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Duan L, Wang Y, Cheng L, Wang J. Changes in Nutritional Outcomes After Roux-en-Y Gastric Bypass: A Systematic Review and Meta-Analysis. Obes Surg 2024; 34:2116-2129. [PMID: 38662252 DOI: 10.1007/s11695-024-07232-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Bariatric surgery (BS) is the most effective treatment for severe obesity and it has beneficial effects on glycemic control and metabolism outcomes. However, the effects of BS on nutritional outcomes are controversial. Therefore, we aimed to evaluate the changes in several nutritional outcomes after Roux-en-Y gastric bypass (RYGB). METHODS A comprehensive search was performed using the following databases: PubMed, Embase, Web of Science, Cochrane Library, WanFang and Chinese National Knowledge Infrastructure. The following outcomes were evaluated: vitamin A, 25-hydroxyvitamin D [25(OH)D], calcium, phosphorus, parathormone (PTH), iron, ferritin, vitamin B12, folate, and zinc. The pooled outcomes were expressed as standard mean difference (SMD) and 95% confidence interval (CI) using a random effects model. RESULTS Fifty-six studies including 5645 individuals with obesity met the inclusion criteria. Serum 25(OH)D (SMD = 0.78, 95%CI 0.38 to 1.20, P < 0.001), phosphorus (SMD = 0.48, 95%CI 0.22 to 0.74, P < 0.001), PTH (SMD = 0.35, 95%CI 0.11 to 0.59, P = 0.005), vitamin B12 (SMD = 1.11, 95%CI 0.41 to 1.80, P = 0.002), and folate (SMD = 1.53, 95%CI 0.77 to 2.28, P < 0.001) significantly increased after RYGB compared with the baseline. Serum ferritin (SMD = - 1.67, 95%CI - 2.57 to - 0.77, P < 0.001), vitamin A (SMD = - 0.64, 95%CI - 0.99 to - 0.29, P < 0.001), and plasma zinc (SMD = - 0.58, 95%CI - 1.09 to - 0.06, P = 0.027) significantly decreased after RYGB. No significant changes in serum calcium (SMD = - 0.14, 95%CI - 0.40 to 0.11, P = 0.219) and iron (SMD = 0.26, 95%CI - 0.11 to 0.64, P = 0.165) were observed after RYGB. CONCLUSIONS Despite the increased levels of 25(OH)D, phosphorus, vitamin B12 and folate, this meta-analysis revealed the unfavorable nutritional consequences after RYGB.
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Affiliation(s)
- Leizhen Duan
- Department of Medical Services, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, China
| | - Yan Wang
- Public Health and Preventive Medicine Teaching and Research Center, Henan University of Chinese Medicine, Zhengzhou, China
| | - Lingling Cheng
- Huajing Town Community Health Service Center, Xuhui District, Shanghai, 200231, China
| | - Jun Wang
- Department of Clinical Nutrition, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Tongbai North Road 16, Zhengzhou, 450001, Henan, China.
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Wasserman H, Jenkins T, Inge T, Ryder J, Michalsky M, Sisley S, Xie C, Kalkwarf HJ. Bone mineral density in young adults 5 to 11 years after adolescent metabolic and bariatric surgery for severe obesity compared to peers. Int J Obes (Lond) 2024; 48:575-583. [PMID: 38177697 DOI: 10.1038/s41366-023-01453-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/06/2023] [Accepted: 12/14/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE Metabolic and bariatric surgery (MBS) is associated with decreased bone mineral density (BMD) in adults. The long-term impact of MBS during adolescence on BMD is unknown. We report bone health status 5 to 11 years after Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) from the Teen-LABS study cohort. METHODS Between 2016 and 2022, BMD was measured by dual energy x-ray absorptiometry (DXA) in 106 young adults who had undergone MBS as adolescents. Volumetric BMD by peripheral quantitative computed tomography was measured on a subset. Ninety-one controls who had not undergone MBS were recruited for comparison. RESULTS In cases (RYGB: mean age 26.8 ± 1.9 years, mean BMI 42.1 ± 9.9 kg/m2, VSG: mean age 25.1 ± 2.1 years, mean BMI 37.1 ± 8.4 kg/m2), compared to controls (mean age 26.5 ± 2.7 years, mean BMI 40.2 ± 8.7 kg/m2) (age p < 0.001, BMI p = 0.02), adjusted mean DXA-BMD (g/cm2) of the RYGB (n = 58) and VSG (n = 48) groups were lower at the hip (-10.0% and -6.3%), femoral neck (-9.6% and -5.7%) and ultra-distal radius (-7.9% and -7.0%; all p < 0.001), respectively. DXA-BMD did not differ between RYGB and VSG groups. Trabecular volumetric BMD at the radius and tibia were lower in the RYGB (-30% and -26%) and VSG (-15% and -14%) groups compared to the control group (p < 0.001). Greater time since MBS was associated with lower BMD Z-scores at the hip (p = 0.05) and femoral neck (p = 0.045). Percent change in body mass index (BMI) from baseline or in the first year after MBS were not associated with bone measures at a median of 9.3 years post MBS. CONCLUSION BMD, especially of the hip and femoral neck, was lower in young adults who underwent MBS during adolescence compared to matched peers who had not undergone MBS. BMD Z-scores of the femoral neck were inversely associated with time since MBS but were not associated with BMI change.
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Affiliation(s)
- Halley Wasserman
- Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, OH, USA.
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Todd Jenkins
- Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, OH, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Thomas Inge
- Department of Surgery, Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Justin Ryder
- Department of Surgery, Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Marc Michalsky
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
- The Ohio State University, College of Medicine, Columbus, OH, USA
| | - Stephanie Sisley
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- ARS/USDA Children's Nutrition Research Center, Houston, TX, USA
| | - Changchun Xie
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Heidi J Kalkwarf
- Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, OH, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Mejaddam A, Höskuldsdóttir G, Lenér F, Wallenius V, Trimpou P, Fändriks L, Mossberg K, Eliasson B, Landin-Wilhelmsen K. Effects of medical and surgical treatment on vitamin D levels in obesity. PLoS One 2023; 18:e0292780. [PMID: 38134006 PMCID: PMC10745143 DOI: 10.1371/journal.pone.0292780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/27/2023] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION Persons living with obesity treated with bariatric surgery are at a high risk of developing nutritional deficiencies. The primary aim of this observational cohort study was to compare vitamin D levels in patients two years after bariatric surgery (Roux-en-Y gastric bypass/RYGB and sleeve gastrectomy/SG) with a very low-energy diet (VLED). The same subjects were also compared with a population sample from the same region at baseline. The primary hypothesis was that surgery, especially RYGB, would lead to an increased prevalence of vitamin D deficiency compared to subjects treated with VLED. 971 individuals eligible for surgical, RYGB (n = 388), SG (n = 201), and medical treatment (n = 382), in routine care, were included consecutively between 2015 and 2017. A random population sample from the WHO-MONICA project was used as a reference, (n = 414). S-calcium, S-25(OH)D (vitamin D), and S-PTH (parathyroid hormone) were measured in all persons with obesity at baseline and two years after treatment (n = 713). Self-reported use of vitamin D and calcium supplementation was registered. RESULTS Vitamin D deficiency (S-25(OH)D <25mmol/l) was found in 5.2% of the persons with obesity at baseline versus 1.7% of the general population (SMD>0.1). S-25(OH)D increased for all treatment groups but was higher in RYGB and SG (SMD>0.1, standardized mean difference). Thirteen subjects (1.8%) had vitamin D deficiency after obesity treatment. CONCLUSION Surgical intervention for obesity followed by vitamin D supplementation was not associated with a higher risk for vitamin D deficiency, irrespective of surgery type, compared to individuals on medical treatment. However, persons living with obesity seeking weight loss treatment are more likely to have deficient vitamin D levels compared to the general population.
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Affiliation(s)
- Ala Mejaddam
- Department of Internal Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gudrún Höskuldsdóttir
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Section for Endocrinology and Diabetology, Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Frida Lenér
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Public Health and Community Medicine Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ville Wallenius
- Department of Surgery, Institution for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Penelope Trimpou
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Section for Endocrinology and Diabetology, Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Fändriks
- Department of Surgery, Institution for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karin Mossberg
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Public Health and Community Medicine Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björn Eliasson
- Section for Endocrinology and Diabetology, Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kerstin Landin-Wilhelmsen
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Section for Endocrinology and Diabetology, Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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Fischer LE, Moreno-Garcia F, Tran R, Harmon A, Little C, Domingue G, Stewart K, Mier Giraud F, Thakral R. Prevalence and risk factors for secondary hyperparathyroidism (SHPT) in patients undergoing bariatric surgery. Surg Endosc 2023; 37:8019-8028. [PMID: 37464065 DOI: 10.1007/s00464-023-10218-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/11/2023] [Indexed: 07/20/2023]
Abstract
INTRODUCTION Secondary hyperparathyroidism (SHPT) after bariatric surgery has significant adverse implications for bone metabolism, increasing the risk for osteoporosis and fracture. Our aim was to characterize prevalence and identify risk factors for SHPT in bariatric surgery patients. METHODS We performed a single-institution, retrospective chart review of patients who underwent bariatric surgery from June 2017 through December 2021. Demographic and clinical data were collected, including serum parathyroid hormone, calcium, and vitamin D3 at enrollment and 3, 6, and 12-months postoperatively. Chi-square or Fisher's exact tests were used to analyze categorical data and Mann-Whitney U test for continuous data. Multivariable analysis using binomial logistic regression assessed risk factors for SHPT. P-values ≤ 0.05 were considered significant. RESULTS 350 patients were analyzed. SHPT prevalence at any time point was 72.9%. 65.8% had SHPT at enrollment; 45.9% resolved with intensive vitamin supplementation; and 19.7% had recurrent SHPT. New-onset SHPT occurred in 8.6%. Persistent SHPT was present in 42.4% at 1-year. Baseline SHPT correlated with black race and T2DM. SHPT at any time point correlated with T2DM and higher baseline BMI. 1-year SHPT correlated with RYGB, depression, and longer time in program. SHPT was not correlated with %TBWL at any time point. In patients with SHPT, vitamin D3 deficiency prevalence was significantly higher at baseline (77.0%) compared to all post-bariatric time points (16.7%, 17.3%, and 23.1%; P < 0.0001). CONCLUSIONS SHPT is highly prevalent in patients with obesity seeking weight loss surgery. 42% had persistent SHPT at 1-year despite appropriate vitamin supplementation. Current vitamin D3 and calcium supplementation protocols may not effectively prevent SHPT in many post-bariatric patients. Low prevalence of concomitant vitamin D3 deficiency with SHPT after bariatric surgery suggests that there may be alternative mechanisms in this population. Further studies are needed to develop effective treatment strategies to mitigate the adverse effects of bariatric surgery on bone metabolism.
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Affiliation(s)
- Laura E Fischer
- Department of Surgery, University of Oklahoma, Oklahoma City, USA.
