DEKAs afterBariatric Surgery*Once Daily All-in-one Multivitamin and Mineral Chewable Tablets with Enhanced Absorption for Dietary Management after Bariatric Surgery

Roberto Jongejan, MD, PhDGus Papas, MD, MPH

* Food for Special Medical Purposes, use only under medical supervision

2

DEKAs Product ConceptRegistered as Food for Special Medical Purposes Use under medical supervision

DEKAs comes with a clinically tested delivery technology• Experte agree that the DEKAs delivery technology enhances absorption of fat-soluble

vitamins and micronutrients.1

DEKAs Bariatric covers all relevant vitamins and minerals in one tablet 2• DEKAs supplies all micronutrients recommended in US Bariatric Surgery guidelines.2,3

DEKAs Bariatric offers scalable dosing to cover all forms of Bariatric Surgery • The most recent guidelines show that patients with gastric banding or a sleeve

gastrectomy may need lower doses for supplementation than patients operated with other techniques.3 Therefore the dosing of DEKAs allows a choice between 1 or 2 chewable tablets per day, depending on patient, procedure and healthcare professional preferences.

1. EASL Clinical Practice Guidelines: Management of cholestatic liver diseases European Association for the Study of the Liver, Journal of Hepatology , Volume 51 , Issue 2 , 237 – 267. DOI: http://dx.doi.org/10.1016/j.jhep.2009.04.009

2. DEKAs Bariatric does not supplement calcium as this should not be combined with the supplementation of iron.3. Parrot J, Frank L, Dilks R, et al. American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional

Guidelines for the Surgical Weight Loss Patient 2016 Update: Micronutrients, In Surgery for Obesity and RelatedDiseases, Volume 13, Issue 5, 2017, Pages 727-741, ISSN 1550-7289, https://doi.org/10.1016/j.soard.2016.12.018.

http://dx.doi.org/10.1016/j.jhep.2009.04.009

3

DEKAs Delivery TechnologyBased on micelle forming ingredients1,2

DEKAs delivery technology has been clinically proven to increase the absorption of fat-soluble vitamins and other lipophilic compounds in conditions of malabsorption such as in cholestatic liver disease and cystic fibrosis.1,2

1. Papas K, Kalbfleisch J, Mohon R, Bioavailability of a novel, water-soluble vitamin E formulation in malabsorbing patients. Dig Dis Sci. (2007) Feb;52( 2) :347-52. DOI 10.1007/s10620-006-9489-2

2. EASL Clinical Practice Guidelines: Management of cholestatic liver diseases European Association for the Study of the Liver, Journal of Hepatology , Volume 51 , Issue 2 , 237 – 267. DOI: http://dx.doi.org/10.1016/j.jhep.2009.04.009

4

Gastric Roux-en-Y bypass (RYGB) surgery in detail

http://www.weightlosssurgery.ca/about-our-surgeries/laparoscopic-roux-en-y-gastric-bypass/

http://www.weightlosssurgery.ca/about-our-surgeries/laparoscopic-roux-en-y-gastric-bypass/

5

Diagram of common surgical options in Bariatric Surgery1,2Different procedures require different post-operative supplementation regimes

AGB - Adjustable gastric banding | GS - gastric sleeve RYGB - Roux-en-Y gastric bypass | BPD - biliopancreatic diversion

1. Heber D, Greenway FL, Kaplan LM, et al. Endocrine and Nutritional Management of the Post-Bariatric Surgery Patient: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, Volume 95, Issue 11, 1 November 2010, Pages 4823–4843, https://doi.org/10.1210/jc.2009-2128

2. Diagram adapted with permission from W. J. Pories: J Clin Endocrinol Metab 2008 Nov; 93:S89–S96, doi: 10.1210/jc.2008-1641

https://doi.org/10.1210/jc.2009-2128

6

Multiple High Rates of Micronutrient Deficiency1-3Both pre- and post Bariatric Surgery

0102030405060708090

100

Vit D Zinc Vit B12 Vit B1 Iron Folate

Patie

nts w

ith d

efic

ienc

y (%

)

Pre-operative (%) Post-operative (%)

1. Adapted from C.I. Story, Improving Nutritional Deficiencies After Metabolic & Bariatric Surgery, Webinar August 2017.2. Stein, J., Stier, C., Raab, H. et al. (2014), Review article: the nutritional and pharmacological consequences of obesity surgery. Aliment

Pharmacol Ther, 40: 582–609. doi:10.1111/apt.128723. Parrot J, Frank L, Dilks R, et al. American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the

Surgical Weight Loss Patient 2016 Update: Micronutrients, In Surgery for Obesity and Related Diseases, Volume 13, Issue 5, 2017, Pages 727-741, ISSN 1550-7289, https://doi.org/10.1016/j.soard.2016.12.018.

