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Andalib A, Safar A, Bouchard P, Demyttenaere S, Court O. Single Anastomosis Duodenal Switch versus Classic Duodenal Switch: Long-term Outcomes from a Prospective Comparative Cohort Study. Obes Surg 2023; 33:3951-3961. [PMID: 37864735 DOI: 10.1007/s11695-023-06900-z] [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: 07/24/2023] [Revised: 10/07/2023] [Accepted: 10/11/2023] [Indexed: 10/23/2023]
Abstract
PURPOSE The literature on long-term outcomes of duodenal switch (DS) compared to single anastomosis duodenal switch (SADI-S) procedures is lacking. We evaluated the long-term outcomes of SADI-S compared to those after the classic DS procedure. METHODS This is a follow-up report from a single-institution prospective cohort study comparing long-term outcomes of SADI-S versus DS both as one- and two-stage procedures (ClinicalTrials.gov: NCT02792166). Data is depicted as count (percentage) or median (interquartile range). RESULTS Forty-two patients underwent SADI-S, of whom 11 had it as a second-stage procedure (26%). Of 20 patients who underwent DS, twelve had it as a second-stage procedure (60%). Both groups were similar at baseline. Median follow-up times for one-stage SADI-S and DS were 57 (24) and 57 (9) months, respectively (p = 0.93). Similar BMI reductions were observed after one-stage SADI-S (16.5 kg/m2 [8.5]) and DS (18.9 kg/m2 [7.2]; p = 0.42). At median follow-up of 51 (21) and 60 (15) months after second-stage SADI-S and DS, respectively (p = 0.60), surgical procedures yielded reductions in BMI of 20.5 kg/m2 (14.0) and 24.0 kg/m2 (13.9), respectively (p = 0.52). Follow-up rates were similar for one-stage (≥ 88%; p = 0.29) and second-stage procedures (≥ 83%; p = 0.16). Similar diabetes and hypertension remissions were found (p = 0.77; P = 0.54, respectively). Despite fat-soluble vitamin deficiencies at baseline, after supplementation, they were either eliminated or less prevalent long-term after SADI-S. Daily bowel movements were also less frequent. CONCLUSIONS Long-term weight and comorbidity outcomes after SADI-S are similar to those of DS both as one- and two-stage surgeries. SADI-S procedure may allow for similar beneficial outcomes with less burden from gastrointestinal symptoms and fat-soluble vitamin deficiencies.
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Affiliation(s)
- Amin Andalib
- Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, QC, Canada.
- McGill University Health Center, Montreal General Hospital, 1650 Cedar Avenue, Room: E16-165A, Montreal, QC, H3G 1A4, Canada.
| | - Ali Safar
- Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
| | - Philippe Bouchard
- Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
| | - Sebastian Demyttenaere
- Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
| | - Olivier Court
- Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
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Giustina A, di Filippo L, Facciorusso A, Adler RA, Binkley N, Bollerslev J, Bouillon R, Casanueva FF, Cavestro GM, Chakhtoura M, Conte C, Donini LM, Ebeling PR, Fassio A, Frara S, Gagnon C, Latella G, Marcocci C, Mechanick JI, Minisola S, Rizzoli R, Santini F, Shaker JL, Sempos C, Ulivieri FM, Virtanen JK, Napoli N, Schafer AL, Bilezikian JP. Vitamin D status and supplementation before and after Bariatric Surgery: Recommendations based on a systematic review and meta-analysis. Rev Endocr Metab Disord 2023; 24:1011-1029. [PMID: 37665480 PMCID: PMC10698146 DOI: 10.1007/s11154-023-09831-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 09/05/2023]
Abstract
Bariatric surgery is associated with a postoperative reduction of 25(OH) vitamin D levels (25(OH)D) and with skeletal complications. Currently, guidelines for 25(OH)D assessment and vitamin D supplementation in bariatric patients, pre- and post-surgery, are still lacking. The aim of this work is to analyse systematically the published experience on 25(OH)D status and vitamin D supplementation, pre- and post-surgery, and to propose, on this basis, recommendations for management. Preoperatively, 18 studies including 2,869 patients were evaluated. Prevalence of vitamin D insufficiency as defined by 25(OH)D < 30 ng/mL (75 nmol/L) was 85%, whereas when defined by 25(OH)D < 20 ng/mL (50 nmol/L) was 57%. The median preoperative 25(OH)D level was 19.75 ng/mL. After surgery, 39 studies including 5,296 patients were analysed and among those undergoing either malabsorptive or restrictive procedures, a lower rate of vitamin D insufficiency and higher 25(OH)D levels postoperatively were observed in patients treated with high-dose oral vitamin D supplementation, defined as ≥ 2,000 IU/daily (mostly D3-formulation), compared with low-doses (< 2,000 IU/daily). Our recommendations based on this systematic review and meta-analysis should help clinical practice in the assessment and management of vitamin D status before and after bariatric surgery. Assessment of vitamin D should be performed pre- and postoperatively in all patients undergoing bariatric surgery. Regardless of the type of procedure, high-dose supplementation is recommended in patients after bariatric surgery.
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Affiliation(s)
- Andrea Giustina
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy.
| | - Luigi di Filippo
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Antonio Facciorusso
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Robert A Adler
- Richmond Veterans Affairs Medical Center and Virginia Commonwealth University, Richmond, VA, USA
| | | | | | - Roger Bouillon
- Laboratory of Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Ageing, 3000 KU, Leuven, Belgium
| | - Felipe F Casanueva
- Molecular Endocrinology Group, Instituto de Investigacion Sanitaria (IDIS), Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS). CIBER de Fisiopatologia de La Obesidad y Nutricion (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Giulia Martina Cavestro
- Gastroenterology and Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marlene Chakhtoura
- Calcium Metabolism and Osteoporosis Program, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Caterina Conte
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Via Di Val Cannuta 247, 00166, Rome, Italy
| | - Lorenzo M Donini
- Experimental Medicine Department, Sapienza University, Rome, Italy
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Australia
| | - Angelo Fassio
- Rheumatology Unit, University of Verona, Verona, Italy
| | - Stefano Frara
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Claudia Gagnon
- Department of Medicine, Université Laval, Quebec City, Canada
| | - Giovanni Latella
- Gastroenterology, Hepatology and Nutrition Division, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Claudio Marcocci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Jeffrey I Mechanick
- Kravis Center for Clinical Cardiovascular Health at Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | | | - René Rizzoli
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Ferruccio Santini
- Obesity and Lipodystrophy Center, University Hospital of Pisa, Pisa, Italy
| | - Joseph L Shaker
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Fabio Massimo Ulivieri
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Jyrki K Virtanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Nicola Napoli
- Department of Medicine and Surgery, Research Unit of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy
| | - Anne L Schafer
- University of California, San Francisco and the San Francisco Veterans Affairs Health Care System, San Francisco, USA
| | - John P Bilezikian
- Department of Medicine, Endocrinology Division, Vagelos College of Physicians and Surgeons Columbia University, New York, NY, USA
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Galyean S, Syn D, Subih HS, Boylan M. Improving vitamin D status in bariatric surgery subjects with monthly high-dose ergocalciferol. INT J VITAM NUTR RES 2021; 92:109-117. [PMID: 34521264 DOI: 10.1024/0300-9831/a000728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Vitamin D insufficiency is common before and after bariatric surgery. Optimal supplementation to treat vitamin D insufficiency is not clearly defined. Objective: Determine if serum 25 (OH) D levels improve by the consumption of an additional monthly ergocalciferol supplement by subjects after bariatric surgery. Study design: Thirty-two subjects were randomly divided to receive an additional 100,000 IUs of ergocalciferol monthly after bariatric surgery (n=10) or standard level vitamin D supplement after bariatric surgery (n=22). Serum 25 (OH) D, calcium, and hemoglobin A1c levels were measured preoperatively and one year after bariatric surgery. Results: Mean changes in BMI at 1-year post-operation was -18.12±6.46 kg/m2 in the control group versus -18.84±4.7 kg/m2; p=0.638 in the vitamin D group. One year after bariatric surgery, the mean changes from baseline in vitamin D levels were 2.69±9.4 and 12.4±17.0 ng/mL in control and intervention groups, respectively. The treated group showed a marginally higher mean increase in Vitamin D than the control group, p=0.059. Other mean changes at 1-year post-surgery that were not significantly different include calcium -0.264±0.45 and -0.21±0.509 mg/dl in control and intervention groups, respectively and Hgb A1c -1.0±1.21 and -0.95±0.071% in control and intervention groups, respectively. Conclusion: This study showed 100,000 IUs ergocalciferol once a month is a safe and effective treatment for vitamin D insufficiency in most patients having bariatric surgery.
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Affiliation(s)
- Shannon Galyean
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, USA
| | - David Syn
- Department of Surgery Advanced Bariatric Surgery Center, Lubbock, TX, USA
| | - Hadil S Subih
- Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, Irbid, Jordan
| | - Mallory Boylan
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, USA
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Sherf-Dagan S, Sinai T, Goldenshluger A, Globus I, Kessler Y, Schweiger C, Ben-Porat T. Nutritional Assessment and Preparation for Adult Bariatric Surgery Candidates: Clinical Practice. Adv Nutr 2021; 12:1020-1031. [PMID: 33040143 PMCID: PMC8262552 DOI: 10.1093/advances/nmaa121] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/25/2020] [Accepted: 09/03/2020] [Indexed: 12/13/2022] Open
Abstract
Bariatric surgery (BS) has proven to be highly efficacious in the treatment of obesity and its comorbidities. However, careful patient selection is critical for its success. Thus, patients should undergo medical, behavioral, and nutritional assessment by a multidisciplinary team. From the nutritional point of view, BS candidates should undergo nutritional assessment, preparation, and education by a registered dietitian in the preoperative period. Currently, detailed specified and comprehensive information on these topics is lacking. The present narrative review aimed to summarize the available literature concerning both the preoperative nutritional assessment components and the preoperative nutritional preparation and education components of patients planning to undergo BS. Current literature indicates that proper management before BS should include a comprehensive nutritional assessment, in which it is advisable to perform a clinical interview to assess patients' medical background, weight management history, eating patterns and pathologies, oral health, physical activity habits, nutritional status, supplementation usage, BS knowledge, surgery expectations and anthropometric measurements. Nutritional preparation and educational strategies should include an individualized preoperative weight-loss nutrition program, improvement of glycemic control, micronutrients deficiencies correction, eating and lifestyle habits adaptation, physical activity initiation, and strengthening knowledge on obesity and BS. At this stage, more well-designed intervention and long-term cohort studies are needed in order to formulate uniform evidence-based nutritional guidelines for patients who plan to undergo BS, including populations at higher nutritional risk. Moreover, postoperative outcomes of presurgical nutritional intervention programs should be studied.