- OU Health Metabolic and Bariatric Surgery Program, University of Oklahoma, 1000 N Lincoln Blvd, Suite 3200, Oklahoma City, OK, 73104, USA.
| | | | - Rachel Tran
- University of Oklahoma School of Medicine, Oklahoma City, USA
| | - Allison Harmon
- University of Oklahoma School of Medicine, Oklahoma City, USA
| | - Cooper Little
- University of Oklahoma School of Medicine, Oklahoma City, USA
| | - Grayson Domingue
- Department of Orthopedic Surgery, University of Oklahoma, Oklahoma City, USA
| | - Kenneth Stewart
- Department of Surgery, University of Oklahoma, Oklahoma City, USA
| | - Fernando Mier Giraud
- Department of Surgery, University of Oklahoma, Oklahoma City, USA
- OU Health Metabolic and Bariatric Surgery Program, University of Oklahoma, 1000 N Lincoln Blvd, Suite 3200, Oklahoma City, OK, 73104, USA
| | - Rishi Thakral
- Department of Orthopedic Surgery, University of Oklahoma, Oklahoma City, USA
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Wasserman H, Jenkins T, Inge T, Ryder J, Michalsky M, Sisley S, Xie C, Kalkwarf H. Bone mineral density 5 to 11 years after metabolic and bariatric surgery in adolescents with severe obesity compared to peers. RESEARCH SQUARE 2023:rs.3.rs-3345103. [PMID: 37790519 PMCID: PMC10543495 DOI: 10.21203/rs.3.rs-3345103/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Objective Metabolic and bariatric surgery (MBS) is associated with decreased bone mineral density (BMD) in adults. The long-term impact of MBS during adolescence on BMD is unknown. We report bone health status 5 to 11 years after Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) from the Teen-LABS study cohort. Methods Between 2016 and 2022, BMD was measured by dual energy x-ray absorptiometry (DXA) in 106 young adults who had undergone MBS as adolescents. Volumetric BMD by peripheral quantitative computed tomography was measured on a subset. Ninety-one controls who had not undergone MBS were recruited for comparison. Results Compared to controls, adjusted mean DXA-BMD of the RYGB (n = 58) and VSG (n = 48) groups were lower at the hip (-10.0% and - 6.3%), femoral neck (-9.6% and - 5.7%) and ultra-distal radius (-7.9% and - 7.0%; all p < 0.001), respectively. DXA-BMD did not differ between RYGB and VSG groups. Trabecular volumetric BMD at the radius and tibia were lower in the RYGB (-30% and - 26%) and VSG (-15% and - 14%) groups compared to the control group (p < 0.001). Greater time since MBS was associated with lower BMD Z-scores at the hip (p = 0.05) and femoral neck (p = 0.045). Percent change in body mass index (BMI) from baseline or in the first year after MSB were not associated with bone measures at a median of 9.3 years post MSB. Conclusion BMD, especially of the hip and femoral neck, was lower in young adults who underwent MBS during adolescence compared to matched peers who had not undergone MBS. BMD Z-scores of the femoral neck decreased with time since MBS but were not associated with BMI change.
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Affiliation(s)
| | | | | | | | - Marc Michalsky
- Center for Healthy Weight and Nutrition at Nationwide Children's Hospital, Columbus, Ohio
| | | | | | - Heidi Kalkwarf
- Cincinnati Children's Hospital Medical Center, Cincinatti OH
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Haghighat N, Sohrabi Z, Bagheri R, Akbarzadeh M, Esmaeilnezhad Z, Ashtary-Larky D, Barati-Boldaji R, Zare M, Amini M, Hosseini SV, Wong A, Foroutan H. A Systematic Review and Meta-Analysis of Vitamin D Status of Patients with Severe Obesity in Various Regions Worldwide. Obes Facts 2023; 16:519-539. [PMID: 37640022 PMCID: PMC10697766 DOI: 10.1159/000533828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 08/14/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Managing nutritional deficiencies is an essential component in the treatment of severe obesity. Vitamin D deficiency is often reported in investigations in severely obese cohorts. However, no prior study has summarized findings on this topic. Consequently, the aim of this systematic review and meta-analysis was to investigate the 25-hydroxyvitamin D [25(OH)D] status in individuals with severe obesity in different regions worldwide. We also evaluated levels of calcium, parathyroid hormone (PTH), and magnesium as secondary outcome measures. METHODS We searched Medline, PubMed, Scopus, the Cochrane Library, and EMBASE for relevant observational studies published in English from 2009 to October 2021. The heterogeneity index among the studies was determined using the Cochran (Q) and I2 tests. Based on the heterogeneity results, the random-effect model was applied to estimate the prevalence of vitamin D deficiency. RESULTS We identified 109 eligible observational studies. Overall, 59.44% of patients had vitamin D deficiency [25(OH)D <20 ng/mL], whereas 26.95% had vitamin D insufficiency [25(OH)D 20-30 ng/mL]. Moreover, the mean 25(OH)D level was 18.65 ng/mL in 96 studies. The pooled mean estimate of the serum calcium, PTH, and magnesium was 9.26 mg/dL (95% confidence interval [CI]: 9.19-9.32, I2 = 99.7%, p < 0.001), 59.24 pg/mL (95% CI: 54.98, 63.51, I2 = 99.7%, p < 0.001), and 0.91 mg/dL (95% CI: 0.84, 0.98, I2 = 100.0%, p < 0.001), respectively. The results of the subgroup analysis indicated that the mean estimates of 25(OH)D were highest in North America (21.71 ng/mL [19.69, 23.74], [I2 = 97.2%, p < 0.001]) and lowest in Southeast Asia (14.93 ng/mL [14.54, 15.33], [I2 = 0.0%, p = 0.778]). CONCLUSION The results obtained showed a significant prevalence of vitamin D deficiency among severely obese individuals in various geographical regions, whereas the highest and lowest mean estimates were reported for North America and Southeast Asia, respectively.
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Affiliation(s)
- Neda Haghighat
- Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Sohrabi
- Department of Community Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Bagheri
- Department of Exercise Physiology, University of Isfahan, Isfahan, Iran
| | - Marzieh Akbarzadeh
- Department of Community Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Esmaeilnezhad
- Department of Community Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Damoon Ashtary-Larky
- Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Barati-Boldaji
- Department of Community Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Morteza Zare
- Department of Community Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoud Amini
- Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Alexei Wong
- Department of Health and Human Performance, Marymount University, Arlington, VA, USA
| | - Hamidreza Foroutan
- Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Long-Term Changes in Bone Density and Bone Metabolism After Gastric Bypass Surgery: a Retrospective Cohort Study. Obes Surg 2023; 33:911-919. [PMID: 36609743 DOI: 10.1007/s11695-022-06448-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/08/2023]
Abstract
PURPOSE Patients with severe obesity submitted to Roux-en-Y gastric bypass (RYGB) are at risk of developing long-term hypovitaminosis D and secondary hyperparathyroidism (SHPT) as well as osteometabolic disease. This study aimed to evaluate calcium-vitamin D-PTH axis and bone mineral density (BMD) changes from post-RYGB patients who were followed-up until a median of 5 years. MATERIALS AND METHODS Vitamin D deficiency was defined as 25-hydroxyvitamin D <20 ng/mL and SHPT as PTH >68 pg/mL, in patients with normal serum creatinine and calcium. BMD was estimated by dual-energy X-ray absorptiometry (DXA, g/cm2). RESULTS We included 127 post-RYGB patients (51±10.6 years, 87.4% self-declared White, 91.3% female, 52.8% postmenopausal). Vitamin D deficiency prevalence was the highest (41.5%) in the second year and the lowest (21.2%) in the third year (p<0.05). SHPT prevalence was 65.4% in the second year and increased to 83.7% in the sixth year (p<0.05). Patients with low BMD in lumbar, femoral neck, and total proximal femur were older and presented menopausal status more frequently than normal BMD group (p<0.05). Older age was a risk marker for altered BMD in femoral neck (OR=1.185; 95% CI 1.118-1.256) and in total proximal femur (OR=1.158; 95% CI 1.066-1.258), both after adjusting for follow-up and excess weight loss. CONCLUSION After 5 years, most bariatric patients presented calcium-vitamin D-PTH axis disruption, in which SHPT was more frequent than hypovitaminosis D. Older patients and menopausal women presented higher rates of low BMD, and older age was a risk marker, especially for low BMD in femoral sites.
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Ighani Arani P, Wretenberg P, Ottosson J, Robertsson O, W-Dahl A. Bariatric surgery prior to total knee arthroplasty is not associated with lower risk of revision: a register-based study of 441 patients. Acta Orthop 2021; 92:97-101. [PMID: 33143505 PMCID: PMC7919889 DOI: 10.1080/17453674.2020.1840829] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Obesity is a considerable medical challenge in society. We investigated the risk of revision for any reasons and for infection in patients having total knee arthroplasty (TKA) for osteoarthritis (OA) within 2 years after bariatric surgery (BS) and compared them with TKAs without BS.Patients and methods - We used the Scandinavian Obesity Surgery Registry (SOReg) and the Swedish Knee Arthroplasty Register (SKAR) to identify patients operated on in 2009-2019 with BS who had had primary TKA for OA within 2 years after the BS (BS group) and compared them with TKAs without prior BS (noBS group). We determined adjusted hazard ratio (HR) for the BS group and noBS group using Cox proportional hazard regression for revision due to any reasons and for infection. Adjustments were made for sex, age groups, and BMI categories preoperatively.Results - 441 patients were included in the BS group. The risk of revision for infection was higher for the BS group with HR 2.2 (95% CI 1.1-4.7) adjusting for BMI before the TKA, while the risk of revision for any reasons was not statistically significant different for the BS group with HR 1.3 (CI 0.9-2.1). Corresponding figures when adjusting for BMI before the BS were HR 0.9 (CI 0.4-2) and HR 1.2 (CI 0.7-2).Interpretation - Our findings did not indicate that BS prior to TKA was associated with lower risk of revision.
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Affiliation(s)
- Perna Ighani Arani
- Department of Orthopedics, Orebro University Hospital; ,Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro; ,Correspondence:
| | - Per Wretenberg
- Department of Orthopedics, Orebro University Hospital; ,Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro;
| | - Johan Ottosson
- Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro; ,Department of Surgery, Örebro University Hospital; ,Scandinavian Obesity Surgery Registry, Örebro;
| | - Otto Robertsson
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund; ,The Swedish Knee Arthroplasty Register, Lund, Sweden
| | - Annette W-Dahl
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund; ,The Swedish Knee Arthroplasty Register, Lund, Sweden
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Metabolic bone changes after bariatric surgery: 2020 update, American Society for Metabolic and Bariatric Surgery Clinical Issues Committee position statement. Surg Obes Relat Dis 2021; 17:1-8. [DOI: 10.1016/j.soard.2020.09.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 12/12/2022]
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Bühler J, Rast S, Beglinger C, Peterli R, Peters T, Gebhart M, Meyer-Gerspach AC, Wölnerhanssen BK. Long-Term Effects of Laparoscopic Sleeve Gastrectomy and Roux-en-Y Gastric Bypass on Body Composition and Bone Mass Density. Obes Facts 2021; 14:131-140. [PMID: 33333510 PMCID: PMC7983539 DOI: 10.1159/000512450] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/12/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Currently, the two most common bariatric procedures are laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). Long-term data comparing the two interventions in terms of their effect on body composition and bone mass density (BMD) are scarce. OBJECTIVE The aim of this study was to assess body composition and BMD at least 5 years after LSG and LRYGB. SETTING Department of Endocrinology and Nutrition, St. Claraspital Basel and St. Clara Research Ltd., Basel, Switzerland. METHODS Bariatric patients at least 5 years after surgery (LSG or LRYGB) were recruited, and body composition and BMD were measured by means of dual-energy X-ray absorptiometry. Data from body composition before surgery were included in the analysis. Blood samples were taken for determination of plasma calcium, parathyroid hormone, vitamin D3, alkaline phosphatase, and C-terminal telopeptide, and the individual risk for osteoporotic fracture assessed by the Fracture Risk Assessment Tool score was calculated. After surgery, all patients received multivitamins, vitamin D3, and zinc. In addition, LRYGB patients were prescribed calcium. RESULTS A total of 142 patients were included, 72 LSG and 70 LRYGB, before surgery: median body mass index 43.1, median age 45.5 years, 62.7% females. Follow-up after a median of 6.7 years. For LRYGB, the percentage total weight loss at follow-up was 26.3% and for LSG 24.1% (p = 0.243). LRYGB led to a slightly lower fat percentage in body composition. At follow-up, 45% of both groups had a T score at the femoral neck below -1, indicating osteopenia. No clinically relevant difference in BMD was found between the groups. CONCLUSIONS At 6.7 years after surgery, no difference in body composition and BMD between LRYGB and LSG was found. Deficiencies and bone loss remain an issue after both interventions and should be monitored.
