4.4 Article

Effects of Omega-Loop Gastric Bypass on Vitamin D and Bone Metabolism in Morbidly Obese Bariatric Patients

Journal

OBESITY SURGERY
Volume 25, Issue 6, Pages 1056-1062

Publisher

SPRINGER
DOI: 10.1007/s11695-014-1492-7

Keywords

Vitamin D; Bone metabolism; Hyperparathyroidism; Morbid obesity; Gastric bypass

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Bariatric patients often suffer from nutrient deficiencies. Little is known about vitamin D levels and bone metabolism in patients undergoing omega-loop gastric bypass (OLGB). We, therefore, evaluated parameters of vitamin D metabolism preoperatively and during the first postoperative year. Within our cohort study, we retrospectively evaluated the respective parameters pre-, 3, 6, and 12 months postoperatively in patients with OLGB, between February 2011 and February 2013. In patients [n = 50; age 46 (15) years, mean (SD); 12 male, 38 female] BMI was 45.4 (6.6) kg/m(2) preoperatively and decreased to 29.1 (3.8) kg/m(2) after 12 months, corresponding to a total body weight loss of 36 %. Preoperatively, the prevalence of vitamin D deficiency was 96 and 30 % demonstrated elevated parathyroid hormone yielding a prevalence of secondary hyperparathyroidism of 17 %. Postoperatively, subjects received individually adjusted vitamin D-3 supplementation (95 % CI 200-3000 IU/day), according to the available guidelines at that time. Nevertheless, every third patient was vitamin D deficient at 12 months (80 %). In patients with preoperative BMI > 45 vs. < 45 kg/m(2), we observed a 3-fold higher risk for vitamin D deficiency over 12 months [OR = 3.10, 95 % CI (1.01-9.51), p = 0.048]. To avoid vitamin D deficiency, morbidly obese patients, particularly those with higher preoperative BMI, should be regularly screened pre- and postoperatively. Standard postsurgical supplementation has not been adequate to restore 25-OHD status and current guidelines are not very specific in terms of timing and dosing of vitamin D-3 supplementation. Consequently, further trials to enhance the evidence on vitamin D supplementation are warranted.

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