Vitamin Insufficiency After Esophagogastric Surgery and Targeted Supplementation: A Multicenter Prospective Intervention Study Named the VITAMIN Study

Abstract

Background/aim: Guidelines on screening for pre or postoperative micronutrients are currently lacking for patients diagnosed with gastric or esophageal cancer. this study aimed to identify micronutrient deficiencies after surgery for esophagogastric neoplasms and to evaluate changes in micronutrient status during targeted supplementation. Methods: This was a non-randomized prospective intervention trial conducted in The Netherlands between December 2021 and December 2024. Patients who underwent esophagectomy or (sub)total gastrectomy were included. At baseline (T0), blood measurement prior to supplementation was performed. All measurements were repeated after six (T1) and 12 months (T2) of supplementation. Both groups received Calcium Soft Chew D3 and a multivitamin supplement depending on the performed surgery (i.e., Multi-E or Multi-G). Results: In total, 107 patients were included (n = 76 esophagectomy group). At T0, at least one micronutrient deficiency was present in 83.9% of patients after gastrectomy (median 30.1 [IQR: 19.4–148.4] weeks after surgery) and in 67.1% of patients after esophagectomy (median 36.6 [IQR: 14.4–108.3] weeks after surgery). The four most common deficiencies at baseline were vitamin D (36.8%), iron (32.7%), zinc (22.8%), and ferritin (20.8%). For vitamin D and iron an increase in concentrations during follow-up was seen (p < 0.002), except for zinc in the esophagectomy group (p < 0.001). Conclusion: During targeted supplementation, the prevalence of several micronutrient deficiencies decreased and several micronutrient concentrations increased. Further prospective randomized studies are needed to confirm these findings.