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Affiliation(s)
- Julian Bühler
- St. Clara Research Ltd., St. Claraspital, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland
| | - Silvan Rast
- St. Clara Research Ltd., St. Claraspital, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Ralph Peterli
- St. Clara Research Ltd., St. Claraspital, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland
| | - Thomas Peters
- Endocrinology and Nutrition, St. Claraspital, Basel, Switzerland
| | - Martina Gebhart
- Endocrinology and Nutrition, St. Claraspital, Basel, Switzerland
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11
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Westerink F, Beijderwellen H, Huibregtse IL, De Hoog MLA, De Brauw LM, Brandjes DPM, Gerdes VEA. Lactose after Roux-en-Y gastric bypass for morbid obesity, is it a problem? Scand J Gastroenterol 2020; 55:1398-1404. [PMID: 33096008 DOI: 10.1080/00365521.2020.1837927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) can cause multiple food intolerances and gastrointestinal complaints are frequently reported after dairy consumption. We aimed to determine the prevalence of lactose malabsorption and intolerance, and complaints associated with dairy consumption in daily life, before and after RYGB. METHOD The lactose breath test (LBT) and lactose tolerance test (LTT) was performed in 84 patients awaiting RYGB surgery and 84 patients after surgery. Gastrointestinal symptoms at baseline and after testing were recorded. Lactose malabsorption was defined as a positive LBT and/or LTT. Lactose intolerance as a positive test combined with an increase of gastrointestinal complains. Dairy consumption in daily life and successive gastrointestinal complaints were registered via a questionnaire. Results of preoperative and postoperative patients were compared. RESULTS Lactose malabsorption was present in 15 (17.9%) of the preoperative patients and in 25 (29.8%) of the postoperative patients (OR 2.46; 95%CI: 1.08-5.59; p = .03). Of the preoperative patients 6 (7.1%) patients met the criteria for lactose intolerance, compared to 8 (9.5%) patients in the postoperative group (OR 1.48; 95%CI 0.48-4.57; p = .50). Twelve (14.3%) preoperative patients indicated to have gastrointestinal complaints after dairy consumption in daily life versus 45 (53.6%) postoperative patients (p < .01). CONCLUSION This study shows no increase in patients with proven lactose intolerance after RYGB compared to preoperative patients. Gastrointestinal complaints after dairy consumption in daily life were far more frequently reported by RYGB patients. It is unlikely that all reported gastrointestinal complaints are actually caused by lactose. Other ingredients in dairy, like fat, are possibly contributory.
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Affiliation(s)
- F Westerink
- Department of Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, The Netherlands.,Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - H Beijderwellen
- Department of Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - I L Huibregtse
- Department of Gastroenterology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - M L A De Hoog
- Spaarne Gasthuis Academy, Hoofddorp, The Netherlands
| | - L M De Brauw
- Department of Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - D P M Brandjes
- Department of Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - V E A Gerdes
- Department of Vascular Medicine, Amsterdam University Medical Centre, Amsterdam, The Netherlands.,Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, The Netherlands
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12
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Bonouvrie DS, de Boer H, Aarts EO. Three-year follow-up of bone status in male patients after bariatric surgery-a prospective single-center cohort study. Surg Obes Relat Dis 2020; 17:771-779. [PMID: 33436310 DOI: 10.1016/j.soard.2020.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/21/2020] [Accepted: 11/20/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND In women, bariatric surgery (BS) leads to a decline in bone mineral density (BMD) and may ultimately lead to premature osteoporosis. The impact in men is largely unknown. OBJECTIVE To assess the effect of BS on bone metabolism in males. SETTING Single-center prospective cohort study. METHODS Twenty-four male BS candidates were prospectively enrolled. Anthropometric characteristics, serum gonadal hormones, markers of bone metabolism, and BMD were measured at baseline, 6-, 12- and 36-months postoperatively. RESULTS Roux-en-Y gastric bypass (RYGB) and adjustable gastric banding (AGB) were performed in 15 and 9 patients, respectively. Nineteen patients completed the 3-year follow-up. At 3 years, BMD of the right and left femur had decreased by 9.1 ± 7.2% and 9.4 ± 5.8% for RYGB and by 6.7 ± 3.9% and 4.5 ± 2.8% for AGB. Radius BMD had decreased by 14.0 ± 5.6% for RYGB and 5.9 ± 4.1% for AGB, i.e., significantly stronger for RYGB (P = .006). Serum parathyroid hormone increased in both groups and 13 of 19 patients developed Vitamin D deficiency. A significant increase of the bone resorption marker was seen only during the first year despite continuation of bone loss. Four patients developed de novo osteopenia or osteoporosis. No fractures were observed. CONCLUSION There are strong indications that male bone metabolism response after BS differs from female metabolism. The most affected site is the radius. In males, the cause of this BMD loss seems multifactorial, including mechanical unloading, hyperparathyroidism, and hypogonadism. However, clinical relevance remains unknown and therefore studies with longer-term follow-up are necessary.
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Affiliation(s)
| | - Hans de Boer
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, Netherlands
| | - Edo O Aarts
- WeighWorks Clinics, Obesity Treatment, Oosterbeek, Netherlands; Obesity Treatment, Allurion Clinic, Hilversum, Netherlands
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13
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Chen X, Zhang J, Zhou Z. Changes in Bone Mineral Density After Weight Loss Due to Metabolic Surgery or Lifestyle Intervention in Obese Patients. Obes Surg 2020; 31:1147-1157. [PMID: 33145717 DOI: 10.1007/s11695-020-05095-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Metabolic surgery and lifestyle intervention are two common methods used to treat obesity, but the effects of weight loss on bone mineral density (BMD) remain controversial. Our aim was to evaluate changes in BMD of the total hip, femoral neck, and lumbar spine after weight loss caused by metabolic surgery or lifestyle intervention. MATERIALS AND METHODS We searched PubMed, Web of Science, and the Cochrane Library to identify relevant studies published before 5 August 2020. The primary outcomes, including the BMD of the total hip, femoral neck, and lumbar spine before and 12 months after metabolic surgery or lifestyle intervention, were extracted. RESULTS A total of 19 studies with 1095 participants with obesity were included. Among them, 603 participants with obesity accepted metabolic surgery, while 492 accepted lifestyle intervention. At 12 months after weight loss, the BMD of the total hip decreased significantly in obese patients (mean difference [MD] = 0.06 g/cm2; 95% confidence interval [CI] 0.03 to 0.08; I2 = 67%; P < 0.001), while the BMD of the lumbar spine did not significantly change (P > 0.05). In the subgroup analysis, the BMD of the femoral neck decreased significantly at 12 months in obese patients who underwent metabolic surgery (MD = 0.08 g/cm2; 95% CI 0.04 to 0.13; I2 = 84%; P < 0.001), while it did not significantly change in obese patients who underwent lifestyle treatment (P > 0.05). CONCLUSION Regardless of whether the patients underwent metabolic surgery or lifestyle treatment, the BMD of the total hip significantly decreased in obese patients after weight loss. Different methods used to lose weight may have different effects on the BMD of the femoral neck. Prospective studies, preferably randomized controlled trials (RCTs), are still required to investigate whether the effects of the two treatments on bone metabolism are truly different.
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Affiliation(s)
- Xi Chen
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Jingjing Zhang
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
| | - Zhiguang Zhou
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
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14
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Bone Mineral Density, Parathyroid Hormone, and Vitamin D After Gastric Bypass Surgery: a 10-Year Longitudinal Follow-Up. Obes Surg 2020; 30:4995-5000. [PMID: 32860128 PMCID: PMC7719110 DOI: 10.1007/s11695-020-04912-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 08/04/2020] [Accepted: 08/10/2020] [Indexed: 12/03/2022]
Abstract
Background The aim of the present study was to study longitudinal changes in bone mineral density (BMD), vitamin D, and parathyroid hormone (PTH) levels in females over a 10-year period after laparoscopic Roux-en-Y gastric bypass (LRYGB). Methods Twenty-three women, mean age 43.4 ± 8.7 years and mean body mass index (BMI) 44.6 ± 5.17 kg/m2 at baseline, were included. BMD, BMI, S-calcium, S-25(OH)-vitamin D, and fP-PTH were measured preoperatively and 2, 5, and 10 years postoperatively. Results Ten years after surgery, BMD of the spine and femoral neck decreased by 20% and 25%, respectively. Changes in serum levels of vitamin D, PTH, and calcium over the same period were small. Conclusion After LRYGB with subsequent massive weight loss, a large decrease in BMD of the spine and femoral neck was seen over a 10-year postoperative period. The fall in BMD largely occurred over the first 5 years after surgery.
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15
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Mansour J, Yammine K, El Alam A, Al-Hajj G, Assi C. Bilateral subtrochanteric insufficiency fracture following mini-gastric bypass. A case report. SICOT J 2020; 6:32. [PMID: 32857035 PMCID: PMC7453788 DOI: 10.1051/sicotj/2020034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/14/2020] [Indexed: 11/14/2022] Open
Abstract
Insufficiency fractures are a common complication of bisphosphonate use and have recently been reported in association with Roux-en-Y Gastric Bypass Surgery (RYGB). This study reports a case of a 62-year-old female, 6 years status post Mini Gastric Bypass – One Anastomosis Gastric Bypass (MGB-OAGB), presenting to our institution with bilateral groin pain of 8 months duration unresponsive to conservative management. Diagnostic workup revealed bilateral medial sub-trochanteric insufficiency fractures. She underwent bilateral intramedullary fixation with satisfactory results. This case might suggest a particular fracture pattern in patients undergoing MGB-OAGB, and raises awareness to screen patients with such presentation to rule out a fracture or to prevent the extension of an existing one.
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Affiliation(s)
- Jad Mansour
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, P.O. Box 11-3288, Beirut, Lebanon - The Center for Evidence-Based Anatomy, Sports & Orthopedic Research, Dubai, United Arab Emirates
| | - Kaissar Yammine
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, P.O. Box 11-3288, Beirut, Lebanon - The Center for Evidence-Based Anatomy, Sports & Orthopedic Research, Dubai, United Arab Emirates
| | - Anthony El Alam
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, P.O. Box 11-3288, Beirut, Lebanon
| | - George Al-Hajj
- Department of General Surgery, Lebanese American University Medical Center-Rizk Hospital, Beirut, and Middle East Institute of Health, Bsalim, Lebanon
| | - Chahine Assi
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, P.O. Box 11-3288, Beirut, Lebanon - The Center for Evidence-Based Anatomy, Sports & Orthopedic Research, Dubai, United Arab Emirates
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16
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Roux-en-Y gastric bypass and gastric sleeve surgery result in long term bone loss. Int J Obes (Lond) 2020; 45:235-246. [PMID: 32848203 DOI: 10.1038/s41366-020-00660-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 07/14/2020] [Accepted: 08/15/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Little is known about the long-term skeletal impact of bariatric procedures, particularly the increasingly commonly performed gastric sleeve surgery (GS). We examined bone density (BMD) change following three types of bariatric surgery Roux-en-Y gastric bypass (RYGB), GS and laparoscopic adjustable gastric banding (LAGB), compared with diet, over 36 months. METHODS Non-randomized, prospective study of participants with severe obesity (n = 52), undergoing weight-loss interventions: RYGB (n = 7), GS (n = 21), LAGB (n = 11) and diet (n = 13). Measurements of calciotropic indices, gut hormones (fasting and post prandial) peptide YY (PYY), glucagon-like peptide 1 (GLP1) and adiponectin together with dual-X-ray absorptiometry and quantitative computed tomography scans were performed thorough the study. RESULTS All groups lost weight during the first 12 months. Despite weight stability from 12 to 36 months and supplementation of calcium and vitamin D, there was progressive bone loss at the total hip (TH) over 36 months in RYGB -14% (95% CI: -12, -17) and GS -9% (95% CI: -7, -10). In RYGB forearm BMD also declined over 36 months -9% (95% CI: -6, -12) and LS BMD declined over the first 12 months -7% (95% CI: -3, -12). RYGB and GS groups experienced significantly greater bone loss until 36 months than LAGB and diet groups, which experienced no significant BMD loss. These bone losses remained significant after adjustment for weight loss and age. RYGB and GS procedures resulted in elevated postprandial PYY, adiponectin and bone turnover markers up to 36 months without such changes among LAGB and diet participants. CONCLUSIONS RYGB and GS but not LAGB resulted in ongoing TH bone loss for three postoperative years. For RYGB, bone loss was also observed at LS and non-weight-bearing forearms. These BMD changes were independent of weight and age differences. We, therefore, recommend close monitoring of bone health following RYGB and GS surgeries.
