Abstract
Background
The primary aim of this study was to evaluate the prevalence of vitamin D deficiency and secondary hyperparathyroidism after Roux-en-Y gastric bypass. Secondly, we have tried to assess predictors for vitamin D deficiency.
Methods
Five hundred thirty-seven patients who underwent primary Roux-en-Y gastric bypass surgery between 1993 and 2003 at the Örebro University Hospital and Uppsala University Hospital were eligible for the study. Patients were asked to provide a blood sample between November 2009 and June 2010 and to complete a questionnaire about their postoperative health status. Serum values of 25-OH vitamin D, parathyroid hormone (PTH), alkaline phosphatase (ALP) and calcium were determined.
Results
Follow-up was completed in 293 patients, of which 83 % were female, with an age of 49 ± 9.9 years after a median time of 11 ± 2.8 years. Vitamin D, PTH and albumin-corrected calcium values were 42 ± 20.4 nmol/L, 89.1 ± 52.7 ng/L and 2.3 ± 0.1 mmol/L, respectively. Of all patients, 65 % were vitamin D deficient, i.e. 25-OH vitamin D <50 nmol/L, and 69 % had PTH above the upper normal reference range, i.e. >73 ng/L. Vitamin D was inversely correlated with PTH levels (p < 0.001) and positively correlated with calcium (p = 0.016). Vitamin D did not correlate with ALP. The only factor found to predict vitamin D deficiency was high preoperative body mass index (BMI) (p = 0.008), whereas gender, age, time after surgery and BMI at follow-up did not.
Conclusions
Vitamin D deficiency and secondary hyperparathyroidism after Roux-en-Y gastric bypass (RYGB) were confirmed in our study because 65 % of patients had vitamin D deficiency, and 69 % had increased PTH levels more than 10 years after surgery. These data are alarming and highlight the need for improved long-term follow-up. Vitamin D deficiency does not seem to progress with time after surgery, possibly due to weight loss. Only preoperative BMI, cutoff point 43 kg/m2, was a predictor of vitamin D deficiency at follow-up. Improved long-term follow-up of patients that undergo RYGB is needed.
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References
Coates PS, Fernstrom JD, Fernstrom MH, et al. Gastric bypass surgery for morbid obesity leads to an increase in bone turnover and a decrease in bone mass. J Clin Endocrinol Metab. 2004;89(3):1061–5.
Carlsson LM, Peltonen M, Ahlin S, et al. Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects. N Engl J Med. 2012;367(8):695–704.
Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52.
Scandinavian Obesity Surgery Register. SOReg Årsrapport 2010. 2010. (Cited 28 Feb 2013). http://www.ucr.uu.se/soreg/index.php/dokument/cat_view/58-dokument/57-arsrapporter. Accessed 11 June 2012.
Zhang R, Naughton DP. Vitamin D in health and disease: current perspectives. Nutr J. 2010;9:65.
Adams JS, Hewison M. Update in vitamin D. J Clin Endocrinol Metab. 2010;95(2):471–8.
Binkley N, Ramamurthy R, Krueger D. Low vitamin D status: definition, prevalence, consequences, and correction. Endocrinol Metab Clin North Am. 2010;39(2):287–301.
Compher CW, Badellino KO, Boullata JI. Vitamin D and the bariatric surgical patient: a review. Obes Surg. 2008;18(2):220–4.
Goldner WS, Stoner JA, Thompson J, et al. Prevalence of vitamin D insufficiency and deficiency in morbidly obese patients: a comparison with non-obese controls. Obes Surg. 2008;18(2):145–50.
Hultin H, Edfeldt K, Sundbom M, et al. Left-shifted relation between calcium and parathyroid hormone in obesity. J Clin Endocrinol Metab. 2010;95(8):3973–81.
Signori C, Zalesin KC, Franklin B, et al. Effect of gastric bypass on vitamin D and secondary hyperparathyroidism. Obes Surg. 2010;20(7):949–52.
Dalcanale L, Oliveira CP, Faintuch J, et al. Long-term nutritional outcome after gastric bypass. Obes Surg. 2010;20(2):181–7.
Johnson JM, Maher JW, DeMaria EJ, et al. The long-term effects of gastric bypass on vitamin D metabolism. Ann Surg. 2006;243(5):701–4. discussion 4–5.