< 30 ng/ml

7

Guidelines for supplementation after Bariatric SurgeryOnly ASMBS 2016 guideline specifies type and amount of micronutrients5

1. American Soc. for Metabolic & Bariatric Surgery - ASMBS (2008)Allied Health Nutritional Guidelines for the Surgical Weight Loss Patient

2. Endocrine Soc. Clinical Practice Guideline (2010)Endocrine and Nutritional Management of the Post-bariatric Surgery Patient

3. European Assoc. for the Study of Obesity - EASOInt. Fed. for the Surgery of Obesity and Metabolic Dis. - IFSO-EC (2013)Interdisciplinary European Guidelines on Metabolic and Bariatric Surgery

4. American College Endocrinologiy (ACE) / The Obesity Society (TOS) (2013 Update)Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient

5. ASMBS (2016 Update)Micronutrients

1. Aills L, Blankenship J, Buffington C, et al. ASMBS Allied Health Nutritional Guidelines for the Surgical Weight Loss Patient. SOARD. 4 (2008); S73-S108. DOI: 10.1016/j.soard.2008.03.002

2. Heber D, Greenway FL, Kaplan LM, et al. Endocrine and Nutritional Management of the Post-Bariatric Surgery Patient: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, Volume 95, Issue 11, 1 November 2010, Pages 4823–4843, https://doi.org/10.1210/jc.2009-2128

3. Fried M, Yumuk V, Oppert J, et al. Interdisciplinary European Guidelines on Metabolic and Bariatric Surgery. Obes Facts 2013;6:449-468. https://doi.org/10.1159/0003554804. Mechanick J.I., Youdim A., Jones D.B., et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient -

2013 update: Cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery (2013) Surgery for Obesity and Related Diseases, 9 (2) , pp. 159-191. DOI: http://dx.doi.org/10.1016/j.soard.2012.12.010

5. Parrot J, Frank L, Dilks R, et al. American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient 2016 Update: Micronutrients, In Surgery for Obesity and Related Diseases, Volume 13, Issue 5, 2017, Pages 727-741, ISSN 1550-7289, https://doi.org/10.1016/j.soard.2016.12.018.

https://doi.org/10.1210/jc.2009-2128https://doi.org/10.1159/000355480http://dx.doi.org/10.1016/j.soard.2012.12.010https://doi.org/10.1016/j.soard.2016.12.018

8

Nutrient Unit Prod. A1 tab

Prod. B1 tab

DEKAs1 tab

DEKAs2 tabs

Vitamin A µgIU

6002000

12004000

15005000

300010000

Vitamin B1 mg 3 4,2 12,5 25Vitamin B12 µg 350 500 500 1000Vitamin D µg

IU75

300050

200062,52500

Gastric Band RYGB125

5000

Vitamin E µgIU

2436

2436

4770

Sleeve BPD/DS95

141

Vitamin K µg 0 135 500 RYGB 1000Folate µg 400 400 400 800Iron mg 70 14 23 45Copper mg 3 1 1 2Zinc mg 22,5 22,5 10 20Nutrient intake at this dose is within guidelines

Daily Dose

Nutrient intake at this dose is below or above the level recommended in the guidelines

DEKAs Bariatric guideline-compliant dosingComparison to competitors in N-Europe

Roux-en-Y gastric bypass (RYGB), Biliopancreatic diversion (BPD), BPD/duodenal switch (BPD/DS)

Start with one per day. Increase to two if needed

DEKAs Guide Compet. Simpl

NutrientUnitProd. A1 tabProd. B1 tabDEKAs1 tabDaily DoseDEKAs2 tabs

Vitamin AµgIU60020001200400015005000300010000

Vitamin B1mg34.212.525

Vitamin B12µg3505005001000

Vitamin DµgIU75300050200062,52500Gastric BandRYGB1255000

Vitamin EµgIU243624364770SleeveBPD/DS95141

Vitamin Kµg0135500RYGB1000

Folateµg400400400800

Ironmg70142345

Coppermg3112

Zincmg22.522.51020

Nutrient intake at this dose is within guidelines

Nutrient intake at this dose is below or above the level recommended in the guidelines

DEKAs Guide Competitors

Nutrient intake at this dose is within guidelines

Nutrient intake at this dose is below or above the level recommended in the guidelines

NutrientUnitCompetitor A1 tabCompetitor B1 tabDEKAs1 tabDaily DoseDEKAs2 tabsUpper LimitGeneral Population