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17
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Guerrero-Pérez F, Casajoana A, Gómez-Vaquero C, Virgili N, López-Urdiales R, Hernández-Montoliu L, Pujol-Gebelli J, Osorio J, Prats A, Vidal-Alabró A, Pérez-Maraver M, Fernández-Veledo S, Vendrell J, Vilarrasa N. Long-Term Effects in Bone Mineral Density after Different Bariatric Procedures in Patients with Type 2 Diabetes: Outcomes of a Randomized Clinical Trial. J Clin Med 2020; 9:jcm9061830. [PMID: 32545353 PMCID: PMC7356739 DOI: 10.3390/jcm9061830] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 11/16/2022] Open
Abstract
There is scant evidence of the long-term effects of bariatric surgery on bone mineral density (BMD). We compared BMD changes in patients with severe obesity and type 2 diabetes (T2D) 5 years after randomization to metabolic gastric bypass (mRYGB), sleeve gastrectomy (SG) and greater curvature plication (GCP). We studied the influence of first year gastrointestinal hormone changes on final bone outcomes. Forty-five patients, averaging 49.4 (7.8) years old and body mass index (BMI) 39.4 (1.9) kg/m2, were included. BMD at lumbar spine (LS) was lower after mRYGB compared to SG and GCP: 0.89 [0.82;0.94] vs. 1.04 [0.91;1.16] vs. 0.99 [0.89;1.12], p = 0.020. A higher percentage of LS osteopenia was present after mRYGB 78.6% vs. 33.3% vs. 50.0%, respectively. BMD reduction was greater in T2D remitters vs. non-remitters. Weight at fifth year predicted BMD changes at the femoral neck (FN) (adjusted R2: 0.3218; p = 0.002), and type of surgery (mRYGB) and menopause predicted BMD changes at LS (adjusted R2: 0.2507; p < 0.015). In conclusion, mRYGB produces higher deleterious effects on bone at LS compared to SG and GCP in the long-term. Women in menopause undergoing mRYGB are at highest risk of bone deterioration. Gastrointestinal hormone changes after surgery do not play a major role in BMD outcomes.
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Affiliation(s)
- Fernando Guerrero-Pérez
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (F.G.-P.); (N.V.); (R.L.-U.); (L.H.-M.); (M.P.-M.)
| | - Anna Casajoana
- Bariatric Surgery Unit, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.C.); (J.P.-G.); (J.O.)
| | - Carmen Gómez-Vaquero
- Department of Rheumatology, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | - Nuria Virgili
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (F.G.-P.); (N.V.); (R.L.-U.); (L.H.-M.); (M.P.-M.)
| | - Rafael López-Urdiales
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (F.G.-P.); (N.V.); (R.L.-U.); (L.H.-M.); (M.P.-M.)
| | - Laura Hernández-Montoliu
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (F.G.-P.); (N.V.); (R.L.-U.); (L.H.-M.); (M.P.-M.)
| | - Jordi Pujol-Gebelli
- Bariatric Surgery Unit, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.C.); (J.P.-G.); (J.O.)
| | - Javier Osorio
- Bariatric Surgery Unit, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.C.); (J.P.-G.); (J.O.)
| | - Anna Prats
- Clinical Nutrition Unit, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | - Anna Vidal-Alabró
- Instituto de Investigación Biomédica-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | - Manuel Pérez-Maraver
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (F.G.-P.); (N.V.); (R.L.-U.); (L.H.-M.); (M.P.-M.)
- Instituto de Investigación Biomédica-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
- CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, 28014 Madrid, Spain; (S.F.-V.); (J.V.)
| | - Sonia Fernández-Veledo
- CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, 28014 Madrid, Spain; (S.F.-V.); (J.V.)
- Pere Virgili Research Institute (IISPV), University Hospital Joan XXIII, 43005and Rovira i Virgili University, 43003 Tarragona, Spain
| | - Joan Vendrell
- CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, 28014 Madrid, Spain; (S.F.-V.); (J.V.)
- Pere Virgili Research Institute (IISPV), University Hospital Joan XXIII, 43005and Rovira i Virgili University, 43003 Tarragona, Spain
| | - Nuria Vilarrasa
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (F.G.-P.); (N.V.); (R.L.-U.); (L.H.-M.); (M.P.-M.)
- CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, 28014 Madrid, Spain; (S.F.-V.); (J.V.)
- Correspondence: ; Tel.: +34-932-602-784
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18
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Ahlin S, Peltonen M, Sjöholm K, Anveden Å, Jacobson P, Andersson-Assarsson JC, Taube M, Larsson I, Lohmander LS, Näslund I, Svensson PA, Carlsson LMS. Fracture risk after three bariatric surgery procedures in Swedish obese subjects: up to 26 years follow-up of a controlled intervention study. J Intern Med 2020; 287:546-557. [PMID: 32128923 DOI: 10.1111/joim.13020] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Previous studies have reported an increased fracture risk after bariatric surgery. OBJECTIVE To investigate the association between different bariatric surgery procedures and fracture risk. METHODS Incidence rates and hazard ratios for fracture events were analysed in the Swedish Obese Subjects study; an ongoing, nonrandomized, prospective, controlled intervention study. Hazard ratios were adjusted for risk factors for osteoporosis and year of inclusion. Information on fracture events were captured from the Swedish National Patient Register. The current analysis includes 2007 patients treated with bariatric surgery (13.3% gastric bypass, 18.7% gastric banding, and 68.0% vertical banded gastroplasty) and 2040 control patients with obesity matched on group level based on 18 variables. Median follow-up was between 15.1 and 17.9 years for the different treatment groups. RESULTS During follow-up, the highest incidence rate for first-time fracture was observed in the gastric bypass group (22.9 per 1000 person-years). The corresponding incidence rates were 10.4, 10.7 and 9.3 per 1000 person-years for the vertical banded gastroplasty, gastric banding and control groups, respectively. The risk of fracture was increased in the gastric bypass group compared with the control group (adjusted hazard ratio [adjHR] 2.58; 95% confidence interval [CI] 2.02-3.31; P < 0.001), the gastric banding group (adjHR 1.99; 95%CI 1.41-2.82; P < 0.001), and the vertical banded gastroplasty group (adjHR 2.15; 95% CI 1.66-2.79; P < 0.001). CONCLUSIONS The risk of fracture is increased after gastric bypass surgery. Our findings highlight the need for long-term follow-up of bone health for patients undergoing this treatment.
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Affiliation(s)
- S Ahlin
- From the, Department of Molecular and Clinical Medicine, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Peltonen
- Department of Chronic Disease Prevention, National Institute of Health and Welfare, Helsinki, Finland
| | - K Sjöholm
- From the, Department of Molecular and Clinical Medicine, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Å Anveden
- From the, Department of Molecular and Clinical Medicine, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Surgery, Halland Hospital, Halmstad, Sweden
| | - P Jacobson
- From the, Department of Molecular and Clinical Medicine, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - J C Andersson-Assarsson
- From the, Department of Molecular and Clinical Medicine, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - M Taube
- From the, Department of Molecular and Clinical Medicine, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - I Larsson
- From the, Department of Molecular and Clinical Medicine, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Unit of Clinical Nutrition, Department of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - L S Lohmander
- Faculty of Medicine, Department of Clinical Sciences Lund, Lund University, Orthopedics, Sweden
| | - I Näslund
- Department of Surgery, Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden
| | - P-A Svensson
- From the, Department of Molecular and Clinical Medicine, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - L M S Carlsson
- From the, Department of Molecular and Clinical Medicine, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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19
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Svanevik M, Risstad H, Hofsø D, Blom-Høgestøl IK, Kristinsson JA, Sandbu R, Småstuen MC, Thorsby PM, Mala T, Hjelmesæth J. Bone Turnover Markers After Standard and Distal Roux-en-Y Gastric Bypass: Results from a Randomized Controlled Trial. Obes Surg 2020; 29:2886-2895. [PMID: 31065919 DOI: 10.1007/s11695-019-03909-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass is associated with increased risk of bone fractures. Malabsorptive procedures may be associated with secondary hyperparathyroidism and detrimental effects on bone health. We aimed to compare the effects of standard and distal gastric bypass on bone turnover markers 2 years after surgery. METHODS Patients with body mass index (BMI) 50-60 kg/m2 (n = 113) were randomized to standard or distal gastric bypass, 105 patients (95%) completed 2-year follow-up. Serum C-terminal telopeptide of type I collagen (CTX-1), procollagen type I N-propeptide (PINP), and bone-derived alkaline phosphatase (BALP) was measured at baseline and up to 2 years after surgery. ANCOVA and linear mixed models were used to compare groups. RESULTS The levels of bone turnover markers increased significantly in both groups, with no statistically significant difference between groups. Two years after standard and distal gastric bypass mean (SD) CTX-1 were 0.81 (0.32) and 0.83 (0.31) μg/L (p = 0.38), mean PINP was 77.6 (23.2) and 77.7 (29.3) μg/L (p = 0.42), and BALP 47.9 (21.9) vs. 50.7 (19.6) μg/L (p = 0.38), respectively. Multiple linear regression analyses showed that PINP and BALP correlated positively (p = 0.01 and p < 0.001) with PTH, but only BALP was significantly higher in patients with secondary hyperparathyroidism (p = 0.001). Type of surgery, vitamin D serum concentrations, and 2-year BMI were all independently associated with PTH levels. CONCLUSION A comparable increase in bone turnover markers 2 years after standard and distal gastric bypass was observed. There was a higher prevalence of secondary hyperparathyroidism after distal gastric bypass, but this did not impact bone turnover markers. TRIAL REGISTRATION Clinical Trials.gov number NCT00821197.