Edholm D, Svensson F, Naslund I, et al. Long-term results 11 years after primary gastric bypass in 384 patients. Surg Obes Relat Dis. 2012;9(5):708–13.
Correcting the calcium. Br Med J. 1977;1(6061):598.
Snellman G, Melhus H, Gedeborg R, et al. Determining vitamin D status: a comparison between commercially available assays. PLoS One. 2010;5(7):e11555.
Institute of Medicine. Dietary reference intakes for calcium and vitamin D. Washington DC: The National Academics Press; 2011 (cited 28 Feb 2013). http://www.iom.edu/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D.aspx. Accessed 18 Feb 2013.
Deitel M, Greenstein RJ. Recommendations for reporting weight loss. Obes Surg. 2003;13(2):159–60.
Beckman LM, Beckman TR, Sibley SD, et al. Changes in gastrointestinal hormones and leptin after Roux-en-Y gastric bypass surgery. J Parenter Enteral Nutr. 2011;35(2):169–80.
Jones Jr KB. Experience with the Roux-en-Y gastric bypass, and commentary on current trends. Obes Surg. 2000;10(2):183–5.
Ducloux R, Nobecourt E, Chevallier JM, et al. Vitamin D deficiency before bariatric surgery: should supplement intake be routinely prescribed? Obes Surg. 2011;21(5):556–60.
Clements RH, Yellumahanthi K, Wesley M, et al. Hyperparathyroidism and vitamin D deficiency after laparoscopic gastric bypass. Am Surg. 2008;74(6):469–74. Discussion 74–5.
Granado-Lorencio F, Simal-Anton A, Salazar-Mosteiro J, et al. Time-course changes in bone turnover markers and fat-soluble vitamins after obesity surgery. Obes Surg. 2010;20(11):1524–9.
Duran de Campos C, Dalcanale L, Pajecki D, et al. Calcium intake and metabolic bone disease after eight years of Roux-en-Y gastric bypass. Obes Surg. 2008;18(4):386–90.
Aasheim ET, Bjorkman S, Sovik TT, et al. Vitamin status after bariatric surgery: a randomized study of gastric bypass and duodenal switch. Am J Clin Nutr. 2009;90(1):15–22.
Folli F, Sabowitz BN, Schwesinger W, et al. Bariatric surgery and bone disease: from clinical perspective to molecular insights. Int J Obes (Lond). 2012;36(11):1373–9.
DiGiorgi M, Daud A, Inabnet WB, et al. Markers of bone and calcium metabolism following gastric bypass and laparoscopic adjustable gastric banding. Obes Surg. 2008;18(9):1144–8.
Heber D, Greenway FL, Kaplan LM, et al. Endocrine and nutritional management of the post-bariatric surgery patient: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010;95(11):4823–43.
Goldner WS, Stoner JA, Lyden E, et al. Finding the optimal dose of vitamin D following Roux-en-Y gastric bypass: a prospective, randomized pilot clinical trial. Obes Surg. 2009;19(2):173–9.
Carlin AM, Rao DS, Yager KM, et al. Treatment of vitamin D depletion after Roux-en-Y gastric bypass: a randomized prospective clinical trial. Surg Obes Relat Dis. 2009;5(4):444–9.
Mechanick JI, Youdim A, Jones DB, 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. Surg Obes Relat Dis. 2013;9(2):159–91.
Acknowledgments
The authors would like to acknowledge Felicity Svensson, MD; Anne Breikert, research nurse; and Ing-Marie Carlsson, research assistant, for their invaluable assistance with this study. This work was supported by the Örebro County Council and the Uppsala-Örebro Regional Research Council (RFR-32261).
Conflict of Interest
The authors declare that there is no conflict of interest that could be perceived as prejudging the impartiality of the research reported.
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Karefylakis, C., Näslund, I., Edholm, D. et al. Vitamin D Status 10 Years After Primary Gastric Bypass: Gravely High Prevalence of Hypovitaminosis D and Raised PTH Levels. OBES SURG 24, 343–348 (2014). https://doi.org/10.1007/s11695-013-1104-y
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DOI: https://doi.org/10.1007/s11695-013-1104-y