Vitamin Aµg6001200150030003000

Vitamin AIU2000400050001000010000

Vitamin B1mg34.212.5Gastric BandRYGB25None set

Vitamin B12µg350500500SleeveBPD/DS1000None set

Vitamin Dµg755062.5RYGB125100

Vitamin DIU30002000250050004000

Vitamin Emg242447951000

Vitamin EIU3636701411500

Vitamin Kµg01355001000None set

Folateµg4004004008001000

Ironmg7014234545

Coppermg3112None set

Zincmg2322.5102040

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DEKAs Guide V3

NutrientUnit1 tabDaily Dose2 tabsUpper LimitGeneral Population

Vitamin Aµg50075010001250150030003000

Vitamin AIU166725003333416650001000010000

Vitamin B1mg12.53.54.512.5Gastric BandRYGB25None set

Vitamin B12µg300350400450500SleeveBPD/DS1000None set

Vitamin Dµg4550556062.5RYGB125100

Vitamin DIU1800200022002400250050004000

Vitamin Emg716.726.736.747951000

Vitamin EIU1024.925373134339.850746268754.776119403701411500

Vitamin Kµg01252503755001000None set

Folateµg01002003004008001000

Ironmg131517.520234545

Coppermg00.250.50.7512None set

Zincmg0246102040

Nutrient intake at this dose is within guidelines

Nutrient intake at this dose is below the level recommended in the guidelines

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Chewables Compared

IngredientFormUnitBar. AdvUS 60#

Roberto Jongejan: Roberto Jongejan:Advanced Multi EABar. Adv. EU 90#DEKAs60#WLS Max NL caps 90#

Roberto Jongejan: Roberto Jongejan:For Duodenal SwitchBiliopancreatic Div.WLS Forte NL Chew 90#

Roberto Jongejan: Roberto Jongejan:For GastricBypassMini BypassWLS Optim NL Chew 90#

Roberto Jongejan: Roberto Jongejan:For SleeveStomach bandUS Guideline MinimumAGB & SG

Roberto Jongejan: Roberto Jongejan:Laparoscopic adjustable gastric banding (LAGB), Roux-en-Y gastric bypass(RYGB), laparoscopic sleeve gastrectomy (SG), biliopancreatic diversion (BPD), andBPD/duodenal switch (BPD/DS) are the primary procedures performedUS Guideline MaximumRYGB, BPD/DS

Roberto Jongejan: Roberto Jongejan:Laparoscopic adjustable gastric banding (LAGB), Roux-en-Y gastric bypass(RYGB), laparoscopic sleeve gastrectomy (SG), biliopancreatic diversion (BPD), andBPD/duodenal switch (BPD/DS) are the primary procedures performedUpperLimit

Vitamin ABetacaroteen en retinylpalmitaatµg15001200150012006001000150030003000

Vitamin B1Thiaminemononitraatmg6.254.212.532.75212None

Vitamin B2Riboflavinemg1.72.81.73.53.52

Vitamin B3Niacinamidemg103210323225

Vitamin B5Calciumpanthotenaatmg10121018189

Vitamin B6Pyridoxal-5-fosfaatmg22.821.412

Vitamin B12Methylcobalamineµg50050050050035010350500None

Vitamin CAscorbinezuurmg4516045120120100

Vitamin DCholecalciferolµg37.55062.525757.575100

Vitamin EGemengde tocoferolen en alfatocoferylacetaatmg502450502412151000

Vitamin KFytomenadionµg50013550030009090300None

Folate5-methyltetrahydrofolaatµg400400400600600300400800

Roberto Jongejan: Roberto Jongejan:800-1000 in childbearing age1000

Biotinµg300100300100100150

IronFumaraatmg22.51422.5917028184545

ChromiumPicolinaatµg60806016016040

CopperCitraatmg111331.912None

IodineKaliumjodideµg7522575225225150

ManganeseCitraatmg141333

MagnesiumBisglycinaatmg256025.00030

MolybdenumNatriummolybdaatµg2510025.011211250

SeleniumSelenomethionineµg351053510510555

ZincBisglycinaatmg822.51022.522.51582240

Boronmg11

Cholinebitartraatmg10510000

Sodium10

Calciummg25Do not co-administer calciumcitrate/antacids with iron1200 -15001800-24003000tablets of 1200 mg 1-2 per day

Inositolmg5000

Coenzyme Q10mg505000

Bar. Adv US 60#

Roberto Jongejan: Roberto Jongejan:Advanced Multi EA

Roberto Jongejan: Roberto Jongejan:Advanced Multi EABar. Adv. EU 90#DEKAs60#WLS Max NL caps 90#

Roberto Jongejan: Roberto Jongejan:For Duodenal SwitchBiliopancreatic Div.WLS Forte NL Chew 90#

Roberto Jongejan: Roberto Jongejan:For GastricBypassMini BypassWLS Optim NL Chew 90#

Roberto Jongejan: Roberto Jongejan:For SleeveStomach band

Roberto Jongejan: Roberto Jongejan:For Duodenal SwitchBiliopancreatic Div.