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Affiliation(s)
- Marius Svanevik
- Morbid Obesity Center, Vestfold Hospital Trust, Tønsberg, Norway. .,Department of Endocrinology, Morbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway. .,Department of Gastrointestinal Surgery, Vestfold Hospital Trust, Tønsberg, Norway.
| | - Hilde Risstad
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Dag Hofsø
- Morbid Obesity Center, Vestfold Hospital Trust, Tønsberg, Norway
| | - Ingvild K Blom-Høgestøl
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Jon A Kristinsson
- Department of Morbid Obesity and Bariatric Surgery, Oslo University Hospital, Oslo, Norway
| | - Rune Sandbu
- Morbid Obesity Center, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Gastrointestinal Surgery, Vestfold Hospital Trust, Tønsberg, Norway
| | - Milada Cvancarova Småstuen
- Morbid Obesity Center, Vestfold Hospital Trust, Tønsberg, Norway.,Oslo Metropolitan University, Oslo, Norway
| | - Per Medbøe Thorsby
- Hormone Laboratory, Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Tom Mala
- Department of Morbid Obesity and Bariatric Surgery, Oslo University Hospital, Oslo, Norway.,Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway
| | - Jøran Hjelmesæth
- Morbid Obesity Center, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Endocrinology, Morbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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20
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Santos D, Lopes T, Jesus P, Cruz S, Cordeiro A, Pereira S, Saboya C, Ramalho A. Bone Metabolism in Adolescents and Adults Undergoing Roux-En-Y Gastric Bypass: a Comparative Study. Obes Surg 2020; 29:2144-2150. [PMID: 30820885 DOI: 10.1007/s11695-019-03797-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To compare the bone metabolism of adolescents and adults with obesity before undergoing a Roux-en-Y gastric bypass (RYGB) and 6 and 12 months after the surgery. MATERIALS AND METHODS Adolescents (G1) and adults (G2) with obesity assessed before (T0), six (T1), and 12 months after (T2) RYGB. Sun exposure, serum concentrations of 25(OH)D, calcium, phosphorous, magnesium, zinc, alkaline phosphatase, parathyroid hormone (PTH), and bone mineral density (BMD) were evaluated. RESULTS Sixty adolescents and 60 adults were assessed. At T0, there was no significant difference between the groups' serum 25(OH)D levels (G1 21.87 + 7.52 ng/mL, G2 21.73 + 7.60 ng/mL, p = 0.94) or sun exposure (G1 17 ± 2.0 min/day, G2 13.2 ± 5.2 min/day, p = 0.85). G1 had high levels of inadequacy of calcium (66.7%), phosphorous (80.0%), and zinc (18.3%) at T0 and had a significant fall in their 25(OH)D (p < 0.01) and magnesium (p < 0.01) levels from T1 to T2. G2 saw a significant lowering of their serum zinc levels from T0 to T1 and T2 (T1 p < 0.01; T2 p < 0.01). In both groups, there was a significant rise in PTH from T1 to T2 (G1 p = 0.04, G2 p = 0.02) and from T0 to T2 (G1 and G2 p < 0.01). In G2, 40.4% of individuals with osteopenia and osteoporosis presented inadequacy of 25(OH)D. CONCLUSION RYGB was found to worsen the inadequacy of micronutrients related to bone metabolism and was associated with secondary hyperparathyroidism and low BMD values, especially among the adolescents. The irreversible damaging effects of obesity on bone metabolism can occur in adolescence.
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Affiliation(s)
- Débora Santos
- Researcher of the Center for Research on Micronutrients (NPqM) of the Institute of Nutrition Josué de Castro of Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, 21.941-902, Brazil
| | - Tais Lopes
- Researcher of the Center for Research on Micronutrients (NPqM) of the Institute of Nutrition Josué de Castro of Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, 21.941-902, Brazil
| | - Patrícia Jesus
- Researcher of the Center for Research on Micronutrients (NPqM) of the Institute of Nutrition Josué de Castro of Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, 21.941-902, Brazil.,School of Medicine at Federal University of Rio de Janeiro (UFRJ), Carlos Chagas avenue, 373. Edifício do Centro de Ciências da Saúde, 2° floor, room 49. Cidade Universitária - Ilha do Fundão, Rio de Janeiro, 21.941-902, Brazil
| | - Sabrina Cruz
- Researcher of the Center for Research on Micronutrients (NPqM) of the Institute of Nutrition Josué de Castro of Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, 21.941-902, Brazil. .,School of Medicine at Federal University of Rio de Janeiro (UFRJ), Carlos Chagas avenue, 373. Edifício do Centro de Ciências da Saúde, 2° floor, room 49. Cidade Universitária - Ilha do Fundão, Rio de Janeiro, 21.941-902, Brazil.
| | - Adryana Cordeiro
- Researcher of the Center for Research on Micronutrients (NPqM) of the Institute of Nutrition Josué de Castro of Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, 21.941-902, Brazil.,School of Medicine at Federal University of Rio de Janeiro (UFRJ), Carlos Chagas avenue, 373. Edifício do Centro de Ciências da Saúde, 2° floor, room 49. Cidade Universitária - Ilha do Fundão, Rio de Janeiro, 21.941-902, Brazil
| | - Silvia Pereira
- Multidisciplinary Center for Bariatric and Metabolic Surgery, School of Medicine of Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.,Researcher of the NPqM at Federal University of Rio de Janeiro, (UFRJ), Rio de Janeiro, Brazil
| | - Carlos Saboya
- Multidisciplinary Center for Bariatric and Metabolic Surgery, School of Medicine of Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.,Researcher of the NPqM at Federal University of Rio de Janeiro, (UFRJ), Rio de Janeiro, Brazil.,Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Andréa Ramalho
- Researcher of the NPqM at Federal University of Rio de Janeiro, (UFRJ), Rio de Janeiro, Brazil.,Department of Social and Applied Nutrition of the Institute of Nutrition at UFRJ. Coordinator of the Center for Research on Micronutrients (NPqM) of the Institute of Nutrition Josué de Castro of UFRJ, Rio de Janeiro, Brazil
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21
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Xu K, Ma J, Liu Z, Wang X, Yan S, Liu Z, Sun F, Wang K. Effect of Sleeve Gastrectomy on Bone Metabolism and Serum 5-Hydroxytryptamine in Obese Rats. Med Sci Monit 2020; 26:e924097. [PMID: 32324718 PMCID: PMC7193245 DOI: 10.12659/msm.924097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Studies have shown that bariatric surgery, such as sleeve gastrectomy (SG), has an adverse effect on bone, including decreased bone mineral density (BMD) and bone metabolism. Peripheral 5-hydroxytryptamine (5-HT) has an adverse regulatory effect on bone formation. Here, we assessed changes in bone metabolism and whether 5-HT is involved in the effect of SG on bone metabolism. MATERIAL AND METHODS A rat model of obesity was established using Wistar rats. After successful modeling, rats were randomly assigned to 2 groups - the SG group and the Sham group - with 10 rats in each group. We then performed sleeve gastrectomy or sham operation. Bone metabolic markers and BMD of rats were measured at 2 and 16 weeks after the operation and the level of 5-HT in serum was determined. Rats were killed at 16 weeks after the operation, and bones of the hind limbs were harvested to measure 5-HT by immunofluorescence. RESULTS BMD was decreased and bone metabolism demonstrated a trend of bone destruction in the rats after SG. A significantly increasing trend in the level of serum 5-HT was found, and bone immunofluorescence showed increased expression of 5-HT. CONCLUSIONS BMD was decrease and bone metabolism demonstrated a trend of bone destruction after SG. SG can affect the level of 5-HT in serum or bone tissue and the 5-HT may be involved in the process through which SG affects bone metabolism.
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Affiliation(s)
- Kai Xu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland).,Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China (mainland)
| | - Junxing Ma
- Gastrointestinal Surgery, Feicheng Hospital Affiliated to Shandong First Medical University, Feicheng People's Hospital, Feicheng, Shandong, China (mainland)
| | - Zhi Liu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Xiaoyang Wang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Shaohua Yan
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland).,Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China (mainland)
| | - Zitian Liu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland).,Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China (mainland)
| | - Fuyun Sun
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland).,Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China (mainland)
| | - Kexin Wang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
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22
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Hewitt S, Kristinsson J, Aasheim ET, Blom-Høgestøl IK, Aaseth E, Jahnsen J, Eriksen EF, Mala T. Relationships Between Vitamin D Status and PTH over 5 Years After Roux-en-Y Gastric Bypass: a Longitudinal Cohort Study. Obes Surg 2020; 30:3426-3434. [PMID: 32306297 PMCID: PMC7378105 DOI: 10.1007/s11695-020-04582-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Purpose Secondary hyperparathyroidism (SHPT) after obesity surgery may affect bone health. Optimal vitamin D levels have not been established to prevent SHPT postoperatively. We investigated whether SHPT differed across threshold levels of serum 25-hydroxyvitamin D (S-25(OH)D) from 6 months up to 5 years after Roux-en-Y gastric bypass (RYGB). Materials and Methods We included 554 patients at follow-up 5 years postoperatively. Blood samples were analysed for S-25(OH)D, ionized calcium (iCa) and parathyroid hormone (PTH) during follow-up. Results PTH and prevalence of SHPT increased from 6 months to 5 years postoperatively, while S-25(OH)D and iCa decreased (all P < 0.001). PTH and SHPT development are related with S-25(OH)D, and PTH differed between all subgroups of S-25(OH)D. SHPT occurred less frequently across all subgroups of S-25(OH)D ≥ 50 nmol/l during follow-up: odds ratio (OR) 0.44 (95% CI 0.36–0.54) in patients with S-25(OH)D ≥ 50 nmol/l, OR 0.38 (0.30–0.49) with S-25(OH)D ≥ 75 nmol/l and OR 0.19 (0.12–0.31) with S-25(OH) D ≥ 100 nmol/l, all compared with S-25(OH)D < 50 nmol/l. At 5 years, 208/554 patients (38%) had SHPT; SHPT was found in 94/188 patients (50%) with S-25(OH)D < 50 nmol/l, in 69/222 (31%) with S-25(OH)D 50–74 nmol/l, in 40/117 (34%) with S-25(OH)D 75–99 nmol/l and in 5/27 (19%) with S-25(OH)D ≥ 100 nmol/l. An interaction existed between S-25(OH)D and iCa. Bone alkaline phosphatase remained increased with SHPT. Conclusions A significant relationship existed between S-25(OH)D and development of PTH and SHPT. The prevalence of SHPT was lower with threshold levels 25(OH)D ≥ 50 nmol/l and ≥ 75 nmol/l over the 5 years, and lowest with S-25(OH)D ≥ 100 nmol/l. Electronic supplementary material The online version of this article (10.1007/s11695-020-04582-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stephen Hewitt
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital HF, Aker, P.O. Box 4950 Nydalen, 0424, Oslo, Norway. .,Institute of Clinical Medicine, University of Oslo, 0450, Oslo, Norway.
