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Vitamin D Status 10 Years After Primary Gastric Bypass: Gravely High Prevalence of Hypovitaminosis D and Raised PTH Levels
Dept Endocrinol, Div Internal Med, Örebro Univ Hosp, Örebro, Sweden.
Örebro University Hospital. Div Surg, Örebro University Hospital, Örebro, Sweden.
Dept Surg Sci, Uppsala Univ, Uppsala, Sweden.ORCID iD: 0000-0003-2172-5310
Dept Surg Sci, Uppsala Univ, Uppsala, Sweden.
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2014 (English)In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 24, no 3, p. 343-348Article in journal (Refereed) Published
Abstract [en]

The primary aim of this study was to evaluate the prevalence of vitamin D deficiency and secondary hyperparathyroidism after Roux-en-Y gastric bypass. Secondly, we have tried to assess predictors for vitamin D deficiency. Five hundred thirty-seven patients who underwent primary Roux-en-Y gastric bypass surgery between 1993 and 2003 at the A-rebro University Hospital and Uppsala University Hospital were eligible for the study. Patients were asked to provide a blood sample between November 2009 and June 2010 and to complete a questionnaire about their postoperative health status. Serum values of 25-OH vitamin D, parathyroid hormone (PTH), alkaline phosphatase (ALP) and calcium were determined. Follow-up was completed in 293 patients, of which 83 % were female, with an age of 49 +/- 9.9 years after a median time of 11 +/- 2.8 years. Vitamin D, PTH and albumin-corrected calcium values were 42 +/- 20.4 nmol/L, 89.1 +/- 52.7 ng/L and 2.3 +/- 0.1 mmol/L, respectively. Of all patients, 65 % were vitamin D deficient, i.e. 25-OH vitamin D < 50 nmol/L, and 69 % had PTH above the upper normal reference range, i.e. > 73 ng/L. Vitamin D was inversely correlated with PTH levels (p < 0.001) and positively correlated with calcium (p = 0.016). Vitamin D did not correlate with ALP. The only factor found to predict vitamin D deficiency was high preoperative body mass index (BMI) (p = 0.008), whereas gender, age, time after surgery and BMI at follow-up did not. Vitamin D deficiency and secondary hyperparathyroidism after Roux-en-Y gastric bypass (RYGB) were confirmed in our study because 65 % of patients had vitamin D deficiency, and 69 % had increased PTH levels more than 10 years after surgery. These data are alarming and highlight the need for improved long-term follow-up. Vitamin D deficiency does not seem to progress with time after surgery, possibly due to weight loss. Only preoperative BMI, cutoff point 43 kg/m(2), was a predictor of vitamin D deficiency at follow-up. Improved long-term follow-up of patients that undergo RYGB is needed.

Place, publisher, year, edition, pages
2014. Vol. 24, no 3, p. 343-348
Keywords [en]
Vitamin D, Gastric bypass, Hyperparathyroidism, Long-term follow-up
National Category
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-56581DOI: 10.1007/s11695-013-1104-yISI: 000330983200001PubMedID: 24163201OAI: oai:DiVA.org:oru-56581DiVA, id: diva2:1083001
Available from: 2017-03-20 Created: 2017-03-20 Last updated: 2018-06-23Bibliographically approved
In thesis
1. Vitamin D and its role in obesity and other associated conditions
Open this publication in new window or tab >>Vitamin D and its role in obesity and other associated conditions
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Vitamin D has received much attention in recent years due to the re-emergence of vitamin D deficiency as a global health issue along with increasing evidence indicating that 1,25-dihydroxivitamin D, the hormonally active form of vita-min D, not only acts in calcium and bone metabolism but also generates ex-traskeletal biological responses.

In this thesis, the role of vitamin D in obesity and other associated condi-tions has been studied.

In paper 1, the prevalence of vitamin D deficiency and secondary hyperpara-thyroidism over the long term after Roux-en-Y gastric bypass (RYGB) were evaluated. We found a substantial prevalence of vitamin D deficiency and secondary hyperparathyroidism after RYGB, whereas calcium levels remained within normal range. An expected improvement in vitamin D status after weight loss could have been countered by the malabsorption induced by surgery.

In paper 2, the prevalence of anemia and related deficiencies over the long term after RYGB were studied. We found that 27% of the patients had anemia postoperatively, 20% had iron deficiency, 12% had folate deficiency and 2% had vitamin B12 deficiency. Anemia was mainly due to iron deficiency, and its frequency did not seem to progress with time after surgery.

In paper 3, the effects of vitamin D supplementation on body composition and cardiorespiratory fitness in overweight men with vitamin D deficiency at baseline were investigated. No statistically significant difference between the placebo and the intervention group regarding changes in percentage body fat, maximum oxygen uptake, BMI and maximum load was found.

In paper 4, the prevalence and determinants of 3-epi-25(OH)D3 were exam-ined. 3-epi-25(OH)D3 was detected in 7.7% of the study population and the mean concentration was 8.4 nmol/L. The quantification of 3-epi-25(OH)D3 would not significantly influence the clinical interpretation of vitamin D levels.

In conclusion, new knowledge about vitamin D is continuously emerging but there is a discrepancy between cross-sectional studies associating low vitamin D levels to obesity and other related metabolic complications and the lack of effects of vitamin D supplementation in clinical trials. Large RCTs with longer duration in obese subjects with baseline vitamin D deficiency are warranted.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2018. p. 67
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 177
Keywords
Vitamin D, obesity, Roux-en-Y gastric bypass, secondary hyperpara-thyroidism, anemia, iron deficiency, body composition, cardiorespiratory fitness, Vitamin D C3 epimer
National Category
General Practice
Identifiers
urn:nbn:se:oru:diva-64979 (URN)978-91-7529-238-0 (ISBN)
Public defence
2018-04-20, Örebro universitet, Campus USÖ, hörsal C3, Södra Grev Rosengatan 32, Örebro, 13:00 (Swedish)
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Available from: 2018-02-12 Created: 2018-02-12 Last updated: 2018-03-28Bibliographically approved

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