Roberto Jongejan: Roberto Jongejan:800-1000 in childbearing age

Roberto Jongejan: Roberto Jongejan:For GastricBypassMini Bypass

Roberto Jongejan: Roberto Jongejan:For SleeveStomach band

Roberto Jongejan: Roberto Jongejan:Laparoscopic adjustable gastric banding (LAGB), Roux-en-Y gastric bypass(RYGB), laparoscopic sleeve gastrectomy (SG), biliopancreatic diversion (BPD), andBPD/duodenal switch (BPD/DS) are the primary procedures performed

Roberto Jongejan: Roberto Jongejan:Laparoscopic adjustable gastric banding (LAGB), Roux-en-Y gastric bypass(RYGB), laparoscopic sleeve gastrectomy (SG), biliopancreatic diversion (BPD), andBPD/duodenal switch (BPD/DS) are the primary procedures performedBarinutrics Calciumcitr 90#Citracal Calciumcitr Maximum 90#Combi Bar AdvCombi DEKAs60#

List Price per unit$43.06€ 47.99€ 33.50€ 44.95€ 49.45€ 38.65€ 26.99€ 32.39€ 74.98€ 39.50

CU per unit609060909090903609060

Internetprice, gross USD$37.44$46.07$40.20$43.02$43.02$35.82$25.91$26.99$71.98$47.40

Internetprice, gross Euro€ 31.20€ 38.39€ 33.50€ 35.85€ 35.85€ 29.85€ 21.59€ 21.59€ 59.98€ 39.50

Internetprice, net€ 36.09€ 31.49€ 33.70€ 33.70€ 28.06€ 20.29€ 20.29€ 56.38€ 37.13

Sending€ 2.50€ 1.72€ 2.50€ 2.50€ 2.50€ 1.72€ 1.72€ 2.50€ 1.72

Total net€ 33.59€ 29.77€ 31.20€ 31.20€ 25.56€ 18.57€ 18.57€ 52.16€ 35.41

Transportation US to EU€ 0.83€ 0.00€ 0.83

Total net net€ 28.94€ 0.00€ 34.58

Total USD$40.30$34.73$37.44$37.44$30.67$22.29$22.29$62.59$41.50

Price per CU€ 0.52€ 0.37€ 0.48€ 0.35€ 0.35€ 0.28€ 0.21€ 0.05€ 0.58€ 0.58

List price per CU€ 0.56€ 0.56€ 0.53€ 0.58€ 0.46€ 0.32€ 0.09€ 0.88€ 0.66

-33%-34%-40%-38%-35%-46%-34%-12%

DEKAs Guide Basis

NutrientUnitDaily DoseUpper Limit

Vitamin Aµg500750100012501500175020002250250027503000325035003000

Vitamin AIU166725003333416650005833666675008333916610000108331166610000

Vitamin B1mg12.53.54.56789101112.515.518.5N/A

Vitamin B12µg300350400450500583666749832915100010831166N/A

Vitamin Dµg4550556065758595105115125130135100

Vitamin DIU18002000220024002600*2800*34003800420046005000520054004000

Vitamin Emg7172737475563717987951031111000

Vitamin EIU102540557082941061171291411531651500

Vitamin Kµg0125250375500580660740820900100011001200N/A

Folateµg010020030040046553059566072580090010001000

Ironmg1315182023263034384145495345

Coppermg00.250.50.751.0001.21.31.51.61.82.02.22.4N/A

Zincmg0246891112141516181940

Nutrient intake at this dose is within guidelines or is below the tolerable upper intake level

Nutrient intake at this dose is below the level recommended in the guidelines

Nutrient intake at this dose is either dangerously low or is above the tolerable upper intake level so needs to be justified by individual patient considerations