| | - Jon Kristinsson
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital HF, Aker, P.O. Box 4950 Nydalen, 0424, Oslo, Norway.,Department of Gastrointestinal Surgery, Oslo University Hospital, P.O. Box 4950, Nydalen, 0407, Oslo, Norway
| | - Erlend Tuseth Aasheim
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital HF, Aker, P.O. Box 4950 Nydalen, 0424, Oslo, Norway.,Department of Global Health and Documentation, Norwegian Directorate of Health, P.O. Box 220, Skøyen, 0213, Oslo, Norway
| | - Ingvild Kristine Blom-Høgestøl
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital HF, Aker, P.O. Box 4950 Nydalen, 0424, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, 0450, Oslo, Norway
| | - Eirik Aaseth
- Department of Medicine, Innlandet Hospital Trust, Elverum, Norway
| | - Jørgen Jahnsen
- Institute of Clinical Medicine, University of Oslo, 0450, Oslo, Norway.,Department of Gastroenterology, Akershus University Hospital, 1474, Lørenskog, Norway
| | - Erik Fink Eriksen
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital HF, Aker, P.O. Box 4950 Nydalen, 0424, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, 0450, Oslo, Norway
| | - Tom Mala
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital HF, Aker, P.O. Box 4950 Nydalen, 0424, Oslo, Norway.,Department of Gastrointestinal Surgery, Oslo University Hospital, P.O. Box 4950, Nydalen, 0407, Oslo, Norway
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23
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Madsen LR, Espersen R, Ornstrup MJ, Jørgensen NR, Langdahl BL, Richelsen B. Bone Health in Patients with Type 2 Diabetes Treated by Roux-En-Y Gastric Bypass and the Role of Diabetes Remission. Obes Surg 2020; 29:1823-1831. [PMID: 30719648 DOI: 10.1007/s11695-019-03753-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) has been associated with negative effects on bone. Whether this association is affected by pre-surgical type 2 diabetes (T2D) and surgically induced diabetes remission is unknown. METHODS In this cross-sectional, matched cohort study 6 years after RYGB, we investigated bone health in 96 individuals with body mass index (BMI) > 35 kg/m2 and T2D (stratified on current diabetes status) treated by RYGB 6 years earlier compared with 49 non-operated individuals with T2D matched with respect to sex, age, and current BMI. Main outcome measures were areal and volumetric bone mineral density (aBMD and vBMD), bone turnover, and odds ratio of osteoporosis/osteopenia. RESULTS The RYGB group had lower hip (0.916 vs 1.010 g/cm2, p < 0.001), forearm (0.497 g/cm2 vs 0.554 g/cm2, p < 0.001) aBMD, (269.63 mg/cm3 vs 306.07 mg/cm3, p < 0.001) tibial, and radial (238.57 mg/cm3 vs 278.14 mg/cm3, p < 0.0001) vBMD than the control group. Relative to the control group, c-terminal cross-linked telopeptide, procollagen type I amino-terminal propeptide, and osteocalcin were 75%, 41%, and 72% higher in the RYGB group, respectively (all p < 0.001). Odds ratio for osteopenia/osteoporosis in operated individuals was 2.21 (95% CI 1.06; 4.79, p = 0.05). Overall, stratified analysis on current diabetes status did not alter these outcomes. CONCLUSIONS Individuals with T2D treated by RYGB, compared to individuals with T2D of similar age and body composition not treated by RYGB, have lower BMD, lower bone strength, and increased levels of several bone turnover markers. Bone health was not associated with current diabetes status in the RYGB group.
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Affiliation(s)
- Lene Ring Madsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark. .,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 132, 8200, Aarhus N, Denmark.
| | - Rasmus Espersen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 132, 8200, Aarhus N, Denmark
| | - Marie Juul Ornstrup
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Niklas Rye Jørgensen
- Department of Clinical Biochemistry, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Odense Patient Data Explorative Network, Odense University Hospital/Institute of Clinical Research, B. Winsløws Vej 9 A, University of Southern Denmark, 5000, Odense C, Denmark
| | - Bente Lomholt Langdahl
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 132, 8200, Aarhus N, Denmark
| | - Bjørn Richelsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 132, 8200, Aarhus N, Denmark
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24
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Hansen S, Jørgensen NR, Hermann AP, Støving RK. Continuous decline in bone mineral density and deterioration of bone microarchitecture 7 years after Roux-en-Y gastric bypass surgery. Eur J Endocrinol 2020; 182:303-311. [PMID: 31940278 PMCID: PMC7087496 DOI: 10.1530/eje-19-0741] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 01/14/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Roux-en-Y-gastric bypass (RYGB) surgery is an effective treatment for morbid obesity. A possible overlooked side effect is negative bone metabolic consequences. DESIGN A seven-year prospective study following ten women and seven men after RYGB (baseline mean age 43 ± 8 years, BMI 42 ± 6 kg/m2). METHODS Lumbar spine and total hip bone mineral density (BMD) using dual energy x-ray absorptiometry, distal radius and tibia bone geometry, volumetric BMD, microarchitecture and finite element estimated bone strength using high-resolution peripheral quantitative CT and biochemical markers of bone remodelling were assessed at baseline, 2 and 7 years. RESULTS Compared to baseline, body weight was 24 ± 10% lower after 2 years and 21 ± 11% after 7 years. During the 7 years of follow-up, radius and tibia vBMD had declined 13 ± 8% and 8 ± 7% from baseline to 2 years and further 10 ± 7% and 7 ± 8% from 2 to 7 years (all P < 0.001). At both radius and tibia, cortical thickness declined and cortical porosity increased. From baseline to 7 years, there were clear indications of deteriorations of the trabecular network with fewer, more widely spaced and more in-homogeneously distributed trabeculae in both radius and tibia. Overall, declines in estimated bone strength of 16 ± 9% in radius and 16 ± 7% in tibia were observed (both P < 0.001). CONCLUSION Seven years after RYGB, evidence of continuous declines in BMD and ongoing deterioration of bone microarchitecture and reduced estimated bone strength compared to baseline and 2 years post-surgery results were found. These findings emphasize the need for regular assessment of bone health in patients with prior RYGB.
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Affiliation(s)
- Stinus Hansen
- Department of Medicine, Hospital South West Jutland, Esbjerg, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Correspondence should be addressed to S Hansen;
| | - Niklas Rye Jørgensen
- Department of Clinical Biochemistry, Rigshospitalet, Glostrup, Denmark
- OPEN, Odense Patient data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anne Pernille Hermann
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Rene Klinkby Støving
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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25
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Duran İD, Gülçelik NE, Bulut B, Balcı Z, Berker D, Güler S. Differences in Calcium Metabolism and Thyroid Physiology After Sleeve Gastrectomy and Roux-En-Y Gastric Bypass. Obes Surg 2019; 29:705-712. [PMID: 30460439 DOI: 10.1007/s11695-018-3595-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Bariatric surgery may modulate the hormones and elements which maintain thyroid and calcium homeostasis. These adaptations in hormonal and elemental aspects have previously been determined via some studies with variations in their findings. Thyroid volume and 24-h urinary calcium are two parameters which have not been investigated regarding whether they change during the bariatric postsurgical period. This study planned to examine the changes in calcium metabolism and thyroid gland functioning after sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). MATERIALS AND METHODS Seventy-three morbidly obese patients with planned bariatric surgery were enrolled in the study. Before and 12 months after the operation, parathormone (PTH), 25-OH-vitamin D3(25vitD3), TSH, free triiodothyronine (fT3), free thyroxine (fT4), calcium (Ca), 24-h urinary Ca and ultrasonography-guided thyroid volume were measured. RESULTS In the beginning, 73 patients were examined and 12 months after surgery out of 25 patients continuing follow-up, 20 (80%) had undergone sleeve gastrectomy (SG) while five (20%) had undergone Roux-en-Y gastric bypass (RYGB). Accompanied by significant BMI decrease, 24-h urinary Ca and thyroid volume did not significantly increase in RYGB, SG, and the whole group after 12 months. The SG group showed a significant drop in TSH (p 0.03) level, while the RYGB group showed significant decreases in fT4 (p 0.00) and fT3 (p 0.00); and significant fT3 decrease (p 0.01) was recorded for the whole group. CONCLUSION Bariatric surgery may modify Ca homeostasis and thyroid gland functional status. We documented that these were not statistically significant increases in 24-h urinary Ca level and thyroid volume after 1 year. Further studies are needed to understand the issue, enrolling more patients who underwent the same bariatric procedure and after accounting for the inhibition of supplementary vitamin and mineral effects.
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Affiliation(s)
- İffet Dağdelen Duran
- Ankara Numune Education and Research Hospital, Department of Endocrinology and Metabolic Diseases, TC. Sağlık Bakanlığı, Ankara, Turkey.
| | - Neşe Ersöz Gülçelik
- Ankara Gülhane Education and Research Hospital, Department of Endocrinology and Metabolic Diseases, TC. Sağlık Bakanlığı, Ankara, Turkey
| | - Bekir Bulut
- Ankara Numune Education and Research Hospital, Department of General Surgery, TC. Sağlık Bakanlığı, Ankara, Turkey
| | - Zeynep Balcı
- Ankara Numune Education and Research Hospital, Department of General Surgery, TC. Sağlık Bakanlığı, Ankara, Turkey
| | - Dilek Berker
- Ankara Numune Education and Research Hospital, Department of Endocrinology and Metabolic Diseases, TC. Sağlık Bakanlığı, Ankara, Turkey
| | - Serdar Güler
- Ankara Numune Education and Research Hospital, Department of Endocrinology and Metabolic Diseases, TC. Sağlık Bakanlığı, Ankara, Turkey
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26
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Nypaver C, Bernstein J, Mehta S. Bilateral subtrochanteric femur insufficiency fractures after bariatric surgery: a case report. Osteoporos Int 2019; 30:1317-1320. [PMID: 30976889 DOI: 10.1007/s00198-019-04956-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/25/2019] [Indexed: 11/30/2022]
Abstract
There have been case reports of proximal femur insufficiency fractures in patients who have previously undergone bariatric surgery. We present a follow-up case of a patient who developed bilateral complete proximal femur insufficiency fractures several years after bariatric surgery. Our patient underwent bilateral intramedullary fixation with a satisfactory postoperative outcome. We review and discuss the definition and pathogenesis of atypical femur fractures (AFFs), which may represent a larger category of insufficiency fractures not exclusive to bisphosphonate use, which includes patients with fractures after bariatric surgery.
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Affiliation(s)
- C Nypaver
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, 3737 Market Street, 6th Floor, Philadelphia, PA, 19104, USA.
| | - J Bernstein
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, 3737 Market Street, 6th Floor, Philadelphia, PA, 19104, USA
| | - S Mehta
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, 3737 Market Street, 6th Floor, Philadelphia, PA, 19104, USA
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Mumphrey MB, Hao Z, Leigh Townsend R, Qualls-Creekmore E, Yu S, Lutz TA, Münzberg H, Morrison CD, Berthoud HR. Gastric bypass surgery in lean adolescent mice prevents diet-induced obesity later in life. Sci Rep 2019; 9:7881. [PMID: 31133715 PMCID: PMC6536499 DOI: 10.1038/s41598-019-44344-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 05/15/2019] [Indexed: 01/09/2023] Open
Abstract
Gastric bypass surgery is the most effective treatment and is often the only option for subjects with severe obesity. However, investigation of critical molecular mechanisms involved has been hindered by confounding of specific effects of surgery and side effects associated with acute surgical trauma. Here, we dissociate the two components by carrying out surgery in the lean state and testing its effectiveness to prevent diet-induced obesity later in life. Body weight and composition of female mice with RYGB performed at 6 weeks of age were not significantly different from sham-operated and age-matched non-surgical mice at the time of high-fat diet exposure 12 weeks after surgery. These female mice were completely protected from high-fat diet-induced obesity and accompanying metabolic impairments for up to 50 weeks. Similar effects were seen in male mice subjected to RYGB at 5-6 weeks, although growth was slightly inhibited and protection from diet-induced obesity was less complete. The findings confirm that RYGB does not indiscriminately lower body weight but specifically prevents excessive diet-induced obesity and ensuing metabolic impairments. This prevention of obesity model should be crucial for identifying the molecular mechanisms underlying gastric bypass surgery.
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Affiliation(s)
- Michael B Mumphrey
- Neurobiology of Nutrition & Metabolism Department, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
| | - Zheng Hao
- Neurobiology of Nutrition & Metabolism Department, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
| | - R Leigh Townsend
- Neurobiology of Nutrition & Metabolism Department, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
| | - Emily Qualls-Creekmore
- Neurobiology of Nutrition & Metabolism Department, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
| | - Sangho Yu
- Neurobiology of Nutrition & Metabolism Department, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
| | - Thomas A Lutz
- Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
| | - Heike Münzberg
- Neurobiology of Nutrition & Metabolism Department, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
| | - Christopher D Morrison
- Neurobiology of Nutrition & Metabolism Department, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
| | - Hans-Rudolf Berthoud
- Neurobiology of Nutrition & Metabolism Department, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA.
