Optimization of Vitamin D Status After Roux-en-Y Gastric Bypass Surgery in Obese Patients Living in Northern Climate

Chan, Lingtak Neander; Neilson, Charlotte H.; Kirk, Elizabeth A.; Colovos, Tiana F.; Javelli, Diane R.; Khandelwal, Saurabh

doi:10.1007/s11695-015-1685-8

Cited by 16 publications

(11 citation statements)

References 37 publications

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“…Figure 2 represents studies that have a number of participants of at least 50 per study group or subgroup, based on bariatric surgery type. It shows that mean 25(OH)D levels were ≤ 20 ng/ml in fifteen studies [51–65], and between 20 and 30 ng/ml in the others [66–77]. The weighted mean 25(OH)D levels (ng/ml) did not differ between studies, classified according to the baseline participants’ mean BMI (mean BMI ≥ 50 kg/m 2 , mean BMI between 45 and 50 kg/m 2 and mean BMI ≤ 45 kg/m 2 ) (Figure 2).…”

Section: Resultsmentioning

confidence: 99%

“…These were divided into categories according to the type of the surgical procedure and the dose range of vitamin D supplementation. Only eight studies showed a mean 25(OH)D level > 30 ng/ml at 6 to 24 months post operatively [51,52,60,66,69,73,75,80]. Thirteen studies showed a mean 25(OH)D level < 20 ng/ml at 6 months to 11 years post operatively [51,54,55,64,78,85–92].…”

Section: Resultsmentioning

confidence: 99%

“…Conversely, studies administering a maintenance vitamin D supplementation of 400–2,000 IU daily, and additional doses to deficient and/or insufficient individuals (additional equivalent dose range 1,100 IU–7,100 IU, total daily dose received 1,500–9,100 IU), with the exception of Fish et al [69], consistently demonstrated an increase in mean 25(OH)D level of 9–13 ng/ml at six months [59] (Appendix), and at one year post operatively (Figure 3) [52,60,62,66,73,75]. The mean baseline 25(OH)D level in this group of studies was 13–25 ng/ml.…”

Section: Resultsmentioning

confidence: 99%

“…Finally, studies that administered vitamin D, as a maintenance dose to all participants (≤2,000 IU daily), and additional doses (range of equivalent daily doses: 1,100–7,100 IU, total daily dose received 1,500–9,100 IU) to vitamin D deficient/insufficient individuals, following malabsorptive and combination procedures, achieved a mean 25(OH)D level above 20 ng/ml in five studies, with mean baseline 25(OH)D level 13–21 ng/ml [53,59,62,69,100], and above 30 ng/ml in six studies, with mean baseline 25(OH)D level 15–25 ng/ml [52,60,66,69,73,75] (Figure 3 and Appendix). …”

Section: Resultsmentioning

confidence: 99%

“…Following bariatric surgery, mean 25(OH)D levels remained < 30 ng/ml, despite various vitamin D supplementation regimens, with the exception of few studies where vitamin D deficiency was corrected using vitamin D replacement equivalent daily doses of 1,100–7,100 IU, as add-on to the maintenance dose of 400 – 2,000 IU daily usually administered to all the study participants (total equivalent daily dose 1,500–9,150 IU). Studies using such regimens showed a substantial increase in mean 25(OH)D level, of 9–13 ng/ml and allowed to the majority of the study population to reach the desirable 25(OH)D level of 20 ng/ml [52,60,62,66,73,75], as recommended by the Institute Of Medicine (IOM) [37]. …”