0123456789101112

Composition

60 chewable tablets per pack1 chewable tablet

IngredientUnitQuantity% RIRef Inname

Vitamin A75% Beta-carotene 25% palmitateμg (IU)1500 (5000)75%800μg6667 IU

Vitamin B1 (thiamine)mg12.51136%1.1mg

Vitamin B2 (riboflavin)mg1.7121%1.4mg

Niacin (B3)mg1063%16mg

Cholinemg10N/Amg

Pantothenic Acid (B5)mg10167%6mg

Vitamin B6 (pyridoxin)mg2143%1.4mg

Biotin (B7)μg300600%50μg

Folic acidμg400200%200μg

Vitamin B12 μg50020000%2.5μg

Vitamin Cmg4556%80mg

Vitamin D3 μg (IU)62,5 (2500)1250%5μg2500

Vitamin Emg (IU)50 (75)417%12mg

Vitamin K1μg500667%75μg

60 chewable tablets per pack1 chewable tablet

IngredientUnitQuantity% RIRef Inname

Ironmg22.5161%14mg

Chromiumμg60150%40μg

Coppermg1100%1mg

Zincmg10100%10mg

Seleniumμg3564%55μg

Iodineμg7550%150μg

Manganesemg150%2mg

Molybdenumμg2550%50μg

Magnesiummg257%375mg

Calciummg253%800mg

Boronmg1N/Amg

Sodiummg10N/Amg

Coenzyme Q10mg5N/Amg

Composition Brochure

1 chewable tablet

IngredientUnitQuantity% RI*Ref Inname

Vitamin A75% Beta-carotene 25% palmitateμg (IU)1500 (5000)75%800μg6667 IU

Vitamin B1 (thiamine)mg12.51136%1.1mg

Vitamin B2 (riboflavin)mg1.7121%1.4mg

Niacin (B3)mg1063%16mg

Cholinemg10N/Amg

Pantothenic Acid (B5)mg10167%6mg

Vitamin B6 (pyridoxin)mg2143%1.4mg

Biotin (B7)μg300600%50μg

Folic acidμg400200%200μg

Vitamin B12 μg50020000%2.5μg

Vitamin Cmg4556%80mg

Vitamin D3 μg (IU)62,5 (2500)1250%5μg2500

Vitamin Emg (IU)50 (75)417%12mg

Vitamin K1μg500667%75μg

Ironmg22.5161%14mg

Chromiumμg60150%40μg

Coppermg1100%1mg

Zincmg10100%10mg

Seleniumμg3564%55μg

Iodineμg7550%150μg

Manganesemg150%2mg

Molybdenumμg2550%50μg

Magnesiummg257%375mg

Calciummg253%800mg

Boronmg1N/Amg

Sodiummg9N/Amg

Coenzyme Q10mg5N/Amg

Composition Unsorted

Nutritional information / Nährwertinformationen / Information nutritionnelle / Información nutricional / informazione nutrizionale / Voedingswaarde-informatie Factor

contains 60 chewable tablets / 1 chewable tablet /100 g28.41

enthält 60 Kautabletten /1 Kautablette /

contient 60 comprimés à croquer /1 comprimé à croquer /

contiene 60 tabletas masticables / 1 tableta masticable /

bevat 60 kauwtabletten1 pastiglia da masticare

1 kauwtablet

Energy / Brennwert / Énergie / Energia / Energie kJ / kcal0 / 02 / 00.05481040.013120

Fat / Fett / Matières grasses / Grasas / Grassi / Vetten g0.26.4

of which / davon / dont / de las cuales / di cui / waarvan:

saturates / gesättigte Fettsäuren / acides gras saturés / ácidos grasos saturados / acidi grassi saturi / verzadigde vetzureng0.11.6

Carbohydrates / Kohlenhydrate / Glucides / Carbohidratos / Carboidrati / Koolhydrateng3.085

of which / davon / dont / de los cuales / di cui / waarvan:

Sugars/ Zucker / Sucres / Azúcares / Zuccheri / Suikersg2.159

Protein / Eiweiß / Protéines / Proteínas / Proteine / Eiwitteng0.154.2

Salt / Salz / Sel / Sal / Sale / Zoutg0.02

Roberto Jongejan: Roberto Jongejan:salt = sodium × 2.5.0.65

Vitamin/ Vitamine / Vitamina Aμg (IU)150 (1250)4261 (35511)426135511

Beta-carotene / Beta-carotin / Bêta-carotène/ Beta-caroteno / Bèta-caroteenμg RE* (IU)400 (3750)11364 (106534)11364106534

Vitamin/ Vitamine / Vitamina Cmg4512781278

Vitamin/ Vitamine / Vitamina D3 μg (IU)50 (2500)1420 (71023)142071023

Vitamin/ Vitamine / Vitamina Emg (IU)46 (75)1307 (2131)13072131

Vitamin/ Vitamine / Vitamina K1μg50014205

Vitamin/ Vitamine / Vitamina B1 - Thiamin(e), Tiaminamg12.5355

Vitamin/ Vitamine / Vitamina B2 - Riboflavin(e), Riboflavinamg1.748

Niacin(e), Niacinamg10284

Vitamin/ Vitamine / Vitamina B6 mg2.057

Folic acid / Folsäure / Acide folique / Ácido fólico / Foliumzuurμg40011364

Vitamin/ Vitamine / Vitamina B12 μg50014205

Biotin(e), Biotinaμg3008523

Pantothenic Acid / Pantothensäure / Acide pantothénique / Ácido pantoténico / Pantotheenzuur Mg10284

Calcium / mg25710

Iron / mg23639

Iodine / μg752131

Magnesium / mg25710

Zink / Zinc / Cincmg10284

Selen / Sélénium / Selenium / Selenio / Seleenμg35994

Coppermg1.0028

Boronmg1.028

Manganesemg1.028

Chromiumμg601705

Molybdenumμg25710

Sodiummg10284

Cholinemg10284

Co(-)enzym(e) Q10, coenzima Q10mg5.0142

Ingredients Guidelines

Nutrient recommended UnitMinimum starting dose AGB, SG, RYGB*Increased dose mostly in BPD or BPD/DS* Tolerable upper intake level for general population

Vitamin Aµg/IU1500 / 50003000 / 100003000 / 10000

Vitamin B1mg12None set

Vitamin B12µg350500None set

Vitamin Dµg/IU75 / 3000as needed for 30 ng/mL100 / 4000

Vitamin Emg/IU15 / 22,5 1000 / 1500

Vitamin Kµg90300None set

Folateµg4008001000

Ironmg1845-6045

Coppermg12None set

Zincmg82240

Calcium **mg120024002000-3000

DEKAs Bariatric is also a complete multivitamin and mineral supplement as is recommended in the guidelines.