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Cornejo-Pareja I, Clemente-Postigo M, Tinahones FJ. Metabolic and Endocrine Consequences of Bariatric Surgery. Front Endocrinol (Lausanne) 2019; 10:626. [PMID: 31608009 PMCID: PMC6761298 DOI: 10.3389/fendo.2019.00626] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 08/29/2019] [Indexed: 12/17/2022] Open
Abstract
Obesity is one of the most serious worldwide epidemics of the twenty-first century according to the World Health Organization. Frequently associated with a number of comorbidities, obesity threatens and compromises individual health and quality of life. Bariatric surgery (BS) has been demonstrated to be an effective treatment to achieve not only sustained weight loss but also significant metabolic improvement that goes beyond mere weight loss. The beneficial effects of BS on metabolic traits are so widely recognized that some authors have proposed BS as metabolic surgery that could be prescribed even for moderate obesity. However, most of the BS procedures imply malabsorption and/or gastric acid reduction which lead to nutrient deficiency and, consequently, further complications could be developed in the long term. In fact, BS not only affects metabolic homeostasis but also has pronounced effects on endocrine systems other than those exclusively involved in metabolic function. The somatotropic, corticotropic, and gonadal axes as well as bone health have also been shown to be affected by the various BS procedures. Accordingly, further consequences and complications of BS in the long term in systems other than metabolic system need to be addressed in large cohorts, taking into account each bariatric procedure before making generalized recommendations for BS. In this review, current data regarding these issues are summarized, paying special attention to the somatotropic, corticotropic, gonadal axes, and bone post-operative health.
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Affiliation(s)
- Isabel Cornejo-Pareja
- Unidad de Gestión Clínica Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga—IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
- Centro de Investigación Biomédica en Red (CIBER) Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Málaga, Spain
| | - Mercedes Clemente-Postigo
- Unidad de Gestión Clínica Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga—IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
- Centro de Investigación Biomédica en Red (CIBER) Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Málaga, Spain
- *Correspondence: Mercedes Clemente-Postigo
| | - Francisco J. Tinahones
- Unidad de Gestión Clínica Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga—IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
- Centro de Investigación Biomédica en Red (CIBER) Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Málaga, Spain
- Francisco J. Tinahones
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Mônaco-Ferreira DV, Leandro-Merhi VA, Aranha NC, Brandalise A, Brandalise NA. VITAMIN D DEFICIENCY AND PARATOHOMMONIUM INCREASE IN LATE POSTOPERATIVE GASTRIC BYPASS IN ROUX-EN-Y. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2018; 31:e1407. [PMID: 30539982 PMCID: PMC6284378 DOI: 10.1590/0102-672020180001e1407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 08/17/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass patients can experience changes in calcium metabolism and hyperparathyroidism secondary to vitamin D deficiency. AIM To evaluate nutritional deficiencies related to the calcium metabolism of patients undergoing gastric bypass with a 10-year follow-up. METHOD This is a longitudinal retrospective study of patients submitted to Roux-en-Y gastric bypass at a multidisciplinary clinic located in the Brazilian southeast region. The study investigated the results of the following biochemical tests: serum calcium, ionized calcium, vitamin D, and parathormone (PTH). The generalized estimating equations (GEE) determined the nutritional deficiencies using a significance level of 5%. RESULTS Among the patients who finished the study (120 months), 82.86% (n=29) had vitamin D deficiency, and 41.94% (n=13) had high PTH. Postoperative time had a significant effect on PTH (p=0.0059). The percentages of patients with vitamin D, serum calcium, and ionized calcium deficiencies did not change significantly over time. CONCLUSION One of the outcomes was vitamin D deficiency associated with secondary hyperparathyroidism. These findings reaffirm the importance of monitoring the bone metabolism of patients submitted to Roux-en-Y gastric bypass. HEADINGS Calcium deficiency. Vitamin D deficiency. Secondary hyperparathyroidism.
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30
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Axelsson KF, Werling M, Eliasson B, Szabo E, Näslund I, Wedel H, Lundh D, Lorentzon M. Fracture Risk After Gastric Bypass Surgery: A Retrospective Cohort Study. J Bone Miner Res 2018; 33:2122-2131. [PMID: 30011091 DOI: 10.1002/jbmr.3553] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 06/13/2018] [Accepted: 07/07/2018] [Indexed: 12/20/2022]
Abstract
Gastric bypass surgery constitutes the most common and effective bariatric surgery to treat obesity. Gastric bypass leads to bone loss, but fracture risk following surgery has been insufficiently studied. Furthermore, the association between gastric bypass and fracture risk has not been studied in patients with diabetes, which is a risk factor for fracture and affected by surgery. In this retrospective cohort study using Swedish national databases, 38,971 obese patients undergoing gastric bypass were identified, 7758 with diabetes and 31,213 without. An equal amount of well-balanced controls were identified through multivariable 1:1 propensity score matching. The risk of fracture and fall injury was investigated using Cox proportional hazards and flexible parameter models. Fracture risk according to weight loss and degree of calcium and vitamin D supplementation 1-year postsurgery was investigated. During a median follow-up time of 3.1 (interquartile range [IQR], 1.7 to 4.6) years, gastric bypass was associated with increased risk of any fracture, in patients with and without diabetes using a multivariable Cox model (hazard ratio [HR] 1.26; 95% CI, 1.05 to 1.53; and HR 1.32; 95% CI, 1.18 to 1.47; respectively). Using flexible parameter models, the fracture risk appeared to increase with time. The risk of fall injury without fracture was also increased after gastric bypass. Larger weight loss or poor calcium and vitamin D supplementation after surgery were not associated with increased fracture risk. In conclusion, gastric bypass surgery is associated with an increased fracture risk, which appears to be increasing with time and not associated with degree of weight loss or calcium and vitamin D supplementation following surgery. An increased risk of fall injury was seen after surgery, which could contribute to the increased fracture risk. © 2018 American Society for Bone and Mineral Research.
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Affiliation(s)
- Kristian F Axelsson
- Department of Orthopaedic Surgery, Skaraborg Hospital, Skövde, Sweden.,Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Malin Werling
- Department of Gastrosurgical Research & Education, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björn Eliasson
- Department of Molecular and Clinical Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva Szabo
- Department of Surgery. Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ingmar Näslund
- Department of Surgery. Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Hans Wedel
- Health Metrics, Sahlgrenska Academin, University of Gothenburg, Gothenburg, Sweden
| | - Dan Lundh
- School of Bioscience, University of Skövde, Skövde, Sweden
| | - Mattias Lorentzon
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden
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31
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Lindeman KG, Greenblatt LB, Rourke C, Bouxsein ML, Finkelstein JS, Yu EW. Longitudinal 5-Year Evaluation of Bone Density and Microarchitecture After Roux-en-Y Gastric Bypass Surgery. J Clin Endocrinol Metab 2018; 103:4104-4112. [PMID: 30219833 PMCID: PMC6194805 DOI: 10.1210/jc.2018-01496] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 09/10/2018] [Indexed: 12/13/2022]
Abstract
CONTEXT Bone health declines in the initial years after Roux-en-Y gastric bypass (RYGB), but long-term skeletal effects are unclear. OBJECTIVE To document longitudinal changes in bone mineral density (BMD) and microarchitecture 5 years after RYGB. DESIGN, SETTING, AND PARTICIPANTS Prospective 5-year observational study of 21 adults with severe obesity receiving RYGB at an academic medical center. MAIN OUTCOME MEASURES Spine and hip areal BMD were measured by dual-energy X-ray absorptiometry, and trabecular volumetric BMD (vBMD) of the spine was assessed by quantitative CT (QCT). We measured vBMD and microarchitecture of the distal radius and tibia by high-resolution peripheral QCT in a subset of subjects. Serum type I collagen C-terminal telopeptide (CTX) and procollagen type I N-terminal propeptide (P1NP) were also measured. RESULTS Areal BMD declined by -7.8% ± 7.6% at the spine and -15.3% ± 6.3% at the total hip by 5 years after RYGB (P ≤ 0.001), although the rate of bone loss slowed in later years. Trabecular spine vBMD decreased by -12.1% ± 12.3% by 5 years (P ≤ 0.001). At peripheral sites, vBMD continued to decrease steadily throughout 5 years, with parallel declines in cortical and trabecular microarchitecture, leading to decreases in estimated failure load of -20% and -13% at the radius and tibia, respectively (P < 0.001). Five years after RYGB, CTX and P1NP were 150% and 34% above baseline (P < 0.001 and P = 0.017, respectively). CONCLUSIONS Sustained high-turnover bone loss and bone microarchitectural deterioration occur in the 5 years after RYGB. Adults receiving RYGB warrant assessment of bone health.
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Affiliation(s)
| | | | - Caroline Rourke
- Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Mary L Bouxsein
- Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Joel S Finkelstein
- Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Elaine W Yu
- Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Correspondence and Reprint Requests: Elaine W. Yu, MD, MMSc, Endocrine Unit, Massachusetts General Hospital, 50 Blossom Street, Thier 1051, Boston, Massachusetts 02114. E-mail:
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32
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Unraveling the compromised biomechanical performance of type 2 diabetes- and Roux-en-Y gastric bypass bone by linking mechanical-structural and physico-chemical properties. Sci Rep 2018; 8:5881. [PMID: 29651097 PMCID: PMC5897570 DOI: 10.1038/s41598-018-24229-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 03/06/2018] [Indexed: 02/01/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a metabolic disorder associated with obesity and hyperglycemia. Roux-en-Y gastric bypass (RYGB) surgery is a common treatment for severely obese patients and T2DM. Both RYGB and T2DM are linked to increased skeletal fragility, though the exact mechanisms are poorly understood. Our aim was to characterize the structural, mechanical and compositional properties of bones from diet-induced obese and RYGB-treated obese (bypass) mice to elucidate which the exact factors are contributing to the increased skeletal fragility. To achieve this, a combinatory approach including microfocus X-ray computed tomography, 3-point bending, finite element modeling and Raman spectroscopy, was used. Compared to aged-matched lean controls, the obese mice displayed decreased cortical thickness, trabecular bone loss, decreased stiffness and increased Young’s modulus. For the bypass mice, these alterations were even more pronounced, and additionally they showed low mineral-to-matrix ratio in the cortical endosteal area. Accumulation of the advanced glycation end-product (AGE) pentosidine was found in the cortex of obese and bypass groups and this accumulation was correlated with an increased Young’s modulus. In conclusion, we found that the increased fracture risk in T2DM- and post-RYGB bones is mainly driven by accumulation of AGEs and macro-structural alterations, generating biomechanical dysfunctionality.
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33
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Hewitt S, Aasheim ET, Søvik TT, Jahnsen J, Kristinsson J, Eriksen EF, Mala T. Relationships of serum 25-hydroxyvitamin D, ionized calcium and parathyroid hormone after obesity surgery. Clin Endocrinol (Oxf) 2018; 88:372-379. [PMID: 29235126 DOI: 10.1111/cen.13531] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 12/01/2017] [Accepted: 12/05/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The high prevalence of secondary hyperparathyroidism (SHPT) after obesity surgery is a concern for long-term bone health. Limited knowledge exists about optimal vitamin D and suppression of parathyroid hormone (PTH) after these procedures. The aim of this study was to investigate the prevalence of SHPT and its relation to vitamin D status. DESIGN A cross-sectional study at Oslo University Hospital, Norway. PATIENTS A total of 502 consecutive patients, age 22-64 years, attending 2-year follow-up after Roux-en-Y gastric bypass. MEASUREMENTS A serum intact PTH >7.0 pmol/L in the absence of elevated serum ionized calcium (iCa) was considered as SHPT. Vitamin D status was defined by serum concentrations of 25-hydroxyvitamin D (S-25(OH)D). RESULTS Altogether, 171 patients (34%) had SHPT. The prevalence of SHPT varied across the range of S-25(OH)D (P < 0.001), being highest (71%) with S-25(OH)D < 25 nmol/L. Compared with S-25(OH)D < 50 nmol/L, the prevalence of SHPT was lower with S-25(OH)D ≥ 50 nmol/L (29.0%; RR = 0.64 (95%-CI:0.50-0.81)) and S-25(OH)D ≥ 75 nmol/L (27.7%; RR = 0.61 (95%-CI:0.44-0.84)). S-25(OH)D ≥ 100 nmol/L was associated with the lowest PTH and the lowest prevalence of SHPT (16.0%; RR = 0.35 (95%-CI:0.14-0.88) compared with S-25(OH)D < 50 nmol/L) and the most normal calcium distribution. These associations were most pronounced with iCa in the lower range. A synergistic association was found for S-25(OH)D and iCa on SHPT. CONCLUSIONS Vitamin D deficient patients had the highest prevalence of SHPT 2 years after gastric bypass. PTH and the prevalence of SHPT were notably lower with S-25(OH)D ≥ 100 nmol/L, compared with lower target levels.