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Affiliation(s)
- Shiri Sherf-Dagan
- Department of Nutritional Sciences, School of Health Sciences, Ariel University, Ariel, Israel
- Department of Nutrition, Assuta Medical Center, Tel Aviv, Israel
| | - Tali Sinai
- Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
- School of Nutritional Sciences, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Ariela Goldenshluger
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, and Sylvan Adams Sports Institute, Tel-Aviv University, Tel Aviv, Israel
| | | | - Yafit Kessler
- Department of Nutritional Sciences, School of Health Sciences, Ariel University, Ariel, Israel
- Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel
| | - Chaya Schweiger
- Nutrition Service, Rabin Medical Center, Campus Beilinson, Petach Tiqva, Israel
| | - Tair Ben-Porat
- Department of Nutrition, Hadassah-Hebrew University Medical Center, Ein-Kerem Campus, Jerusalem, Israel
- Department of Human Metabolism and Nutrition, Braun School of Public Health, Hebrew University, Jerusalem, Israel
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Alejo Ramos M, Ballesteros Pomar MD, Urioste Fondo AM, González Herráez L, González de Francisco T, Sierra Vega M, Cano Rodríguez IM. Bone metabolism and fracture risk after Biliopancreatic Diversion. ENDOCRINOL DIAB NUTR 2021; 68:144-152. [PMID: 34167693 DOI: 10.1016/j.endien.2021.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 08/20/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Bariatric surgery (BS) is an effective treatment. However, there have been concerns regarding the negative effect on the bone. The aim of this study was to assess changes in bone metabolism and the risk of fracture after biliopancreatic diversion (BPD). MATERIAL AND METHODS A retrospective analysis of obese patients undergoing BPD between 1998 and 2017 was conducted, and patients with at least 1 year of follow-up were included. The incidence of fracture and of changes in bone metabolism was studied. RESULTS In total, 216 patients were included (78.2% female), with a mean age of 42.5(10.6) years. The median follow-up was 6.8(IQR 10.2-3.2) years. The mean body mass index (BMI) was 49.7(6.3) kg/m2. 13.2% (n=29) suffered a bone fracture after surgery; the time until the first fracture was 7.9(3.8) years (55.2% secondary to a casual fall). The rate of fracture incidence was 19.6 per 1000 person-years (95%CI: 1.3-2.7), prevalence was 13.4% (95%CI: 8.9-18.0). The risk of bone fractures seems to increase with longer postoperative evolution time. PTH (pg/ml) levels were significantly higher in patients with fractures (1 year, 98.1 vs. 77.8; 5 years, 162.5 vs. 110.3 p<0.05, adjusted HR 1.10; 95%CI 1.01-1.11). Subjects with a higher %EWL had less risk of fractures after surgery (adjusted HR 0.97; 95%CI 0.94-0.99). Moreover, 25(OH)D levels were lower, and osteocalcin and β-Crosslaps levels were slightly higher (not significant) in patients with fractures. CONCLUSION BPD is related to important changes in bone metabolism, which can lead to an increased risk of bone fractures. Assessing the risk of fractures should be part of BS patient care.
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Affiliation(s)
- Mirian Alejo Ramos
- Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, Spain.
| | | | - Ana M Urioste Fondo
- Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, Spain
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Bone metabolism and fracture risk after Biliopancreatic Diversion. ACTA ACUST UNITED AC 2021; 68:144-152. [PMID: 33495111 DOI: 10.1016/j.endinu.2020.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 07/13/2020] [Accepted: 08/20/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Bariatric surgery (BS) is an effective treatment. However, there have been concerns regarding the negative effect on the bone. The aim of this study was to assess changes in bone metabolism and the risk of fracture after biliopancreatic diversion (BPD). MATERIAL AND METHODS A retrospective analysis of obese patients undergoing BPD between 1998 and 2017 was conducted, and patients with at least 1 year of follow-up were included. The incidence of fracture and of changes in bone metabolism was studied. RESULTS In total, 216 patients were included (78.2% female), with a mean age of 42.5(10.6) years. The median follow-up was 6.8(IQR 10.2-3.2) years. The mean body mass index (BMI) was 49.7(6.3) kg/m2. 13.2% (n=29) suffered a bone fracture after surgery; the time until the first fracture was 7.9(3.8) years (55.2% secondary to a casual fall). The rate of fracture incidence was 19.6 per 1000 person-years (95%CI: 1.3-2.7), prevalence was 13.4% (95%CI: 8.9-18.0). The risk of bone fractures seems to increase with longer postoperative evolution time. PTH (pg/ml) levels were significantly higher in patients with fractures (1 year, 98.1 vs. 77.8; 5 years, 162.5 vs. 110.3 p<0.05, adjusted HR 1.10; 95%CI 1.01-1.11). Subjects with a higher %EWL had less risk of fractures after surgery (adjusted HR 0.97; 95%CI 0.94-0.99). Moreover, 25(OH)D levels were lower, and osteocalcin and β-Crosslaps levels were slightly higher (not significant) in patients with fractures. CONCLUSION BPD is related to important changes in bone metabolism, which can lead to an increased risk of bone fractures. Assessing the risk of fractures should be part of BS patient care.
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Andalib A, Bouchard P, Alamri H, Bougie A, Demyttenaere S, Court O. Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S): short-term outcomes from a prospective cohort study. Surg Obes Relat Dis 2020; 17:414-424. [PMID: 33158766 DOI: 10.1016/j.soard.2020.09.015] [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] [Received: 05/04/2020] [Revised: 07/29/2020] [Accepted: 09/06/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is a modification of the classic duodenal switch (DS). These modifications are intended to address concerns about DS, including malnutrition, longer operative times, and technical challenges, while preserving the benefits. OBJECTIVES To evaluate safety and outcomes of SADI-S as it compares to classic DS procedure. SETTING Bariatric Surgery Center of Excellence, University Hospital, Montreal, Canada. METHODS In a single-institution prospective cohort study, we compared safety and outcomes of the SADI-S versus DS procedures (ClinicalTrials.gov: NCT02792166; registered: 06/2016). Data is depicted as count (percentage) or median (interquartile range). RESULTS There were 42 patients who underwent SADI-S, of whom 11 had it as a second-stage procedure (26%). There were 20 patients who underwent DS, of whom 12 had it as second-stage procedures (60%). Both groups were similar at baseline. The median age was 45 (14) years, 39 (63%) were female, the median body mass index (BMI) was 48.2 (7.7) kg/m2, and 29 (47%) patients had diabetes. The operative time was shorter for 1-stage SADI-S versus DS surgery (211 [70] versus 250 [60] min, respectively; P = .05) but was similar for second-stage procedures (P = .06). The 90-day complication rates were 11.9% (N = 5/42) after SADI-S and 5.0% (N = 1/20) after DS surgery (P = .64). There were no mortalities. Median follow-ups for 1-stage SADI-S and DS were 17 (11) and 12 (24) months, respectively (P = .65). Similar BMI changes were observed after 1-stage SADI-S (17.9 kg/m2 [8.7]) and DS (17.5 kg/m2 [16]; P = .65). At median follow-ups of 10 (20) and 14 (16) months after second-stage SADI-S and DS, respectively (P = .53), surgical procedures yielded added 5.0 kg/m2 (5.8) and 6.5 kg/m2 (7.1) changes in BMI, respectively (P = .26). Complete remission rates for diabetes were 91% after SADI-S (n = 21/23) and 50% after DS (n = 3/6). Compared with the SADI-S procedure, DS surgery was associated with higher frequencies of deficiencies in some fat-soluble vitamins, especially vitamin D. CONCLUSIONS The SADI-S procedure is safe, and its short-term outcomes, including weight loss and the resolution of co-morbidities, are similar to those of DS. SADI-S surgery also has promising potential as a second-stage procedure after sleeve gastrectomy.
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Affiliation(s)
- Amin Andalib
- Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, Canada.
| | - Philippe Bouchard
- Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, Canada
| | - Hussam Alamri
- Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, Canada
| | - Alexandre Bougie
- Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, Canada
| | - Sebastian Demyttenaere
- Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, Canada
| | - Olivier Court
- Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, Canada
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Serum Parathyroid Hormone and 25-Hydroxyvitamin D Concentrations Before and After Biliopancreatic Diversion. Obes Surg 2019; 28:1886-1894. [PMID: 29322299 DOI: 10.1007/s11695-017-3101-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Biliopancreatic diversion with duodenal switch (BPD-DS) decreases vitamin D and calcium absorption, which may result in secondary hyperparathyroidism. This study aimed at evaluating the prevalence of vitamin D deficiency and secondary hyperparathyroidism before and after BPD-DS. METHODS A retrospective analysis of patients who had undergone BPD-DS at a tertiary bariatric center between 2003 and 2010 and for whom simultaneous measurements of serum 25-hydroxyvitamin D and parathyroid hormone were available within 5 years post-op was performed. The prevalence of vitamin D deficiency (< 20 ng/ml) and secondary hyperparathyroidism (> 65 pg/mL) at different time points was calculated. RESULTS Included were 1436 patients (mean ± SD, age 42.7 ± 10.4 years; BMI 51.5 ± 8.6 kg/m2; 69.8% women). Prevalence of vitamin D deficiency decreased up to 6-12 months after surgery (from 35.8% at baseline down to 6-9%) then rose progressively, plateauing at 15.5% after 36 months. Prevalence of hyperparathyroidism was 28.5% before surgery and rose progressively after surgery, reaching 68.6% at 5 years. Mean serum corrected calcium increased from 0 to 6 months then decreased up to 36 months. Preoperatively, the prevalence of hypocalcemia was 7.3%. It increased after 12 months, attaining 26.9% at 48 months. CONCLUSIONS Prevalence of vitamin D deficiency and secondary hyperparathyroidism is high before BPD-DS. Despite a low prevalence of vitamin D deficiency after surgery, prevalence of hyperparathyroidism increased steadily 1 year after surgery, preceded by a decrease in serum calcium. Factors explaining the high prevalence of secondary hyperparathyroidism after BPD-DS and its long-term impact on bone health should be addressed.
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Abstract
Bariatric surgeries are considered the only effective way of weight loss therapy in morbidly obese patients, i.e. body mass index ≥ 35. However, micronutrient deficiencies and malnutrition are common after most bariatric procedures and thus, pre- and postoperative nutritional assessment and corrections are advised. The present review is presented in an effort to describe in some detail about prevalence, and mechanisms of macro- and micronutrient deficiencies in obese and post-bariatric surgery individuals. We also aimed to summarize the data on screening and supplementation of macro- and micronutrients before and after bariatric surgeries.