* Adjustable Gastric Banding (AGB), Sleeve Gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), Biliopancreatic diversion (BPD), BPD/duodenal switch (BPD/DS)** Calcium (or antacids) should be taken separately and not be co-adminstered with iron

Blad1

BariNutr Caps

per potaantalper dagper potper chewaantal

Prijs€ 19.0060€ 0.63Prijs€ 19.00€ 0.6330€ 38.00

€ 48.00€ 0.5390€ 32.00

BariNutrics Multi 60 caps Euro 15,20IngrediëntenBariNutrics Multi Kers 30 tabs Euro 15,99DEKAs

Ingrediënten per 2 capsulesRI*per kauwtablet

Vitamine A (betacaroteen en retinylpalmitaat)1200 mcg150%Vitamine ABetacaroteen en retinylpalmitaat1501200 µg600Vitamine A

Vitamine B1 (thiaminemononitraat)4,2 mg382%Vitamine B1Thiaminemononitraat3824,2 mg6.3Vitamine B1

Vitamine B2 (riboflavine)2,8 mg200%Vitamine B2Riboflavine2002,8 mg1.7Vitamine B2

Vitamine B3 (niacinamide)32 mg200%Vitamine B3Niacinamide20032 mg10Niacine (Vitamin B3)

Vitamine B5 (calciumpanthotenaat)12 mg200%Vitamine B5Calciumpanthotenaat20012 mg10Pantothenzuur (Vitamine B5)

Vitamine B6 (pyridoxal-5-fosfaat)2,8 mg200%Vitamine B6Pyridoxal-5-fosfaat2002,8 mg2Vitamine B6

Vitamine B12 (methylcobalamine)500 mcg20000%Vitamine B12Methylcobalamine20000500 µg500Vitamine B12

Vitamine C (ascorbinezuur)160 mg200%Vitamine CAscorbinezuur200160 mg45Vitamine C

Vitamine D (cholecalciferol)50 mcg1000%Vitamine DCholecalciferol100050 µg50Vitamine D3

Vitamine E (gemengde tocoferolen en alfatocoferylacetaat)24 mg200%Vitamine EGemengde tocoferolen en alfatocoferylacetaat20024 mg46Vitamine E

Vitamine K (fytomenadion)135 mcg180%Vitamine KFytomenadion180135 µg1000Vitamine K

Folaat (calcium-L-methylfolaat)400 mcg200%Folaat5-methyltetrahydrofolaat (5-MTHF), Metafolin®200400 µg400Foliumzuur

Biotine100 mcg200%Biotine200100 µg300Biotine

Ijzer (fumaraat)14 mg100%IjzerFumaraat10014 mg22.5IJzer

Chroom (picolinaat)80 mcg200%ChroomPicolinaat20080 µg60Chroom

Koper (citraat)1000 mcg100%KoperCitraat1001000 µg1Koper

Jodide (kaliumjodide)225 mcg150%JodideKaliumjodide150225 µg75Jodium

Mangaan (citraat)4 mg200%MangaanCitraat2004 mg1Mangaan

Molybdeen (natriummolybdaat)100 mcg200%MagnesiumBisglycinaat1660 mg25Magnesium

Selenium (methionine)105 mcg191%MolybdeenNatriummolybdaat200100 µg25Molybdeen

Zink (bisglycinaat)22,5 mg225%SeleniumSelenomethionine191105 µg35Selenium

Cholinebitartraat5 mgZinkBisglycinaat22522,5 mg7.5Zink

Inositol5 mgCholinebitartraat5 mg10Choline

Gemengd met: hydroxypropylmethylcellulose, siliciumdioxide, magnesiumstearaatInositol5 mg5.0Coenzyme Q10

*RI = Referentie Inname

*RI = referentie inname

Ingrediënten kers:

Zoetstoffen: xylitol en sorbitol, magnesiumbisglycinaat, draagstof: hydroxypropylcellulose, ascorbinezuur, antiklontermiddel: stearinezuur, smaakstoffen: kersenaroma en citroenzuur, zinkbisglycinaat, kleurstof: rodebietenpoeder, ijzerfumaraat, antiklontermiddelen: magnesiumstearaat en siliciumdioxide, niacinamide, alfatocoferylacetaat, mangaancitraat, calciumpantothenaat, natuurlijk gemengde tocoferolen, thiaminemononitraat, cholinebitartraat, inositol, bètacaroteen,zoetstof: sucralose, pyridoxal-5-fosfaat, ribo avine, kopercitraat, retinylpalmitaat, chromiumpicolinaat, methylcobalamine, calcium-L-methylfolaat, kaliumjodide, selenomethionine, natriummolybdaat, fytomenadion, biotine, cholecalciferol 

Ingrediënten citrus:

Fructose, magnesiumbisglycinaat, draagstof: hydroxypropylcellulose, zoetstof: xylitol, antiklontermiddel: stearinezuur, ascorbinezuur, smaakstoffen: gesproeidroogd sinaasappelsappoeder, natuurlijk sinaasappelaroma en citrusaroma, zinkbisglycinaat, smaakstof: citroenzuur, ijzerfumaraat, niacinamide, antiklontermiddelen: magnesiumstearaat en silciumdioxide, alfatocoferylacetaat, mangaancitraat, calciumpantothenaat, natuurlijk gemengde tocoferolen, kurkumawortelextract (Curcuma longa), zoetstof: sucralose, thiamine mononitraat, cholinebitartraat, inositol, bètacaroteen, pyridoxal-5-fosfaat, ribo avine, kopercitraat, retinylpalmitaat, chromiumpicolinaat, methylcobalamine, calcium-L-methylfolaat, kaliumjodide, selenomethionine, natriummolybdaat, fytomenadion, biotine, cholecalciferol 

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€ 19,99voor 30 kauwtabletten € 47,99voor 90 tabletten

Aanbevolen publieksprijs

FitforMe

FitforMe

€ 0.55

90

€ 49.45€ 32.97

StudymedicationWLS Optimum 1 capsWLS Forte 1 chewWLS Maximum 1 caps 1 DEKAs BarRef Quant

SleeveMaagbandGastricBypassMini BypassDuodenal SwitchBiliopancreatic Div.

Vitamine ARetinolpalmitaat100080060012001500188%800

Vitamine B1Thiamine HCL2.82.752.7536.25569%1.1

Vitamine B2Riboflavine3.523.53.51.7121%1.4

Niacine (Vitamin B3)Nicotimanide322532321063%16

Pantothenzuur (Vitamine B5)Calcium Pantothenaat189181810167%6

Vitamine B6Pyridoxin HCL2.82.01.01.42.0143%1.4

BiotineBiotine600150100100300600%50

FoliumzuurPteroylmonoglutaminezuur600500600600400200%200

Vitamine B12Cyanocobalamine35010035050050020000%2.5

Vitamine CAscorbinezuur1201001201204556%80

Vitamine D3Cholecalciferol12.57.52525631250%5

Vitamine ED-alfa-Tocopherol succinaat2412245050419%12

ChroomChroom III Chloride1604016016060150%40

JodiumKaliumjodaat1501502252257550%150

MangaanMangancitraat3333150%2

MolybdeenNatriummolybdaat112501121122550%50

SeleniumNatriumseleniet105551051053564%55

ZinkZinkcitraat22.52822.522.57.575%10

IJzerFerro Fumaraat7028709122.5161%14

KoperKopergluconaat31.9331100%1

Vitamin K1Vitamin K190300500667%75

CholineCholine10

MagnesiumMagnesium257%375

Coenzyme Q10Coenzyme Q105

Vitamin B12 1000μg

Vitamin D3 100 (5000)μg (IU)

Vitamin K11000μg

Biotin (B7)600μg

Vitamin B1 (thiamine)12.5mg

Vitamin E / TPGS92 (150)mg (IU)

Folic acid (B11)800μg

Pantothenic Acid (B5)20mg

Iron45mg

Chromium120μg

Vitamin B6 (pyridoxin)4mg

Vitamin B2 (riboflavin)3.4mg

Copper2mg

Zink15mg

Vitamin A75% Beta-carotene 25% palmitate10000(IU)

Selenium70μg

Niacin20mg

Vitamin C90mg

Iodine150μg

Manganese2mg

Molybdenum50μg

Magnesium50mg

Calcium50mg

Boron2mg

Sodium20mg

Choline20mg

Coenzyme Q1010mg

DEKAs Guide V2

NutrientUnitDaily Dose1 tab2 tabsUpper Limit

Vitamin Aµg5007501000125015003000325035003000

Vitamin AIU1667250033334166500010000108331166610000

Vitamin B1mg12.53.54.56SleeveRYGB121518N/A

Vitamin B12µg300350400450500Gastric BdBPD/DS100010831166N/A

Vitamin D*µg4550556062.58595105125130135100

Vitamin D*IU180020002200240025003400380042005000520054004000

Vitamin Emg717273747951031111000

Vitamin EIU10254055701411531651500

Vitamin Kµg0125250375500100011001200N/A

Folateµg010020030040080090010001000

Ironmg131518202345495345

Coppermg00.250.50.75122.22.4N/A

Zincmg0246816181940

Nutrient intake at this dose is within guidelines and/or within the tolerable upper intake level

Nutrient intake at this dose is below the level recommended in the guidelines

Nutrient intake at this dose is either dangerously low or is above the tolerable upper intake level so needs to be justified by individual patient considerations

0123456789101112

9

DEKAs prototype formulation clinically tested in RCTSignificantly better than the standard bariatric vitamin regime used at Johns Hopkins Center for Bariatric Surgery, Baltimore, USA 1

tart with one per day, increase to two if needed.