Section: Discussionmentioning

confidence: 99%

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Hypovitaminosis D in bariatric surgery: A systematic review of observational studies

et al. 2016

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Background Obesity is a public health problem that carries global and substantial social and economic burden. Relative to non-surgical interventions, bariatric surgery has the most substantial and lasting impact on weight loss. However, it leads to a number of nutritional deficiencies requiring long term supplementation. Objectives The aims of this paper are to review 25-hydroxyvitamin D [25(OH)D] status pre and post - bariatric surgery, describe the dose response of vitamin D supplementation, and assess the effect of the surgical procedure on 25(OH)D level following supplementation. Methods We searched Medline, PubMed, the Cochrane Library and EMBASE, for relevant observational studies published in English, from 2000–April 2015. The identified references were reviewed, in duplicate and independently, by two reviewers. Results We identified 51 eligible observational studies assessing 25(OH)D status pre and/or post bariatric surgery. Mean pre-surgery 25(OH)D level was below 30 ng/ml in 29 studies and 17 of these studies showed mean 25(OH)D levels ≤ 20 ng/ml. Mean 25(OH)D levels remained below 30 ng/ml following bariatric surgery despite various vitamin D replacement regimens, with only few exceptions. The increase in postoperative 25(OH)D levels tended to parallel increments in vitamin D supplementation dose but varied widely across studies. An increase in 25(OH)D level by 9–13 ng/ml was achieved when vitamin D deficiency was corrected using vitamin D replacement doses of 1,100–7,100 IU/day, in addition to the usual maintenance equivalent daily dose of 400 – 2,000 IU (total equivalent daily dose 1,500–9,150 IU). There was no difference in mean 25(OH)D level following supplementation between malabsorptive/ combination procedures and restrictive procedures. Conclusion Hypovitaminosisis D persists in obese patients undergoing bariatric surgery, despite various vitamin D supplementation regimens. Further research is needed to determine the optimal vitamin D dose to reach desirable 25(OH)D levels in this population, and to demonstrate whether this dose varies according to the surgical procedure.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Hypovitaminosis D in bariatric surgery: A systematic review of observational studies

et al. 2016

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Vitamin D status and supplementation before and after Bariatric Surgery: Recommendations based on a systematic review and meta-analysis

Giustina,

di Filippo,

Facciorusso

et al. 2023

Rev Endocr Metab Disord

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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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Cholecalciferol Injections Are Effective in Hypovitaminosis D After Duodenal Switch: a Randomized Controlled Study

2018

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BackgroundBy treating obesity, one of the major epidemics of this past century, through bariatric surgery, we may cause complications due to malnourishment in a growing population. At present, vitamin D deficiency is of interest, especially in patients with inferior absorption of fat-soluble nutrients after biliopancreatic diversion with duodenal switch (BPD/DS).MethodsTwenty BPD/DS patients, approximately 4 years postoperatively, were randomized to either intramuscular supplementation of vitamin D with a single dose of 600,000 IU cholecalciferol, or a control group. Patients were instructed to limit their supplementation to 1400 IU of vitamin D and to avoid the influence of UV-B radiation; the study was conducted when sunlight is limited (December to May).ResultsDespite oral supplementation, a pronounced deficiency in vitamin D was seen (injection 19.3; control 23.2 nmol/l) in both groups. The cholecalciferol injection resulted in elevated 25[OH]D levels at 1 month (65.4 nmol/l), which was maintained at 6 months (67.4 nmol/l). This resulted in normalization of intact parathyroid hormone (PTH) levels. No changes in vitamin D or PTH occurred in the control group.ConclusionsIn BPD/DS patients, having hypovitaminosis D despite full oral supplementation, a single injection of 600,000 IU of cholecalciferol was effective in elevating vitamin D levels and normalizing levels of intact PTH. The treatment is simple and highly effective and thus recommended, especially in cases of reduced UV-B radiation.

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Optimization of Vitamin D Status After Roux-en-Y Gastric Bypass Surgery in Obese Patients Living in Northern Climate

Abstract: The prevalence of hypovitaminosis D before RYGB was comparable to patients living in the non-northern climate. Daily vitamin D intake meeting at least 2000 IU is associated with greater improvement in serum vitamin D concentration.

Cited by 16 publications

References 37 publications

Hypovitaminosis D in bariatric surgery: A systematic review of observational studies

Hypovitaminosis D in bariatric surgery: A systematic review of observational studies

Vitamin D status and supplementation before and after Bariatric Surgery: Recommendations based on a systematic review and meta-analysis

Cholecalciferol Injections Are Effective in Hypovitaminosis D After Duodenal Switch: a Randomized Controlled Study

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