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Affiliation(s)
- Sonmoon Mohapatra
- Department of Gastroenterology and Hepatology, Saint Peter's University Hospital - Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ, United States
| | - Keerthana Gangadharan
- Department of Internal Medicine, Saint Peter's University Hospital - Rutgers Robert Wood, Johnson School of Medicine, New Brunswick, NJ, United States
| | - Capecomorin S Pitchumoni
- Department of Gastroenterology, Hepatology and Clinical Nutrition, Saint Peter's University Hospital - Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ, United States.
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For whom the bell tolls? It is time to retire the classic BPD (bilio-pancreatic diversion) operation. Surg Obes Relat Dis 2019; 15:1029-1031. [PMID: 31101565 DOI: 10.1016/j.soard.2019.03.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 02/17/2019] [Indexed: 01/11/2023]
Abstract
With the culture of safety and lowering risks that took place 20 years ago, sleeve gastrectomy has emerged as a procedure of choice. Hence, for super- and super-super-obese patients, there is a tendency these days to perform surgeries in 2 stages, and sleeve is the procedure of choice. Because sleeve is not part of a classic bilio-pancreatic diversion, it is unlikely that this operation will be done as a second stage, making this operation obsolete.
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11
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Secondary Hyperparathyroidism in Patients with Biliopancreatic Diversion After 10 Years of Follow-up, and Relationship with Vitamin D and Serum Calcium. Obes Surg 2018; 29:999-1006. [DOI: 10.1007/s11695-018-03624-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Abstract
Surgical hypoparathyroidism is the most common cause of hypoparathyroidism and the result of intentional or inadvertent extirpation, trauma, or devascularization of the parathyroid glands. Surgical hypoparathyroidism may present as a medical emergency. Pediatric patients, those with Graves disease, and those undergoing extensive neck dissections or reoperative neck surgery are at particular risk for this complication. Extensive surgical expertise, immediate or delayed autotransplantation, and prophylactic and postoperative calcium/vitamin D supplementation in select patients are associated with a reduction in the risk of surgical hypoparathyroidism. Intraoperative parathyroid imaging is among novel strategies being investigated to mitigate surgical hypoparathyroidism in the intraoperative setting.
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Affiliation(s)
- Hadiza S Kazaure
- Section of Endocrine Surgery, Department of Surgery, Duke Cancer Institute, Duke University Medical Center, Box 2945, Durham, NC 27710, USA
| | - Julie Ann Sosa
- Department of Surgery, University of California, San Francisco, 513 Parnassus Avenue, Suite S320, Box 0104, San Francisco, CA 94143, USA.
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Denucci GC, Mantilla TF, Amaral F, Basting RT, França F, Turssi CP. Saliva with reduced calcium and phosphorous concentrations: Effect on erosion dental lesions. Oral Dis 2018; 24:957-963. [PMID: 29423930 DOI: 10.1111/odi.12843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 12/27/2017] [Accepted: 01/31/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate whether saliva formulations with reduced calcium (Ca) and inorganic phosphorous (Pi) concentration would affect dental erosion caused by hydrochloric acid (HCl). METHODS Enamel and root dentine bovine slabs were embedded, polished, and measured for surface Knoop microhardness (SMH). After reference areas were created, specimens were exposed to HCl solution (0.01 M; pH 2; 120 s) and immersed in artificial salivas (6 hr) containing three different Ca/Pi concentrations (n = 15), which simulate serum conditions of normo-, mild, or severe hypocalcemia. The control group was immersed in Ca/Pi-free saliva. The study protocol was carried out 2×/day for 5 days. Surface loss of enamel and root dentine was assessed using an optical profilometer, and SMH was remeasured for enamel. RESULTS One-way analysis of variance (p < .001) and Tukey's test showed that enamel loss in groups subjected to artificial salivas that simulated mild or severe hypocalcemia did not differ from that resembling normocalcemia. %SMH was lower when saliva was mildly and normally concentrated in Ca/Pi (p < .001). Root dentine loss was higher in saliva simulating severe hypocalcemia than in those referring to mild, hypo-, and normocalcemia. CONCLUSIONS Depending on the dental substrate, salivary formulations resembling serum hypocalcemia affected surface loss due to erosion and rehardening thereof.
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Affiliation(s)
- G C Denucci
- São Leopoldo Mandic School of Dentistry, Campinas, Brazil
| | - T F Mantilla
- Department of Restorative Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Flb Amaral
- Division of Cariology and Restorative Dentistry, São Leopoldo Mandic Institute and Dental Research Center, Campinas, Brazil
| | - R T Basting
- Division of Cariology and Restorative Dentistry, São Leopoldo Mandic Institute and Dental Research Center, Campinas, Brazil
| | - Fmg França
- Division of Cariology and Restorative Dentistry, São Leopoldo Mandic Institute and Dental Research Center, Campinas, Brazil
| | - C P Turssi
- Division of Cariology and Restorative Dentistry, São Leopoldo Mandic Institute and Dental Research Center, Campinas, Brazil
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Hood MM, Kelly MC, Feig EH, Webb V, Bradley LE, Corsica J. Measurement of adherence in bariatric surgery: a systematic review. Surg Obes Relat Dis 2018; 14:1192-1201. [PMID: 29853195 DOI: 10.1016/j.soard.2018.04.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 12/22/2022]
Abstract
After bariatric surgery, rates of adherence to behavioral recommendations, including attending regular appointments and following specific dietary, physical activity, and vitamin use recommendations, tend to be highly variable across studies. Lack of consistency in measurement of adherence is a likely contributor to this variability, making it challenging to determine the prevalence and impact of nonadherence in this population. PubMed was searched for articles measuring behavioral adherence or compliance in patients after bariatric surgery, resulting in 85 articles. Articles were reviewed for the definition and measurement of adherence in each area (appointment attendance, as well as dietary, physical activity, and vitamin use adherence), and on the use and reporting of recommended adherence measurement strategies. Over half of the articles measured adherence to appointment attendance. Significant variability was found across adherence definitions and measurement methods, and use of recommended adherence measurement strategies was poor. Adherence was mostly commonly measured via self-report (either verbal or written) using cutoffs for adherent versus nonadherent behavior. Over half of studies assessed adherence up to ≥2 years postsurgery. Recommendations for ways to improve adherence measurement in patients who have had bariatric surgery are outlined.
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Affiliation(s)
- Megan M Hood
- Rush University Medical Center, Chicago, Illinois.
| | | | - Emily H Feig
- Rush University Medical Center, Chicago, Illinois
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15
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Abstract
BACKGROUND The reported prevalence of hypocalcemia after bariatric surgery ranges from 1% after Roux-en-Y gastric bypass (RYGB) to 25% after bilio-pancreatic diversion-duodenal switch (BPD-DS). OBJECTIVE We aimed to define the prevalence of post-operative hypocalcemia and identify clinical predisposing factors. SETTING The study was conducted in an Academic Medical Center, USA. METHODS Retrospective analysis of all patients undergoing bariatric surgery from May 2008 to December 2014 at Mayo Clinic Rochester, Minnesota was performed. Patients with revision surgeries were excluded. Hypocalcemia was defined as the lowest recorded serum calcium occurring at least 2 weeks post-operatively. RESULTS Nine hundred ninety-nine patients fulfilled the criteria above. After correction for serum albumin concentration, 36 patients had serum calcium ≤8.9 mg/dl. Mean serum calcium was 8.1 ± 0.6 mg/dl. The prevalence was 1.9% in the RYGB group, 9.3% in the sleeve gastrectomy (SG) group, and 10% in the BPD-DS group. In all three surgical types, patients with hypocalcemia had significantly lower serum albumin and serum 25 (OH) vitamin D concentrations when compared to their normocalcemic counterparts (P < 0.01). The presence of renal insufficiency and vitamin D deficiency was associated with the highest risk of developing hypocalcemia after surgery [OR 16.8 (6.45-47.7) and 7.1(2.9-17.3), respectively]. Pre-operative renal insufficiency increased the odds of developing hypocalcemia by 20-fold. CONCLUSIONS In our series, hypocalcemia was identified in 3.6% of patients undergoing all bariatric surgery. Patients who are predisposed to developing post-operative hypocalcemia, such as those with pre-operative renal impairment, or post-operative vitamin D deficiency and renal insufficiency, may benefit from increased surveillance and prevention strategies.
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16
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Ben-Porat T, Elazary R, Sherf-Dagan S, Goldenshluger A, Brodie R, Mintz Y, Weiss R. Bone Health following Bariatric Surgery: Implications for Management Strategies to Attenuate Bone Loss. Adv Nutr 2018; 9:114-127. [PMID: 29659692 PMCID: PMC5916426 DOI: 10.1093/advances/nmx024] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/11/2017] [Accepted: 12/18/2017] [Indexed: 01/19/2023] Open
Abstract
Bariatric surgery (BS) is an effective treatment for morbid obesity and its associated comorbidities. Following such a procedure, however, patients are at risk of developing metabolic bone disease owing to the combination of rapid weight loss, severely restricted dietary intake, and reduced intestinal nutrient absorption. Patients undergoing malabsorptive procedures are at a higher risk of postoperative bone health deterioration than those undergoing restrictive procedures; however, studies have demonstrated negative skeletal consequences of restrictive procedures as well. The clinical practice guidelines of some international associations have previously addressed preoperative evaluation and postoperative clinical care in order to maintain bone health in BS patients. Nevertheless, some issues regarding bone health in BS patients remain unclear owing to the lack of relevant randomized clinical trials, including doses of nutritional supplements pre- and post-BS. This review summarizes the current data regarding the skeletal consequences of BS and its mechanisms, with an emphasis on the preventive strategies and nutritional care that may be warranted in order to attenuate bone deterioration following BS.
