Bone Metabolism in Adolescents and Adults Undergoing Roux-En-Y Gastric Bypass: a Comparative Study

Santos, D.P.A.; Lopes, Taís de S.; Jesus, Patrí­cia Britto Ribeiro de; Cruz, Sabrina; Cordeiro, Adryana; Pereira, Sílvia; Saboya, Carlos; Ramalho, Andréa

doi:10.1007/s11695-019-03797-5

Cited by 16 publications

(13 citation statements)

References 34 publications

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“…In Teen‐Labs, there was no significant change in 25 OHD levels after RYGB and SG, although levels declined after the first post‐operative year 21 . Other adolescent studies have also not found a significant change in 25 OHD and calcium levels in the 1 to 2 years after SG and RYGB 23‐25 . The stable or increasing levels of 25 OHD in our patients and other recent adolescent studies are likely secondary to more stringent supplementation guidelines post‐operatively, although adherence at T6 and T12 is not known in our sample.…”

Section: Discussioncontrasting

confidence: 55%

“…Conversely, Elhag et al found the prevalence of secondary hyperparathyroidism, defined in their study as PTH >65 pg/mL, improved from 33.3% to 16.7% post‐operatively, with no evidence of hypocalcemia following SG 22 . In Santos et al, the PTH levels rose during the post‐operative year from 47.32 to 63.17 pg/mL following RYGB 25 . In comparison to RYGB, our data, like other adolescent SG data, does not show post‐operative secondary hyperparathyroidism, which we presume is from a less invasive procedure and more consistent vitamin D3 and calcium supplementation.…”

Section: Discussionmentioning

confidence: 85%

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The effects of adolescent laparoscopic adjustable gastric band and sleeve gastrectomy on markers of bone health and bone turnover

et al. 2020

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Summary 25‐hydroxy vitamin D (25 OHD) deficiency and secondary hyperparathyroidism have been seen after metabolic and bariatric surgery, but data are lacking on the bone health outcomes of adolescent sleeve gastrectomy (SG). The purpose of this study was to examine bone‐related nutrition after SG, compared to laparoscopic adjustable gastric band (LAGB), and trend bone turnover markers following SG. This is an observational study of 197 adolescents who underwent LAGB (n = 98) or SG (n = 99). Bone health labs were collected at baseline and 6 and/or 12 months after LAGB or SG, with additional analysis of bone turnover markers in the SG group. Calcium and 25 OHD levels increased at 6 and 12 months after LAGB and SG, with no difference between the surgeries. Parathyroid hormone levels decreased only in the SG group. SG patients had increased osteocalcin and carboxy‐terminal cross‐linking telopeptide of type 1 collagen (CTX) at 6 and 12 months post‐SG, although CTX decreased between 6 and 12 months. Excess weight loss at 6 months predicted the rise in CTX, but the changes in osteocalcin and CTX could not be attributed to 25 OHD deficiency, hypocalcemia or hyperparathyroidism. Patients had improved 25 OHD levels post‐surgery, which may be secondary to stringent vitamin supplementation guidelines. However, there were marked increases in bone turnover markers following SG. More studies are needed to evaluate the effects of SG on adolescent bone health and to correlate the early changes in bone turnover with bone mineral density and fracture risk.

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Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 85%

The effects of adolescent laparoscopic adjustable gastric band and sleeve gastrectomy on markers of bone health and bone turnover

et al. 2020

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“…Full‐text review of 355 studies resulted in the exclusion of 273 studies (Figure 1). Among the 82 included studies, 15 were of vitamin B 1 , 18–32 28 of folate, 18–45 42 of vitamin B 12 , 18–59 13 of vitamin A, 18,19,23,25,26,28–30,36,39,55,60,61 11 of vitamin E, 18,19,23,25,26,28,29,61–64 57 of vitamin D, 18,19,21–33,37–39,41,42,45,47,51,52,55,59,61,65–94 42 of calcium,…”

Section: Resultsmentioning

confidence: 99%

Micronutrient status in bariatric surgery patients receiving postoperative supplementation per guidelines: Insights from a systematic review and meta‐analysis of longitudinal studies