1. Steele K, Peterson L, Papas K, et al. Efficacy of a chewable multivitamin/mineral supplement in preventing vitamin deficiency in Roux en-Y gastric bypass patients: A randomized controlled clinical trial. ASMBS Poster A6208, November 4-6, 2014. Full publication will follow shortly.

Study outline• DEKAs prototype formulation + calcium (n=29) was RCT-tested against the

standard regimen (n=27, 2 multivitamins + 500 mcg B12 + iron + calcium) at Johns Hopkins, Baltimore, USA after Roux-en-Y Gastric Bypass Surgery.

• Mean BMI 47, mean age 42, 89% female patients.• Plasma levels of vitamins A, D, E, folate, thiamine, vitamin B12, ferritin & iron, were

measured preoperatively and 3 months postoperatively. Main results for the DEKAs prototype group• A greater percentage of optimal levels for the majority of vitamins and minerals.• PTH (p=0,02), vitamin D (p=0,02), thiamine (p=0,01), folate (p=0,03) and beta

carotene (p=0,04) improved significantly.• Better initial taste (p=0,01)• Better aftertaste (p=0,04)• Greater satisfaction and compliance

10

What makes DEKAs Bariatric specialDEKAs Bariatric chewable tablets

DEKAs has a unique delivery technology• The delivery technology ensures enhanced absorption of fat-soluble vitamins and micronutrients.1

DEKAs is guideline compliant: one dose covers all minerals and vitamins2• The composition of DEKAs incorporates the latest consensus guidelines on bariatric surgery.3

DEKAs was clinically tested in RYGB patients and improved results in a meaningful way 4• In a clinical study a prototype formulation of DEKAs Bariatric showed significantly better results than the

standard bariatric vitamin used in the Johns Hopkins Center for Bariatric Surgery, Baltimore, USA 4

DEKAs is taste-optimized and contains no paraben, gluten, casein or lactose• DEKAs is based on natural flavors.

DEKAs eliminates the risk of hypervitaminosis A• Most of the vitamin A in DEKAs is given as ß-carotene, which is a precursor to vitamin A and is converted

by the body to vitamin A as needed. No risk of hypervitaminosis A.

1. EASL Clinical Practice Guidelines: Management of cholestatic liver diseases European Association for the Study of the Liver, Journal of Hepatology , Volume 51 , Issue 2 , 237 – 267. DOI: http://dx.doi.org/10.1016/j.jhep.2009.04.009

2. DEKAs Bariatric does not supplement calcium as this should not be combined with the supplementation of iron.3. Parrot J, Frank L, Dilks R, et al. American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the

Surgical Weight Loss Patient 2016 Update: Micronutrients, In Surgery for Obesity and Related Diseases, Volume 13, Issue 5, 2017, Pages 727-741, ISSN 1550-7289, https://doi.org/10.1016/j.soard.2016.12.018.

4. Steele K, Peterson L, Papas K, et al. Efficacy of a chewable multivitamin/mineral supplement in preventing vitamin deficiency in Roux en-Y gastric bypass patients: A randomized controlled clinical trial. ASMBS Poster A6208, November 4-6, 2014.

http://dx.doi.org/10.1016/j.jhep.2009.04.009https://doi.org/10.1016/j.soard.2016.12.018

11

Nutritional Information DEKAs BariatricFood for Special Medical Purposes. Use only under medical supervision.

12

Product Information DEKAs BariatricFood for Special Medical Purposes. Use only under medical supervision.

DEKAs after�Bariatric Surgery*��Once Daily All-in-one Multivitamin and Mineral Chewable Tablets with Enhanced Absorption for Dietary Management after Bariatric SurgeryDEKAs Product Concept�Registered as Food for Special Medical Purposes �Use under medical supervision�DEKAs Delivery Technology�Based on micelle forming ingredients1,2Gastric Roux-en-Y bypass (RYGB) surgery in detail�Diagram of common surgical options in Bariatric Surgery1,2�Different procedures require different post-operative supplementation regimes �Multiple High Rates of Micronutrient Deficiency1-3�Both pre- and post Bariatric SurgeryGuidelines for supplementation after Bariatric Surgery�Only ASMBS 2016 guideline specifies type and amount of micronutrients5 �DEKAs Bariatric guideline-compliant dosing�Comparison to competitors in N-Europe�DEKAs prototype formulation clinically tested in RCT�Significantly better than the standard bariatric vitamin regime used at Johns Hopkins Center for Bariatric Surgery, Baltimore, USA 1��tart with one per day, increase to two if needed.�What makes DEKAs Bariatric special�DEKAs Bariatric chewable tablets�Nutritional Information DEKAs Bariatric�Food for Special Medical Purposes. Use only under medical supervision.���Product Information DEKAs Bariatric�Food for Special Medical Purposes. Use only under medical supervision.���