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Affiliation(s)
- Tair Ben-Porat
- Departments of Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Department of Human Metabolism and Nutrition, Hebrew University, Jerusalem, Israel
| | - Ram Elazary
- Departments of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Ariela Goldenshluger
- Departments of Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ronit Brodie
- Departments of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yoav Mintz
- Departments of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ram Weiss
- Department of Human Metabolism and Nutrition, Hebrew University, Jerusalem, Israel
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17
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Obispo Entrenas A, Legupin Tubio D, Lucena Navarro F, Martin Carvajal F, Gandara Adan N, Redondo Bautista M, Abiles Osinaga J. Relationship Between Vitamin D Deficiency and the Components of Metabolic Syndrome in Patients with Morbid Obesity, Before and 1 Year After Laparoscopic Roux-en-Y Gastric Bypass or Sleeve Gastrectomy. Obes Surg 2017; 27:1222-1228. [PMID: 27864670 DOI: 10.1007/s11695-016-2445-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Vitamin D deficiency (VDD) is associated with obesity and metabolic syndrome (MS). After bariatric surgery (BS), high rates of VDD often persist and some patients are refractory to the resolution of comorbidities. The aim of the present study is to analyse the relationship between the levels of vitamin D and the persistence of MS components at 12 months after BS, according to the surgical technique used. METHODS We performed a retrospective study of 46 patients undergoing BS: 23 underwent laparoscopic Roux-en-Y gastric bypass (LRYGBP) and 23 laparoscopic sleeve gastrectomy (LSG). These patients had an average BMI of 45 kg/m2 (34-63). Levels of vitamin D were classified as deficient (<20 ng/dl), insufficient (20-30 ng/dl) or normal (>30 ng/dl) and analysed in relation to the components of MS (high blood pressure (HBP), dyslipidaemia (DL) and type 2 diabetes mellitus (T2DM) preoperatively and 12 months after surgery. RESULTS VDD was observed in 77% of the patients prior to surgery. There were no significant associations between predisposing factors and baseline vitamin D. After surgery, plasma levels of vitamin D increased in both groups, but only 18% of the patients achieved normal values. Both groups had achieved significant improvements in MS components. Thus, 63% of all the patients achieved complete resolution of HBP, 54% that of DL and 77% that of T2DM. Moreover, MS was present in 11% of the patients, compared to 63% at baseline, and the MS resolution rate was 83%, with no significant differences between LRYGBP and LSG. CONCLUSIONS There is a relationship between VDD and persistence of MS, and particularly so with T2DM. VDD could represent a predictor of MS persistence at 12 months after surgery.
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Affiliation(s)
- Ana Obispo Entrenas
- Department of Bariatric Surgery, Costa del Sol Hospital, Marbella, Málaga, Spain.
| | - David Legupin Tubio
- Department of Gastroenterology Surgery, Costa del Sol Hospital, Marbella, Málaga, Spain
| | | | | | | | - Maximino Redondo Bautista
- Department of Surgical Specialties, Biochemical and Immunological, Faculty of Medicine, Malaga University, Malaga, Spain
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Brancatella A, Cappellani D, Vignali E, Canale D, Marcocci C. Calcifediol Rather Than Cholecalciferol for a Patient Submitted to Malabsortive Bariatric Surgery: A Case Report. J Endocr Soc 2017; 1:1079-1084. [PMID: 29264560 PMCID: PMC5686642 DOI: 10.1210/js.2017-00114] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 07/11/2017] [Indexed: 11/19/2022] Open
Abstract
Vitamin D deficiency following malabsorptive bariatric surgery can lead to osteomalacia. We report a patient with severe vitamin D deficiency following malabsorptive bariatric surgery successfully treated with calcifediol but not cholecalciferol. A 40-year-old woman, submitted to biliopancreatic diversion 20 years before and chronically treated with 50,000 IU cholecalciferol weekly, was admitted to our Endocrine Unit because of severe lower back pain, muscle weakness, and generalized muscular hypotrophy, associated with hypocalcemia and elevated PTH levels. Initial evaluation revealed low serum albumin, low albumin-corrected serum calcium (7.36 mg/dL), high serum PTH (240 pg/mL), bone-specific alkaline phosphatase (125 μg/L) and 1,25-dihydroxyvitamin D (112 pg/mL) concentrations, undetectable serum 25-hydroxyvitamin D (<7 ng/mL), and evidence of reduced liver function. Bone mineral density was markedly low. Normocalcemia was initially restored with intravenous albumin and calcium gluconate. Treatment with calcitriol (0.5 μg three times daily) and oral calcium carbonate (1000 mg daily) was simultaneously started and cholecalciferol was replaced with calcifediol [125 μg (5000 IU) daily)]. During follow-up the calcifediol dose was progressively tapered to 25 μg (1000 IU) daily and the calcitriol dose was progressively reduced and finally withdrawn. Serum albumin and other biochemical parameters normalized, bone mineral density significantly increased, and the patient's clinical conditions progressively improved, with a substantial recovery of autonomy. Serum vitamin D binding protein at the last observation was in the normal range. Our data suggest that calcifediol might be more efficacious than cholecalciferol for prevention and treatment of vitamin D deficiency in patients treated by malabsorptive bariatric surgery.
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Affiliation(s)
- Alessandro Brancatella
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, 56124 Pisa, Italy
| | - Daniele Cappellani
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, 56124 Pisa, Italy
| | - Edda Vignali
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, 56124 Pisa, Italy
| | - Domenico Canale
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, 56124 Pisa, Italy
| | - Claudio Marcocci
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, 56124 Pisa, Italy
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19
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Ceriani V, Pinna F, Lodi T, Pontiroli AE. Revision of Biliopancreatic Diversion for Side Effects or Insufficient Weight Loss: Codification of a New Procedure. Obes Surg 2017; 27:1091-1097. [PMID: 28197865 DOI: 10.1007/s11695-017-2575-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE Addressing the problem of proctologic sequelae after Scopinaro's classical BPD, we elongated the common limb from 50 to 200 cm at the expense of the alimentary limb and simultaneously, with the aim of avoiding weight regain, reduced the gastric pouch from 500 to 40 ml. After increased experience with the new procedure, we observed a favourable tendency towards further weight loss. Thus, we subsequently extended the indication to the procedure to patients with unsatisfactory weight loss after Scopinaro's classical BPD (SBPD). METHODS We retrospectively reviewed our clinical experience with the new procedure. RESULTS From March 2008 to December 2014, 38 patients were submitted to the revisional procedure. The indication to surgical revision was proctologic in 26 patients and unsatisfactory weight loss in 12. After the revisional procedure, a significant reduction in bowel movements per day was observed, together with a significant reduction in body weight (from preoperative 87.1 ± 21 to 69.2 ± 13.5 kg at post-operative year 1 and 68.1 ± 11.9 kg at year 5; p < 0.001) and a parallel reduction in BMI (from preoperative 33.03 ± 7.6 to 26.8 ± 4.1 at post-operative year 1 and 26.9 ± 2.8 at year 5; p < 0.001). Mean excess BMI percent loss was 49.5 ± 94.6% at post-operative month 3, 76.51 ± 74.9% at year 1 and 76.2 ± 31.3% at year 5. Nutritional and metabolic parameters remained stable. Similar results were observed, analysing separately both groups of patients. CONCLUSIONS Our preliminary data suggest that the proposed procedure could represent a safe and effective revisional tool to treat invalidating proctologic sequelae after SBPD, or when weight loss may be deemed unsatisfactory.
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Affiliation(s)
- Valerio Ceriani
- General Surgery, IRCCS Multimedica, Via Milanese 300, Sesto San Giovanni, 20099, Milan, Italy
| | - Ferdinando Pinna
- General Surgery, IRCCS Multimedica, Via Milanese 300, Sesto San Giovanni, 20099, Milan, Italy.
| | - Tiziana Lodi
- General Surgery, IRCCS Multimedica, Via Milanese 300, Sesto San Giovanni, 20099, Milan, Italy
| | - Antonio E Pontiroli
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
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20
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Nutrient Status 9 Years After Biliopancreatic Diversion with Duodenal Switch (BPD/DS): an Observational Study. Obes Surg 2017; 27:1709-1718. [DOI: 10.1007/s11695-017-2560-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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21
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Busetto L, Dicker D, Azran C, Batterham RL, Farpour-Lambert N, Fried M, Hjelmesæth J, Kinzl J, Leitner DR, Makaronidis JM, Schindler K, Toplak H, Yumuk V. Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management. Obes Facts 2017; 10:597-632. [PMID: 29207379 PMCID: PMC5836195 DOI: 10.1159/000481825] [Citation(s) in RCA: 207] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 09/21/2017] [Indexed: 12/17/2022] Open
Abstract
Bariatric surgery is today the most effective long-term therapy for the management of patients with severe obesity, and its use is recommended by the relevant guidelines of the management of obesity in adults. Bariatric surgery is in general safe and effective, but it can cause new clinical problems and is associated with specific diagnostic, preventive and therapeutic needs. For clinicians, the acquisition of special knowledge and skills is required in order to deliver appropriate and effective care to the post-bariatric patient. In the present recommendations, the basic notions needed to provide first-level adequate medical care to post-bariatric patients are summarised. Basic information about nutrition, management of co-morbidities, pregnancy, psychological issues as well as weight regain prevention and management is derived from current evidences and existing guidelines. A short list of clinical practical recommendations is included for each item. It remains clear that referral to a bariatric multidisciplinary centre, preferably the one performing the original procedure, should be considered in case of more complex clinical situations.