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Affiliation(s)
- Stephen Hewitt
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Erlend Tuseth Aasheim
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | | | - Jørgen Jahnsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| | - Jon Kristinsson
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
- Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway
| | - Erik Fink Eriksen
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tom Mala
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
- Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway
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Corbeels K, Verlinden L, Lannoo M, Simoens C, Matthys C, Verstuyf A, Meulemans A, Carmeliet G, Van der Schueren B. Thin bones: Vitamin D and calcium handling after bariatric surgery. Bone Rep 2018; 8:57-63. [PMID: 29955623 PMCID: PMC6019966 DOI: 10.1016/j.bonr.2018.02.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/25/2018] [Accepted: 02/01/2018] [Indexed: 02/06/2023] Open
Abstract
Bariatric surgery has proven to be a valuable treatment option for morbid obesity. However, these procedures can lead to impaired intestinal absorption of calcium and vitamin D, thereby challenging calcium homeostasis and possibly contributing to bone loss leading to an increased fracture risk. Besides calcium and vitamin D malabsorption, hormonal changes occurring after surgery can also be the source of observed bone loss. In this review, first, a case report will be discussed, highlighting the relevance of this topic. Afterwards, changes in bone density and fracture risk, after the two most performed types of bariatric surgery, Sleeve Gastrectomy (SG) and Roux-en-Y Gastric Bypass (RYGB) will be discussed. In addition, we discuss the putative underlying mechanisms leading to bone changes based on both preclinical and clinical observations. Nonetheless, it is clear further research is needed to further elucidate the exact mechanisms of bone loss following bariatric surgery and subsequently identify potential treatment options for bone preservation. Bariatric surgery induces bone loss and leads to increased fracture risk. Bone resorption increases after both SG and, more strongly, after RYGB. Malabsorption and adipose tissue-related hormones likely contribute to bone loss.
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Affiliation(s)
- Katrien Corbeels
- KU Leuven, Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Clinical and Experimental Endocrinology, Leuven, Belgium
| | - Lieve Verlinden
- KU Leuven, Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Clinical and Experimental Endocrinology, Leuven, Belgium
| | - Matthias Lannoo
- KU Leuven, Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Clinical and Experimental Endocrinology, Leuven, Belgium
| | - Caroline Simoens
- KU Leuven, Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Clinical and Experimental Endocrinology, Leuven, Belgium.,KU Leuven, Department of Cellular and Molecular Medicine, Laboratory of Ion Channel Research, VIB Center for Brain and Disease Research, Leuven, Belgium
| | - Christophe Matthys
- KU Leuven, Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Clinical and Experimental Endocrinology, Leuven, Belgium
| | - Annemieke Verstuyf
- KU Leuven, Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Clinical and Experimental Endocrinology, Leuven, Belgium
| | - Ann Meulemans
- KU Leuven, Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Clinical and Experimental Endocrinology, Leuven, Belgium
| | - Geert Carmeliet
- KU Leuven, Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Clinical and Experimental Endocrinology, Leuven, Belgium
| | - Bart Van der Schueren
- KU Leuven, Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Clinical and Experimental Endocrinology, Leuven, Belgium
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35
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Marcil G, Bourget-Murray J, Shinde S, Switzer N, Debru E, Church N, Mitchell P, Reso A, Gill RS. The incidence of fractures following bariatric surgery: A systematic review. INTERNATIONAL JOURNAL OF SURGERY OPEN 2018. [DOI: 10.1016/j.ijso.2018.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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36
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Is Trabecular Bone Score Valuable in Bone Microstructure Assessment after Gastric Bypass in Women with Morbid Obesity? Nutrients 2017; 9:nu9121314. [PMID: 29207490 PMCID: PMC5748764 DOI: 10.3390/nu9121314] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 11/22/2017] [Accepted: 11/28/2017] [Indexed: 12/18/2022] Open
Abstract
Introduction: The effects of bariatric surgery on skeletal health raise many concerns. Trabecular bone score (TBS) is obtained through the analysis of lumbar spine dual X-ray absorptiometry (DXA) images and allows an indirect assessment of skeletal microarchitecture (MA). The aim of our study was to evaluate the changes in bone mineral density (BMD) and alterations in bone microarchitecture assessed by TBS in morbidly obese women undergoing Roux-en-Y gastric bypass (RYGB), over a three-year follow-up. Material/Methods: A prospective study of 38 morbidly obese white women, aged 46.3 ± 8.2 years, undergoing RYGB was conducted. Biochemical analyses and DXA scans with TBS evaluation were performed before and at one year and three years after surgery. Results: Patients showed normal calcium and phosphorus plasma concentrations throughout the study. However, 25-hydroxyvitamin D (25(OH)D3) decreased, and 71% of patients had a vitamin D deficiency at three years. BMD at femoral neck and lumbar spine (LSBMD) significantly decreased 13.53 ± 5.42% and 6.03 ± 6.79%, respectively, during the three-year follow-up; however Z-score values remained above those for women of the same age. TBS was within normal ranges at one and three years (1.431 ± 106 and 1.413 ± 85, respectively), and at the end of the study, 73.7% of patients had normal bone MA. TBS at three years correlated inversely with age (r = −0.41, p = 0.010), body fat (r = −0.465, p = 0.004) and greater body fat deposited in trunk (r = −0.48, p = 0.004), and positively with LSBMD (r = 0.433, p = 0.007), fat mass loss (r = 0.438, p = 0.007) and lean mass loss (r = 0.432, p = 0.008). In the regression analysis, TBS remained associated with body fat (β = −0.625, p = 0.031; R2 = 0.47). The fracture risk, calculated by FRAX® (University of Sheffield, Sheffield, UK), with and without adjustment by TBS, was low. Conclusion: Women undergoing RYGB in the mid-term have a preserved bone MA, assessed by TBS.
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37
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Petzel MQB, Hoffman L. Nutrition Implications for Long-Term Survivors of Pancreatic Cancer Surgery. Nutr Clin Pract 2017; 32:588-598. [DOI: 10.1177/0884533617722929] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Maria Q. B. Petzel
- Department of Clinical Nutrition and Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Leah Hoffman
- Department of Nutritional Sciences, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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38
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Switzer NJ, Marcil G, Prasad S, Debru E, Church N, Mitchell P, Billington EO, Gill RS. Long-term hypovitaminosis D and secondary hyperparathyroidism outcomes of the Roux-en-Y gastric bypass: a systematic review. Obes Rev 2017; 18:560-566. [PMID: 28273687 DOI: 10.1111/obr.12525] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/24/2017] [Accepted: 01/25/2017] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Pre-operative Vitamin D deficiency is markedly prevalent in prospective bariatric surgery patients. While bariatric surgery leads to significant weight loss, it can exacerbate or prolong Vitamin D deficiency. We systematically reviewed the literature to assess whether secondary hyperparathyroidism is maintained in the medium to long term in patients following the Roux-en-Y gastric bypass. METHODS A comprehensive literature search was conducted through Medline, Embase, Scopus, Web of Science, Dare, Cochrane library and HTA database. The search terms used were bariatric surgery, gastric bypass and hyperparathyroidism. RESULTS Fourteen studies were included (n = 2688 subjects). Parathyroid hormone levels rose gradually from a mean pre-operative level of 5.69 ± 1.2 pmol/L to 6.36 ± 0.77 pmol/L, 7.59 ± 0.73 pmol/L and 8.29 ± 1.41 pmol/L at 2 years, between 2 and 5 years, and beyond 5 years, respectively. Vitamin D levels slowly fell to a mean of 20.50 ± 4.37 ng/mL and 20.76 ± 3.80 ng/mL between follow-up intervals 2-5 years and beyond 5, respectively. CONCLUSION It appears that hyperparathyroidism persists at 5-year follow-up after gastric bypass, despite most patients being supplemented with calcium and Vitamin D.
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Affiliation(s)
- N J Switzer
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - G Marcil
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - S Prasad
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - E Debru
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - N Church
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - P Mitchell
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - E O Billington
- Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - R S Gill
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
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Himbert C, Ose J, Delphan M, Ulrich CM. A systematic review of the interrelation between diet- and surgery-induced weight loss and vitamin D status. Nutr Res 2016; 38:13-26. [PMID: 28381350 DOI: 10.1016/j.nutres.2016.12.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 11/30/2016] [Accepted: 12/03/2016] [Indexed: 12/30/2022]
Abstract
Obesity is a major global health problem and has been associated with vitamin D deficiency. Intentional weight loss may alter vitamin D status and, conversely, vitamin D supplementation has been hypothesized to aid in weight loss. A systematic literature search in PubMed/Medline identified 3173 articles of which 37 studies (randomized controlled trials (RCT) [n=17], non-RCTs [n=20]) are summarized as effect of: (I) diet-induced weight loss on vitamin D status (n=7), (II) vitamin D supplementation on diet-induced weight loss (n=11), (III) surgery-induced weight loss on vitamin D status (n=15), and (IV) vitamin D supplementation after surgery-induced weight loss on vitamin D status (n=5). While all studies on the effect of diet-induced weight loss on vitamin D status have consistently reported increased vitamin D levels, the targeted percentage of weight loss that is necessary for an increase has varied between 5% and >10%. N=11 RCTs testing the effect of vitamin D supplementation observe that vitamin D supplementation does not result in increased weight loss, but may affect body fat loss. Vitamin D deficiency and subsequent hyperparathyroidism have been detected in post-surgery patients, and there is evidence that vitamin D supplementation improves these post-surgery complications. We review the current evidence addressing the role of vitamin D status and supplementation in diet- and surgery-induced weight loss. Subsequently, we highlight gaps in current research and suggest directions for future research including differences in vitamin D supplementation dosages, indoor vs. outdoor exercise, and the assessment of vitamin D status in different body pools.
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Affiliation(s)
- Caroline Himbert
- Huntsman Cancer Institute, Population Sciences, Salt Lake City, UT; Department of Population Health Sciences, University of Utah, Salt Lake City, UT; University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jennifer Ose
- Huntsman Cancer Institute, Population Sciences, Salt Lake City, UT; Department of Population Health Sciences, University of Utah, Salt Lake City, UT
| | - Mahmoud Delphan
- Huntsman Cancer Institute, Population Sciences, Salt Lake City, UT; Department of Population Health Sciences, University of Utah, Salt Lake City, UT; Exercise Immunology, Physical Education and Sport Sciences Department, Tarbiat Modares University, Tehran, Iran
| | - Cornelia M Ulrich
- Huntsman Cancer Institute, Population Sciences, Salt Lake City, UT; Department of Population Health Sciences, University of Utah, Salt Lake City, UT.
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