomisation study to assess the causality of these associations. Methods Two, one and 14 independent single nucleotide polymorphisms associated with serum folate, vitamin B6 and vitamin B12 at the genome-wide significance threshold were selected as genetic instruments. Summary-level data for the associations of the vitamin-associated genetic variants with cancer were obtained from the UK Biobank study including 367,561 individuals and FinnGen consortium comprising up to 176,899 participants. Results Genetically predicted folate and vitamin B6 concentrations were not associated with overall cancer, overall digestive system cancer or oesophageal, gastric, colorectal or pancreatic cancer. Genetically predicted vitamin B12 concentrations were positively associated with overall digestive system cancer (ORSD, 1.12; 95% CI 1.04, 1.21, p = 0.003) and colorectal cancer (ORSD 1.16; 95% CI 1.06, 1.26, p = 0.001) in UK Biobank. Results for colorectal cancer were consistent in FinnGen and the combined ORSD was 1.16 (95% CI 1.08, 1.25, p < 0.001). There was no association of genetically predicted vitamin B12 with any other site-specific digestive system cancers or overall cancer. Conclusions These results provide evidence to suggest that elevated serum vitamin B12 concentrations are associated with colorectal cancer.

scholarly journals Optimizing Multivitamin Supplementation for Sleeve Gastrectomy Patients

2021 ◽  
Author(s):  
Laura Heusschen ◽  
Agnes A. M. Berendsen ◽  
Mellody I. Cooiman ◽  
Laura N. Deden ◽  
Eric J. Hazebroek ◽  
...  
Keyword(s):  
Sleeve Gastrectomy ◽  
Vitamin B12 ◽  
Vitamin B6 ◽  
Controlled Trial ◽  
Serum Vitamin ◽  
Serum Levels ◽  
Multivitamin Supplementation ◽  
Serum Vitamin D ◽  
Multivitamin Supplement ◽  
Vitamin D Levels

Abstract Purpose Micronutrient deficiencies are frequently reported after sleeve gastrectomy (SG), and therefore lifelong daily multivitamin supplementation is highly recommended. Based on literature and the results of a previous randomized controlled trial, a specialized multivitamin supplement for SG patients was further optimized (WLS Optimum 2.0, FitForMe). The present study reports on its short-term effectiveness. Materials and Methods An open-label study was performed in which 76 patients were included to receive WLS Optimum 2.0 for 12 months (Opt 2.0 group). This group was compared with a group of 75 patients that had received WLS Optimum 1.0 for 12 months during a previous study (Opt 1.0 group). Results Intention-to-treat analysis (Opt 1.0, n = 69; Opt 2.0, n = 75) showed higher serum levels of vitamin B12, vitamin B6, and zinc, and a lower prevalence of deficiencies for vitamin B12 and phosphate in the Opt 2.0 group. MCV and serum folic acid levels were higher in the Opt 1.0 group. Over the 12-month study period, mean increase in serum levels of phosphate, vitamin B6, and zinc was higher in the Opt 2.0 group, and MCV and serum vitamin D levels increased more in the Opt 1.0 group. Conclusion The present study showed that the use of a specialized multivitamin supplement for SG patients is effective at preventing deficiencies for most vitamins and minerals, specifically in compliant patients. However, a strict follow-up regime remains necessary to monitor nutritional status and to improve patient compliance.

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