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Affiliation(s)
- Luca Busetto
- Department of Internal Medicine, University of Padova, Padova, Italy
- *Prof. Dr. Luca Busetto, Clinica Medica 3, Azienda Ospedaliera di Padova, Via Giustiniani 2, 35128 Padova, Italy,
| | - Dror Dicker
- Department of Internal Medicine D and Obesity Clinic, Hasharon Hospital, Rabin Medical Center, Petah Tikva, Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Carmil Azran
- Clinical Pharmacy, Herzliya Medical Center, Herzliya, Israel
| | - Rachel L. Batterham
- Centre for Obesity Research, Rayne Institute, Department of Medicine, University College London, London, UK
- University College London Hospital Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospital, London, UK
- National Institute of Health Research, University College London Hospital Biomedical Research Centre, London, UK
| | - Nathalie Farpour-Lambert
- Obesity Prevention and Care Program Contrepoids, Service of Therapeutic Education for Chronic Diseases, Department of Community Medicine, Primary Care and Emergency, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Martin Fried
- OB Klinika, Centre for Treatment of Obesity and Metabolic Disorders, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jøran Hjelmesæth
- Morbid Obesity Centre, Vestfold Hospital Trust and Department of Endocrinology, Morbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Johann Kinzl
- Department of Psychiatry and Psychotherapy II, Medical University Innsbruck, Innsbruck, Austria
| | | | - Janine M. Makaronidis
- Centre for Obesity Research, Rayne Institute, Department of Medicine, University College London, London, UK
- National Institute of Health Research, University College London Hospital Biomedical Research Centre, London, UK
| | - Karin Schindler
- Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Hermann Toplak
- Department of Medicine, Medical University Graz, Graz, Austria
| | - Volkan Yumuk
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
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Lespessailles E, Toumi H. Vitamin D alteration associated with obesity and bariatric surgery. Exp Biol Med (Maywood) 2017; 242:1086-1094. [PMID: 28103699 DOI: 10.1177/1535370216688567] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Obesity and severe obesity constitute growing serious health problems reaching epidemic proportion in most countries. Interactions and relationships between obesity and bone tissue and its metabolism are complex but are more and more studied and recognized. Obesity is associated with an altered hormonal profile including particularly bone-regulating hormones like vitamin D. Bariatric surgery procedures, thanks to their effectiveness to achieve therapeutic endpoints for comorbidities associated with obesity, have had an increasing success. However, these surgeries by producing mechanical restriction and or malabsorption syndrome lead to nutritional deficiencies including vitamin D. In this review, we aim to (1) discuss the nutritional deficiency of vitamin D in the obese, (2) to summarize the different surgical options in bariatric surgery and to present the evidence concerning these procedures and their associated profile in vitamin D post-operative insufficiency, (3) to present the different recommendations in clinical practice to prevent or treat vitamin D deficiencies or insufficiencies in patients treated by bariatric surgery and finally to introduce emerging assumptions on the relationship between vitamin D, microbiota composition and circulating bile acids. Impact statement Obesity and severe obesity constitute growing serious health problems reaching epidemic proportion in most countries with a prevalence increasing from 6.4 in 1975 to 14.9% in 2014. This present review summarizes currently available data on vitamin D deficiencies in the obese population before and after bariatric surgery. The important evidence emerging from our evaluation confirms that obese patients are at risk of multiple nutritional deficiencies, especially vitamin D deficiency, before bariatric surgery. Our survey confirms that the precise role of the gut microbiome and its associated changes on the vitamin D metabolism after the different bariatric surgery procedures has not yet been studied. Furthermore, whether differences in the microbiota may alter the therapeutic responses to vitamin D is not known.
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Affiliation(s)
- Eric Lespessailles
- 1 Univ. Orleans, I3MTO Laboratory EA 4708, Orleans 45067, France.,2 Rheumatology Department, Hospital Orleans, Orleans 45067, France
| | - Hechmi Toumi
- 1 Univ. Orleans, I3MTO Laboratory EA 4708, Orleans 45067, France.,2 Rheumatology Department, Hospital Orleans, Orleans 45067, France
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Chouiali A, Mallet PL, Fink G, Biron S, Langlois MF. Comparison of two methods for measuring 25-OH vitamin D in the follow-up of patients after bilio-pancreatic diversion bariatric surgery. Clin Biochem 2016; 50:210-216. [PMID: 27863211 DOI: 10.1016/j.clinbiochem.2016.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/07/2016] [Accepted: 11/08/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Our objective was to compare the ECLIA from Roche versus the LC-MS/MS method for quantitation of serum 25-hydroxy-vitamin D in patients who have undergone bariatric surgery. DESIGN AND METHODS Cross-sectional and correlational studies were performed on three different groups for the 25-OH-D levels quantitated by both methods. The control group of apparently healthy subjects was randomly selected in a clinical chemistry laboratory. Test groups were patients who had undergone bilio-pancreatic diversion (BPD) and were supplemented either with vitamin D2 or with vitamin D3. The number of samples per group was established according to the CLSI recommendation protocol (EPO9-A2-IR). RESULTS The agreement of LC-MS/MS with the Roche method was acceptable in the apparently healthy subjects group and in the post-BPD D3-supplemented group with an average bias of -1.7% and -9.2%, respectively. However, this agreement was unacceptable in the post-BPD D2-supplemented group with an average bias of -45.3%. The LC-MS/MS enabled us to detect four patients who had excess vitamin D or poisoning with vitamin D for which it was necessary to stop the supplementation with vitamin D in the D2 -supplemented group. CONCLUSION Despite the apparent good agreement between the Roche method and LC-MS/MS in the healthy subjects group and in the post-DBP D3-supplemented patient group, a considerable bias seems to exist, particularly in the presence of D2. The LC-MS/MS method is therefore the most accurate method to follow the vitamin D2 -supplemented bariatric population.
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Affiliation(s)
- Ahlem Chouiali
- Department of Clinical Biochemistry, CIUSSS-CHUS and CHUS Research Center, Faculty of Medicine & Health Sciences, Sherbrooke University, Sherbrooke, Quebec, Canada.
| | - Pierre-Luc Mallet
- Department of Clinical Biochemistry, CIUSSS-CHUS and CHUS Research Center, Faculty of Medicine & Health Sciences, Sherbrooke University, Sherbrooke, Quebec, Canada
| | - Guy Fink
- Department of Clinical Biochemistry, CIUSSS-CHUS and CHUS Research Center, Faculty of Medicine & Health Sciences, Sherbrooke University, Sherbrooke, Quebec, Canada
| | - Simon Biron
- Department of Surgery, Faculty of Medicine & Health Sciences, Lava University l, Quebec, Quebec, Canada
| | - Marie-France Langlois
- Department of Medicine, CIUSSS-CHUS and CHUS Research Center, Faculty of Medicine & Health Sciences, Sherbrooke University, Sherbrooke, Quebec, Canada
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24
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Lanzarini E, Nogués X, Goday A, Benaiges D, de Ramón M, Villatoro M, Pera M, Grande L, Ramón JM. High-Dose Vitamin D Supplementation is Necessary After Bariatric Surgery: A Prospective 2-Year Follow-up Study. Obes Surg 2016; 25:1633-8. [PMID: 25596938 DOI: 10.1007/s11695-015-1572-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND We assessed the need of vitamin D supplementation to achieve normal 25-hydroxyvitamin D (25[OH]D) levels after bariatric surgery and whether there were differences between laparoscopy sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS A total of 164 morbid obese patients undergoing bariatric surgery from January 2008 to June 2011 were followed for 2 years. Serum levels of 25(OH)D and intact parathyroid hormone (iPTH) were measured preoperatively and at 3, 6, 9, 12, 18, and 24 months after operation. All patients received 400 IU/day of 25(OH)D. Patients received additional supplementation with 16,000 IU of vitamin D3 (calcifediol) every 2 weeks if 25(OH)D serum levels were < 30 ng/mL (intervention group). RESULTS Ninety-six (58.5 %) patients underwent LSG and 68 (41.5 %) LRYGB. A total of 106 (64.6 %) patients received calcifediol supplementation (62 in the LSG group and 44 in the LRYGB group). Normal 25(OH)D levels at 24 months were recorded in 69 % of patients in the intervention group and in 48.3 % in the non-intervention group. At 24 months, mean 25(OH)D levels in the non-intervention group were significantly lower among LRYGB patients than among LSG patients (P = 0.009). In the intervention group, normal 25(OH)D levels were achieved in 60 % of patients treated with LSG and in 22.2 % of those treated with LRYGB. Secondary hyperparathyroidism was presented in 49 (29.9 %) patients preoperatively but without significant differences in iPTH levels between the two surgical procedures. CONCLUSION Patients undergoing bariatric surgery should receive high-dose vitamin D supplementation independently of the surgical technique.
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Affiliation(s)
- Enrique Lanzarini
- Section of Gastrointestinal Surgery, Hospital Universitari del Mar, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autònoma de Barcelona, Barcelona, Spain
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25
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Association between body weight and composition and plasma 25-hydroxyvitamin D level in the Diabetes Prevention Program. Eur J Nutr 2015; 56:161-170. [PMID: 26525562 DOI: 10.1007/s00394-015-1066-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 09/30/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We examined associations between body weight and plasma 25-hydroxyvitamin D concentration (25OHD) in prediabetes and sought to estimate the impact of adiposity on these associations. METHODS The study was conducted in the placebo (n = 1082) and intensive lifestyle (n = 1079) groups of the Diabetes Prevention Program (DPP), a multicenter trial to prevent type 2 diabetes in adults with prediabetes. Weight and 25OHD were measured at baseline, month 6, years 1 and 2. In a subset (n = 584), visceral (VAT) and subcutaneous (SAT) adiposity were assessed by computed tomography at baseline and year 1. RESULTS In cross-sectional analyses, baseline body weight, total fat, VAT, and SAT were inversely associated with plasma 25OHD concentration after multivariable adjustment. VAT accounted for 40 % [95 % CI 11, 69] of the association of body weight with plasma 25OHD concentration. There was no significant contribution by total fat or SAT. Two-year changes in plasma 25OHD concentration varied inversely with changes in body weight (p < 0.0001). One-year changes in total fat, VAT, or SAT were not significant mediators of the association between change in plasma 25OHD concentration and body weight. CONCLUSION Our study found an inverse association between body weight and plasma 25OHD concentration at baseline and over a 2-year period in adults with prediabetes. These findings in the DPP, a weight loss intervention study, raise the possibility that weight loss increases plasma 25OHD concentration. Whether adiposity mediates this association remains inconclusive.
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Herman CK, Hoschander AS, Wong A. Post-Bariatric Body Contouring. Aesthet Surg J 2015; 35:672-87. [PMID: 25902949 DOI: 10.1093/asj/sjv008] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The "epidemic" of obesity has recently been accompanied by a new "epidemic" of massive weight loss. The demand for post-bariatric contouring is rising and, as such, it is extremely important for plastic surgeons to be well versed in the treatment of these patients. Unfortunately, the problem is not solely surgical. OBJECTIVES The aim of this article is to understand the nutritional and psychological complications that can occur in patients following massive weight loss, to understand the anatomic deformities in massive weight loss as a means to correct those deformities surgically, and to understand the complications from post-bariatric contouring procedures in an effort to avoid them. METHODS This article discusses the nutritional and psychological considerations in the massive weight loss patient, anatomical considerations in this patient group, and the surgical techniques designed to address these anatomic concerns. Important pertinent studies are reviewed and discussed. RESULTS Anatomical changes are encountered in each region of the body: there are surgical options available to correct them, although potential complications are associated with these surgical procedures. These surgical options are reviewed as well as the risk and benefits associated with them. CONCLUSIONS There are many problems that need to be addressed in the massive weight loss patient prior to embarking on surgical treatment. Additionally, surgery on massive weight loss patients has unique considerations that distinguish these operations from those performed on the non-bariatric population.