Kwon

et al. 2021

Obesity Reviews

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Summary The micronutrient status and optimal monitoring schedule after bariatric surgery have not been sufficiently assessed. This systematic review and meta‐analysis investigated the longitudinal changes in micronutrient status after bariatric surgery. PubMed, EMBASE, and Cochrane Library were searched for articles that measured preoperative and postoperative serum micronutrient levels in patients undergoing Roux‐en‐Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Among guideline‐adherent studies, the longitudinal changes in micronutrient status were investigated using weighted mean difference (WMD) using a random‐effects model. Among the 82 included studies, the guideline adherence rates for micronutrient supplementation after bariatric surgery did not exceed 20%. In patients supplemented per guidelines, vitamin A significantly decreased after RYGB by −7.54 (95% confidence interval [CI], −10.16 to −4.92) μg/dl at 12–23 months, vitamin E decreased after RYGB by −2.35 (95% CI, −3.65 to −1.05) μg/dl at ≥24 months, and ferritin by −54.93 (95% CI, −77.19 to −32.67] μg/L at ≥24 months after SG, compared with baseline, with moderate level of evidence. Significant decreases in micronutrient levels at certain follow‐up intervals in studies with supplementation per guidelines need to be considered to establish a post‐bariatric micronutrient monitoring schedule for timely detection and management of micronutrient deficiencies.

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“…Vitamin D is important for calcium homeostasis and bone metabolism. There are concerns that bone health may be adversely affected by bariatric surgery, and that vitamin D deficiency may play a part [12][13][14][15][16][17][18]. One meta-analysis of 51 studies found mean vitamin D levels ≤ 20 ng/mL (50 nmol/L) in a third of studies [10]; mean vitamin D levels remained ≤ 30 ng/ mL (75 nmol/L) following bariatric surgery despite various vitamin D replacement regimens, with few exceptions.…”

Section: Introductionmentioning

confidence: 99%

Vitamin D Status After Gastric Bypass or Sleeve Gastrectomy over 4 Years of Follow-up

et al. 2019

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Background Bariatric surgery for severe obesity can lead to micronutrient/vitamin deficiencies. Aims To study baseline and post-surgical prevalence of vitamin D deficiency in patients undergoing bariatric surgery. Participants and Setting Patients undergoing bariatric surgery in a university teaching hospital in North West England. Methods We performed an observational cohort analysis of longitudinal data on vitamin D and related parameters in patients who underwent bariatric surgery. Patients were routinely recommended daily combined calcium and vitamin D supplementation post-surgery. Results We studied 460 patients who had completed at least 12 months post-operatively; mean (standard deviation) age was 48.0 (10.5) years, weight 144.7 (27.3) kg and body mass index 50.0 (7.6) kg/m 2 ; 292 (63.5%) underwent gastric bypass and 168 (36.5%) sleeve gastrectomy. Vitamin D level was 33.1 (23.9) nmol/L at baseline, rising to 57.1 (23.1) nmol/L at 12 months postsurgery. Whereas 43.2% had vitamin D deficiency and 34.7% insufficiency preoperatively, 8.9% and 26.7% had deficiency and insufficiency, respectively, at 12 months with similar trends up to 4 years of follow-up. There were no significant differences between procedures or sexes in vitamin D levels or sufficiency rates. Conclusion Vitamin D deficiency and insufficiency were prevalent pre-surgery and reduced significantly with routine supplementation post-surgery.

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Bone Metabolism in Adolescents and Adults Undergoing Roux-En-Y Gastric Bypass: a Comparative Study

Cited by 16 publications

References 34 publications

The effects of adolescent laparoscopic adjustable gastric band and sleeve gastrectomy on markers of bone health and bone turnover

The effects of adolescent laparoscopic adjustable gastric band and sleeve gastrectomy on markers of bone health and bone turnover

Micronutrient status in bariatric surgery patients receiving postoperative supplementation per guidelines: Insights from a systematic review and meta‐analysis of longitudinal studies

Vitamin D Status After Gastric Bypass or Sleeve Gastrectomy over 4 Years of Follow-up

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