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Affiliation(s)
- Charles K Herman
- Dr Herman is the Chief Medical Executive, Chairman of the Department of Surgery and Chief of the Division of Plastic and Reconstructive Surgery, Pocono Health Systems, East Stroudsburg, PA; Clinical Professor of Surgery, The Commonwealth Medical College, Scranton, PA; and Assistant Clinical Professor of Surgery, Albert Einstein College of Medicine, New York, NY. Dr. Hoschander is the Chief Resident and Dr. Wong is a Resident in the Division of Plastic Surgery, University of Miami, Miller School of Medicine, Miami, FL
| | - Ari S Hoschander
- Dr Herman is the Chief Medical Executive, Chairman of the Department of Surgery and Chief of the Division of Plastic and Reconstructive Surgery, Pocono Health Systems, East Stroudsburg, PA; Clinical Professor of Surgery, The Commonwealth Medical College, Scranton, PA; and Assistant Clinical Professor of Surgery, Albert Einstein College of Medicine, New York, NY. Dr. Hoschander is the Chief Resident and Dr. Wong is a Resident in the Division of Plastic Surgery, University of Miami, Miller School of Medicine, Miami, FL
| | - Anselm Wong
- Dr Herman is the Chief Medical Executive, Chairman of the Department of Surgery and Chief of the Division of Plastic and Reconstructive Surgery, Pocono Health Systems, East Stroudsburg, PA; Clinical Professor of Surgery, The Commonwealth Medical College, Scranton, PA; and Assistant Clinical Professor of Surgery, Albert Einstein College of Medicine, New York, NY. Dr. Hoschander is the Chief Resident and Dr. Wong is a Resident in the Division of Plastic Surgery, University of Miami, Miller School of Medicine, Miami, FL
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Cole AJ, Beckman LM, Earthman CP. Vitamin D status following bariatric surgery: implications and recommendations. Nutr Clin Pract 2014; 29:751-8. [PMID: 25190686 DOI: 10.1177/0884533614546888] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Individuals with extreme obesity who qualify for bariatric surgery are frequently vitamin D deficient before and after surgery. The anatomical changes that occur during some bariatric procedures may lead to decreased absorption of vitamin D, although vitamin D absorption and metabolism has not been quantified or compared across surgeries, and multiple other factors could influence vitamin D status in these individuals. Vitamin D treatment and dosing studies show that there is variability in how individuals respond to supplementation regimens regardless of the bariatric procedure. It is unknown if improving vitamin D status before and/or after bariatric surgery can affect health-related outcomes in this population beyond the traditional roles of vitamin D. Vitamin D has been purported to positively influence a variety of obesity-related comorbidities. Furthermore, in light of the potential role of vitamin D in immunity and inflammation, it seems important to consider the ramifications of vitamin D deficiency in the postbariatric individual in the critical care setting and particularly in the context of aging. Additional research is needed to develop evidence-based guidelines for optimal treatment of vitamin D deficiency in individuals before and after bariatric surgery and to determine the impact of vitamin D repletion on non-bone health-related outcomes in these individuals.
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Affiliation(s)
- Abigail J Cole
- Department of Food Science and Nutrition, University of Minnesota, St Paul, Minnesota
| | | | - Carrie P Earthman
- Department of Food Science and Nutrition, University of Minnesota, St Paul, Minnesota
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Rodríguez-Carmona Y, López-Alavez FJ, González-Garay AG, Solís-Galicia C, Meléndez G, Serralde-Zúñiga AE. Bone mineral density after bariatric surgery. A systematic review. Int J Surg 2014; 12:976-82. [PMID: 25110331 DOI: 10.1016/j.ijsu.2014.08.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 07/19/2014] [Accepted: 08/01/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Bone regulation system may be affected after bariatric surgeries, but procedures impact differently to bone mineral density (BMD) and measures restraining bone loss are frequently neglected until clinical consequences become manifest. This is a systematic review aimed to elucidate whether BMD loss is comparable after different bariatric surgeries. MATERIALS AND METHODS A search of morbid obese adults, undergone to bariatric surgery, with BMD measured by dual-energy X-ray absorptiometry at baseline and after surgery studies was performed in several databases. Studies were assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement and COCHRANE Risk of Bias tool. The random model was selected for meta-analysis; heterogeneity was analyzed with T(2), inconsistency (I(2) > 50%) and Chi(2) (p < 0.10). Level of evidence and strength of recommendations were summarized using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE System). RESULTS Twelve studies met the selection criteria. After one year, reduction in total BMD in patients with mixed surgical procedures was significant: -0.03 g/cm(2) (CI 95% 0.00 to -0.06, p < 0.05). BMD was reduced by -0.12 g/cm(2) (CI 95% -0.10 to -0.15, p < 0.001) in the hip, -0.07 g/cm(2) (CI 95% -0.03 to -0.11, p < 0.001) in the column, and -0.03 g/cm(2) (IC 95% -0.02 to -0.04, p < 0.001) in the forearm, but not in restrictive surgeries. Studies included showed high heterogeneity and low quality of evidence. CONCLUSIONS Patients undergone to mixed bariatric surgery had significant higher BMD deterioration as demonstrated in this review, suggesting that more attention for preventing fractures is required.
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Affiliation(s)
- Yanelli Rodríguez-Carmona
- Nutrigenetics and Nutrigenomics Laboratory, Instituto Nacional de Medicina Genómica, Periférico Sur 4809, Arenal Tepepan, Tlalpan, CP 14610 Mexico City, Mexico.
| | - Francisco J López-Alavez
- Universidad Autónoma Metropolitana Unidad Xochimilco, Calzada del Hueso 1100, Villa Quietud, Coyoacán, CP 04960 Mexico City, Mexico.
| | - Alejandro G González-Garay
- Department of Research Methodology, Instituto Nacional de Pediatría, Insurgentes Sur 3700C, Insurgentes Cuicuilco, Coyoacán, CP 04530 Mexico City, Mexico.
| | - Cecilia Solís-Galicia
- Instituto Nacional de Pediatría, Insurgentes Sur 3700C, Insurgentes Cuicuilco, Coyoacán, CP 04530 Mexico City, Mexico.
| | - Guillermo Meléndez
- Hospital General de México "Dr. Eduardo Liceaga", Dr. Balmis 148 Col. Doctores, Cuauhtémoc, CP 06726 Mexico City, Mexico.
| | - Aurora E Serralde-Zúñiga
- Clinical Nutrition, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Sección XVI Tlalpan, CP 14000, Mexico City, Mexico.
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Litchford MD. Counteracting the Trajectory of Frailty and Sarcopenia in Older Adults. Nutr Clin Pract 2014; 29:428-434. [DOI: 10.1177/0884533614536231] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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100 Years of Weight Loss Surgery: Voluntary Weight Loss, Involuntary Bone Loss. Clin Rev Bone Miner Metab 2014. [DOI: 10.1007/s12018-014-9165-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Biagioni MFG, Mendes AL, Nogueira CR, Paiva SA, Leite CV, Mazeto GM. Weight-Reducing Gastroplasty with Roux-en-Y Gastric Bypass: Impact on Vitamin D Status and Bone Remodeling Markers. Metab Syndr Relat Disord 2014; 12:11-5. [DOI: 10.1089/met.2013.0026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
| | - Adriana L. Mendes
- Department of Internal Medicine, São Paulo State University, FMB-UNESP, Botucatu, Brazil
| | - Célia R. Nogueira
- Department of Internal Medicine, São Paulo State University, FMB-UNESP, Botucatu, Brazil
| | - Sérgio A.R. Paiva
- Department of Internal Medicine, São Paulo State University, FMB-UNESP, Botucatu, Brazil
| | - Celso V. Leite
- Department of Surgery, Botucatu Medical School, São Paulo State University, FMB-UNESP, Botucatu, Brazil
| | - Gláucia M.F.S. Mazeto
- Department of Internal Medicine, São Paulo State University, FMB-UNESP, Botucatu, Brazil
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Abstract
Bariatric surgery is an effective and increasingly common treatment for severe obesity and its many comorbidities. The side-effects of bariatric surgery can include detrimental effects on bone and mineral metabolism. Bone disease in patients who have had bariatric surgery is affected by preoperative abnormalities in bone and mineral metabolism related to severe obesity. Changes that arise after bariatric surgery are specific to procedure type: the most pronounced abnormalities in calciotropic hormones and bone loss are noted after procedures that result in the most malabsorption. The most consistent site for bone loss after all bariatric procedures is at the hip. There are limitations of dual-energy x-ray absorptiometry technology in this population, including artefact introduced by adipose tissue itself. Bone loss after bariatric surgery is probably multifactorial. Proposed mechanisms include skeletal unloading, abnormalities in calciotropic hormones, and changes in gut hormones. Few data for fracture risk in the bariatric population are available, and this is a crucial area for additional research. Treatment should be geared toward correction of nutritional deficiencies and study of bone mineral density in high-risk patients. We explore the skeletal response to bariatric surgery, potential mechanisms for changes, and strategies for management.
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Affiliation(s)
- Emily M Stein
- Columbia University College of Physicians and Surgeons, Columbia University, New York 10032, USA.
| | - Shonni J Silverberg
- Columbia University College of Physicians and Surgeons, Columbia University, New York 10032, USA
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Sundaram U, McBride C, Shostrom V, Meza J, Goldner WS. Prevalence of Preoperative Hypothyroidism in Bariatric Surgery Patients and Postoperative Change in Thyroid Hormone Requirements. Bariatr Surg Pract Patient Care 2013. [DOI: 10.1089/bari.2013.0006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Umasankari Sundaram
- Department of Internal Medicine, Division of Diabetes, Endocrinology and Metabolism, University of Nebraska Medical Center, Omaha, Nebraska
| | - Corrigan McBride
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Valerie Shostrom
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Jane Meza
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Whitney S. Goldner
- Department of Internal Medicine, Division of Diabetes, Endocrinology and Metabolism, University of Nebraska Medical Center, Omaha, Nebraska
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Sawaya RA, Jaffe J, Friedenberg L, Friedenberg FK. Vitamin, mineral, and drug absorption following bariatric surgery. Curr Drug Metab 2013; 13:1345-55. [PMID: 22746302 DOI: 10.2174/138920012803341339] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 04/28/2012] [Accepted: 05/02/2012] [Indexed: 02/07/2023]
Abstract
UNLABELLED The prevalence of obesity continues to rise throughout the world. Increasingly, bariatric surgery is used for those with morbid obesity as a pivotal approach to achieve weight loss. Along with substantial weight loss, malabsorption of essential vitamins, minerals, and drugs also occurs. Therefore, more than ever, a better understanding of the physiology and mechanisms by which these deficiencies occur is essential. We review the normal physiology of vitamin, mineral, and drug absorption. This is followed by a description of currently performed bariatric surgeries in the United States. A detailed review of specific nutrient and mineral deficiency states is presented, based on the most significant studies published in the last two decades. Of note, screening and supplementation recommendations have been included. Drug absorption data after these procedures is presented and discussed. Studies were identified by searching the Cochrane Registry and MEDLINE using relevant search terms, as well as through review of the reference section of included manuscripts. CONCLUSIONS Bariatric surgery can be effectively used to achieve sustainable weight-loss in morbidly obese patients. It simultaneously brings forth important functional consequences on nutrient deficiencies and drug absorption that clinician's must be aware of. Further prospective, randomized research on specific procedures and deficiencies is required.
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Bordalo LA, Teixeira TFS, Bressan J, Mourão DM. [Bariatric surgery: how and why to supplement]. Rev Assoc Med Bras (1992) 2013; 57:113-20. [PMID: 21390468 DOI: 10.1590/s0104-42302011000100025] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 10/12/2010] [Indexed: 01/01/2023] Open
Abstract
Patients who have undergone bariatric surgery are at increased risk of developing nutritional deficiencies from limited food intake and absorption of different nutrients. A systematic review of several database websites (PubMed and ISI Web of Science) was conducted from September 1983 to April 2010 to identify literature related to micronutrient deficiencies occurring after bariatric surgery. Keywords used individually or in various combinations in the search were bariatric surgery, obesity, vitamin/mineral deficiencies, protein deficiency, nutrient absorption and nutrient supplementation. Literature suggests that to prevent or treat nutritional deficiencies resulting from anatomical changes due to surgical techniques nutritional supplementation is usually necessary. The success of oral nutritional supplementation to correct or prevent nutritional deficiencies depends on several factors. Thus, to understand how nutrients can be administered is very important for clinical practice. This review aims to provide help for the best selection of nutrients to ensure an adequate replacement of nutrients in patients who have undergone bariatric surgery.
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Rock CL, Emond JA, Flatt SW, Heath DD, Karanja N, Pakiz B, Sherwood NE, Thomson CA. Weight loss is associated with increased serum 25-hydroxyvitamin D in overweight or obese women. Obesity (Silver Spring) 2012; 20:2296-301. [PMID: 22402737 PMCID: PMC3849029 DOI: 10.1038/oby.2012.57] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Low circulating concentrations of vitamin D metabolites have been associated with increased risk for several diseases and clinical conditions. Large observational studies and surveys have shown that obesity is independently associated with lower serum 25-hydroxyvitamin D (25(OH)D) concentration. Few studies have examined the effect of weight loss on serum 25(OH)D concentration. The purpose of this study was to prospectively examine the effect of weight loss on serum 25(OH)D concentration. Data were collected from 383 overweight or obese women who participated in a 2-year clinical trial of a weight-loss program, in which 51% (N = 195) lost at least 5% of baseline weight by 24 months, 18% (N = 67) lost 5-10%, and 33% (N = 128) lost >10%. Women who did not lose weight at 24 months had an increase in serum 25(OH)D of 1.9 (9.7) ng/ml (mean (SD)); 25(OH)D increased by 2.7 (9.1) ng/ml for those who lost 5-10% of baseline weight; and 25(OH)D increased by 5.0 (9.2) ng/ml for those who lost >10% of baseline weight (P = 0.014). At baseline, 51% (N = 197) of participants met or exceeded the recommended serum concentration of 20 ng/ml. By study end, 64% (N = 230) of overweight or obese women met this goal, as well as 83% (N = 20) of those whose weight loss achieved a normal BMI. These findings suggest that weight loss, presumably associated with a reduction in body fat, is associated with increased serum 25(OH)D concentration in overweight or obese women.
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Affiliation(s)
- Cheryl L Rock
- Department of Family and Preventive Medicine, and Moores UCSD Cancer Center, University of California, San Diego, La Jolla, California, USA.
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Manco M, Calvani M, Nanni G, Greco AV, Iaconelli A, Gasbarrini G, Castagneto M, Mingrone G. Low 25-Hydroxyvitamin D Does Not Affect Insulin Sensitivity in Obesity after Bariatric Surgery. ACTA ACUST UNITED AC 2012; 13:1692-700. [PMID: 16286516 DOI: 10.1038/oby.2005.207] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE A positive correlation between levels of 25-hydroxyvitamin D [25(OH)D] and insulin sensitivity has been shown in healthy subjects. We aimed to test the hypothesis that concentration of 25(OH)D influences insulin sensitivity in obesity before and after weight loss. RESEARCH METHODS AND PROCEDURES We investigated the relation between serum 25(OH)D and insulin sensitivity (estimated by euglycemic-hyperinsulinemic clamp) in 116 obese women (BMI > or = 40 kg/m2) evaluated before and 5 and 10 years after biliopancreatic diversion (BPD). Body composition was estimated by the isotope dilution method. RESULTS Prevalence of hypovitaminosis D was 76% in the obese status and 91% and 89% at 5 and 10 years after BPD, respectively, despite ergocalciferol supplementation. 25(OH)D concentration decreased from 39.2 +/- 22.3 in obesity (p = 0.0001) to 27.4 +/- 16.4 and 25.1 +/- 13.9 nM 5 and 10 years after BPD, respectively. Whole-body glucose uptake increased from 24.27 +/- 4.44 at the baseline to 57.29 +/- 11.56 and 57.71 +/- 8.41 mumol/kg(fat free mass) per minute 5 and 10 years after BPD, respectively (p = 0.0001). Predictor of 25(OH)D was fat mass (R2 = 0.26, p = 0.0001 in obesity; R2 = 0.20, p = 0.02 after BPD). Parathormone correlated with fat mass (R2 = 0.19; p = 0.0001) and BMI (R2 = 0.053; p = 0.01) and inversely with M value (R2 = 0.16; p = 0.0001), but only in obese subjects. DISCUSSION A high prevalence of hypovitaminosis D was observed in morbid obesity both before and after BPD. Low 25(OH)D did not necessarily imply increased insulin resistance after BPD, a condition where, probably, more powerful determinants of insulin sensitivity overcome the low circulating 25(OH)D levels. However, the present data cannot exclude some kind of influence of vitamin D status on glucose and insulin metabolism.
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Affiliation(s)
- Melania Manco
- Department of Internal Medicine, Catholic University, School of Medicine, 484 Pineta Sacchetti, 00168 Rome, Italy.
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Lalmohamed A, de Vries F, Bazelier MT, Cooper A, van Staa TP, Cooper C, Harvey NC. Risk of fracture after bariatric surgery in the United Kingdom: population based, retrospective cohort study. BMJ 2012; 345:e5085. [PMID: 22867649 PMCID: PMC3413006 DOI: 10.1136/bmj.e5085] [Citation(s) in RCA: 138] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To estimate fracture risk in patients receiving bariatric surgery versus matched controls. DESIGN Population based, retrospective cohort study. SETTING Use of records from the United Kingdom General Practice Research Database, now known as the Clinical Practice Research Datalink (from January 1987 to December 2010). PARTICIPANTS Patients with a body mass index of at least 30, with a record of bariatric surgery (n=2079), and matched controls without a record (n=10,442). Each bariatric surgery patient was matched to up to six controls by age, sex, practice, year, and body mass index. Patients were followed from the date of bariatric surgery for the occurrence of any fracture. We used time dependent Cox regression to calculate relative rates of fracture, adjusted for disease and previous drug treatment, and time-interaction terms to evaluate fracture timing patterns. MAIN OUTCOME MEASURE Relative rates of any, osteoporotic, and non-osteoporotic fractures. RESULTS Mean follow-up time was 2.2 years. Overall, there was no significantly increased risk of fracture in patients who underwent bariatric surgery, compared with controls (8.8 v 8.2 per 1000 person years; adjusted relative risk 0.89, 95% confidence interval 0.60 to 1.33). Bariatric surgery also did not affect risk of osteoporotic and non-osteoporotic fractures. However, we saw a trend towards an increased fracture risk after three to five years following surgery, as well as in patients who had a greater decrease in body mass index after surgery, but this was not significant. CONCLUSION Bariatric surgery does not have a significant effect on the risk of fracture. For the first few years after surgery, these results are reassuring for patients undergoing such operations, but do not exclude a more protracted adverse influence on skeletal health in the longer term.
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Affiliation(s)
- Arief Lalmohamed
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
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Zinc and copper serum levels of morbidly obese patients before and after biliopancreatic diversion: 4 years of follow-up. J Gastrointest Surg 2011; 15:2178-81. [PMID: 21826547 DOI: 10.1007/s11605-011-1647-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2011] [Accepted: 07/26/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND Zinc and copper are two essential trace elements. However, few studies have been conducted specifically to investigate these deficiencies in patients who underwent bariatric surgery. The aim of our work was to describe the influence of biliopancreatic diversion (BPD) on serum copper and zinc levels during 4 years. METHODS We have analyzed a consecutive series of 65 patients who have been followed-up for 4 years after undergoing open BPD. RESULTS The final (4 years) initial excess weight percent loss was 63.5%. A significant improvement of BMI, weight, waist circumference, and fat mass was detected. The preoperative average zinc (42.2 ± 53.2 μg/dl) and copper (61.3 ± 58.6 μg/dl) levels are under the lower limit of the normal values. These data show a deficient micronutrient status in morbidly obese patients, 73.8% of patients had low basal zinc values and 67.8% low basal copper values. Values of both micronutrients at different times (6 months, 1, 2, 3, and 4 years) were lower than basal value. CONCLUSION BPD is an effective method of sustainable weight loss. Otherwise, a high prevalence of zinc and copper basal deficiencies in morbidly obese seeking bariatric surgery was detected. These deficiencies of copper and zinc increased during the 4 years of follow-up after BDP.
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Life-Threatening Hypocalcemia following Subtotal Parathyroidectomy in a Patient with Renal Failure and Previous Roux-en-Y Gastric Bypass Surgery. Case Rep Endocrinol 2011; 2011:370583. [PMID: 22937282 PMCID: PMC3420727 DOI: 10.1155/2011/370583] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Accepted: 10/02/2011] [Indexed: 01/14/2023] Open
Abstract
Background. Roux-en-Y gastric bypass (RYGB) can result in calcium and vitamin D deficiency. Parathyroid surgery carries the risk of immediate and long-term hypocalcemia. Methods and Results. We describe a 54-year-old woman with history of end-stage renal disease and gastric bypass surgery who developed calciphylaxis requiring a 3.5-gland parathyroidectomy. Seven weeks later, she presented with weakness, perioral numbness, leg cramps, a positive Chvostek's sign, hypotension, prolonged QT-interval, and serum calcium of 5.4 mg/dL. Oral and intravenous calcium, calcitriol, and high calcium bath hemodialysis were given. She required 18 days of intravenous calcium and an outpatient maintenance regimen of calcitriol 6 mcg/day, calcium carbonate 8 grams/day, calcium citrate 1.2 grams/day, and ergocalciferol 50,000 IU/week. Conclusion. The patient's life-threatening prolonged hypocalcemia and large requirements of calcium and calcitriol were due to a combination of malabsorption, hypoparathyroidism, and renal failure. Special considerations should be given to bariatric surgery patients undergoing neck exploration.
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Kaafarani HMA, Shikora SA. Nutritional support of the obese and critically ill obese patient. Surg Clin North Am 2011; 91:837-55, viii-ix. [PMID: 21787971 DOI: 10.1016/j.suc.2011.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
With the dramatic increase in the prevalence of obesity worldwide and in the United States, it is virtually certain that clinicians will be caring for bariatric and obese nonbariatric patients in increasing numbers. This patient population presents several difficulties from the medical and surgical management perspectives. In particular, nutrition of the bariatric patient and critically ill obese patient is challenging. A clear understanding of the nutritional assessment and unique management strategies available for the bariatric and the critically ill obese patient is essential to provide them with the safest and most effective care.
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Affiliation(s)
- Haytham M A Kaafarani
- Department of Surgery, Tufts Medical Center and Tufts University School of Medicine, 800 Washington Street, Box 437, Boston, MA 02111, USA
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Vitamin D and Calcium Status and Appropriate Recommendations in Bariatric Surgery Patients. Gastroenterol Nurs 2011; 34:367-74. [DOI: 10.1097/sga.0b013e318229bcd0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Morales MJ, Díaz-Fernández MJ, Caixàs A, Cordido F. [Medical issues of surgical treatment of obesity]. Med Clin (Barc) 2011; 138:402-9. [PMID: 21565365 DOI: 10.1016/j.medcli.2011.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 02/25/2011] [Accepted: 03/01/2011] [Indexed: 01/06/2023]
Affiliation(s)
- María José Morales
- Servicio de Endocrinología y Nutrición, Hospital Meixoeiro, Complexo Hospitalario Universitario de Vigo, Vigo, Pontevedra, España
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Alcalde OL, Duce AM, Bustos FA, Torres RF, Huarte MG, González JG, Pérez CG. Ultrasonic value is not useful to detect bone changes following a biliopancreatic diversion. Obes Surg 2011; 21:173-8. [PMID: 21104205 DOI: 10.1007/s11695-010-0323-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
To study the evolution of the bone mass by ultrasonic transmission after biliopancreatic diversion. Forty eight morbid obese patients were prospectively studied during 36 months following the Larrad biliopancreatic diversion. The bone metabolism was studied by PTHi and the urinary pirydinolines. The bone mass by echography and bone densitometry, which correlate to the levels of PTHi and pyridinolines. After 3 years the bone mass decreased from 50.15 +/- 7.31 kg/m(2), preoperatively, to 34.03 +/- 4.53 kg/m2 (p < 0.001). There was an increase of the PTHi value (from 71.4 +/- 79.6 to 91.65 +/- 43.06 pg/ml) (p = 0.01), and the urinary pirydinolines (from 7.93 +/- 4.06 an 11.4 +/- 10.12 nM/mM) (p < 0.05). The ultrasonic transmission speed increased (from 1,990.93 +/- 62.38 to 2,035.25 +/- 53.98 m/s). However, the bone mineral content (BMC) did not show changes (from 3,016.5 +/- 562.8 to 2,909.6 +/- 304.2 g), as well as the Bone Mineral Density (BMD) (of 1,174.2 +/- 98.8 g/cm2). Neither correlation was found between the BMD (r = 0.212; p = 0.6), the BMC (r =-0.125; p = 0.768), and the T-score (r = 0.592, p = 0.093). The study of the bone mass through ultrasonic transmission speed revealed low sensitivity during the assessment of the morbid obese patients. A percentage of cases of osteopenia were observed despite the fact that they are not reflected in the bone content or in the bone mass. Ultrasonic evaluation of bone mass has no value in the morbidly obese, by the clear negative correlation between ultrasound velocity and thickness of soft tissue.
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Komplikationen und metabolische Störungen nach bariatrischen Operationen aus gastroenterologischer Sicht. DER GASTROENTEROLOGE 2011. [DOI: 10.1007/s11377-010-0469-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Williams SE. Metabolic bone disease in the bariatric surgery patient. J Obes 2011; 2011:634614. [PMID: 21274274 PMCID: PMC3022191 DOI: 10.1155/2011/634614] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Accepted: 11/09/2010] [Indexed: 12/13/2022] Open
Abstract
Bariatric surgery has proven to be a life-saving measure for some, but for others it has precipitated a plethora of metabolic complications ranging from mild to life-threatening, sometimes to the point of requiring surgical revision. Obesity was previously thought to be bone protective, but this is indeed not the case. Morbidly obese individuals are at risk for metabolic bone disease (MBD) due to chronic vitamin D deficiency, inadequate calcium intake, sedentary lifestyle, chronic dieting, underlying chronic diseases, and the use of certain medications used to treat those diseases. After bariatric surgery, the risk for bone-related problems is even greater, owing to severely restricted intake, malabsorption, poor compliance with prescribed supplements, and dramatic weight loss. Patients presenting for bariatric surgery should be evaluated for MBD and receive appropriate presurgical interventions. Furthermore, every patient who has undergone bariatric surgery should receive meticulous lifetime monitoring, as the risk for developing MBD remains ever present.
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Affiliation(s)
- Susan E. Williams
- Department of Internal Medicine,
Cleveland Clinic,
9500 Euclid Avenue / G-10,
Cleveland, OH 44195-0001, USA
- *Susan E. Williams:
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Bacci V, Silecchia G. Vitamin D status and supplementation in morbid obesity before and after bariatric surgery. Expert Rev Gastroenterol Hepatol 2010; 4:781-94. [PMID: 21108597 DOI: 10.1586/egh.10.69] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Interest in vitamin D has increased recently because of its role on multiple biologic mechanisms and the high prevalence of deficits, particularly in obese individuals. The epidemic of morbid obesity has led to a growing number of bariatric surgical procedures, the only therapeutic modality with a reasonable chance of success on a long-term basis. Vitamin D status following bariatric surgery depends on several interacting factors and should be monitored carefully. We review vitamin D, calcium and parathyroid hormone dynamics following the main types of bariatric surgery and the guidelines for the postoperative periodic assessment and therapy.
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Affiliation(s)
- Vincenzo Bacci
- Laparoscopic Surgical Department, Policlinico Umberto I University Hospital, 'La Sapienza' University, Viale del Policlinico 155, 00161 Rome, Italy
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Heber D, Greenway FL, Kaplan LM, Livingston E, Salvador J, Still C. Endocrine and nutritional management of the post-bariatric surgery patient: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2010; 95:4823-43. [PMID: 21051578 DOI: 10.1210/jc.2009-2128] [Citation(s) in RCA: 294] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE We sought to provide guidelines for the nutritional and endocrine management of adults after bariatric surgery, including those with diabetes mellitus. The focus is on the immediate postoperative period and long-term management to prevent complications, weight regain, and progression of obesity-associated comorbidities. The treatment of specific disorders is only summarized. PARTICIPANTS The Task Force was composed of a chair, five additional experts, a methodologist, and a medical writer. It received no corporate funding or remuneration. CONCLUSIONS Bariatric surgery is not a guarantee of successful weight loss and maintenance. Increasingly, patients regain weight, especially those undergoing restrictive surgeries such as laparoscopic banding rather than malabsorptive surgeries such as Roux-en-Y bypass. Active nutritional patient education and clinical management to prevent and detect nutritional deficiencies are recommended for all patients undergoing bariatric surgery. Management of potential nutritional deficiencies is particularly important for patients undergoing malabsorptive procedures, and strategies should be employed to compensate for food intolerance in patients who have had a malabsorptive procedure to reduce the risk for clinically important nutritional deficiencies. To enhance the transition to life after bariatric surgery and to prevent weight regain and nutritional complications, all patients should receive care from a multidisciplinary team including an experienced primary care physician, endocrinologist, or gastroenterologist and consider enrolling postoperatively in a comprehensive program for nutrition and lifestyle management. Future research should address the effectiveness of intensive postoperative nutritional and endocrine care in reducing morbidity and mortality from obesity-associated chronic diseases.
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Affiliation(s)
- David Heber
- David Geffen School of Medicine at University of California, Los Angeles, California 90095, USA
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Balsa JA, Botella-Carretero JI, Peromingo R, Caballero C, Muñoz-Malo T, Villafruela JJ, Arrieta F, Zamarrón I, Vázquez C. Chronic increase of bone turnover markers after biliopancreatic diversion is related to secondary hyperparathyroidism and weight loss. Relation with bone mineral density. Obes Surg 2010; 20:468-73. [PMID: 19937150 DOI: 10.1007/s11695-009-0028-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Accepted: 11/04/2009] [Indexed: 01/12/2023]
Abstract
BACKGROUND Biliopancreatic diversion (BPD) is the most effective bariatric procedure. Around 70% of these patients have secondary hyperparathyroidism (SH) in the long term as a consequence of calcium and vitamin D malabsorption. This work was aimed to study the influence of SH on bone turnover and its relationship with bone mineral density (BMD). METHODS Bone turnover markers were determined in 63 BPD patients and 34 morbidly obese controls. In the BPD group, we also studied the influence of age, loss of weight, common channel length, PTH, vitamin D, and serum calcium on bone turnover as well as its relation with BMD. RESULTS BPD patients showed significantly higher PTH, osteocalcin, and beta-CTx levels than controls. In the multivariate regression analysis, only PTH (beta=0.42; P=0.0002), menopausal status (beta=0.31; P=0.007) and the percentage of lost BMI (beta=-0.24; P=0.03) significantly predicted the osteocalcin level (R2=0.33; F=9.56; P<0.0001). Similarly, only PTH (beta=0.39; P=0.0005), menopausal status (beta=0.37; P=0.001) and the percentage of lost BMI (beta=-0.23; P=0.04) significantly predicted the beta-CTx level (R2=0.33; F=9.82; P<0.0001). Osteocalcin and beta-CTx levels correlated negatively with BMD at lumbar spine (r=-0.38, P=0.002 and r=-0.30, P=0.02, respectively). CONCLUSIONS Chronic SH and the loss of weight determine a high rate of bone turnover that is associated with decreasing BMD in BPD patients.
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Affiliation(s)
- José Antonio Balsa
- Department of Endocrinology and Clinical Nutrition, Hospital Ramón y Cajal, Carretera de Colmenar Km. 9.1, Madrid, Spaine.
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