Serum fat-soluble vitamin deficiency andabnormal calcium metabolism after malabsorptivebariatric surgery

Slater, Guy; Ren, Christine; Siegel, Niccole; Williams, Trudy; Barr, Di; Wolfe, Barrie; Dolan, Kevin; Fielding, George

doi:10.1016/j.gassur.2003.09.020

Cited by 423 publications

(260 citation statements)

References 14 publications

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“…8,9 Parenteral replacement is quick and effective in treating visual disturbance as was evident in our patient. Thiamine deficiency has been described in up to 49% of RYGB patients.…”

Section: Discussionsupporting

confidence: 62%

Complications from micronutrient deficiency following bariatric surgery

Wilson

Datta

2014

Ann Clin Biochem

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We report a case of clinically significant micronutrient deficiencies following biliary pancreatic diversion (BPD) surgery. Our patient was admitted to hospital six years after BPD surgery following a low impact humeral fracture complicated by postoperative wound infection. On presentation she complained of a widespread rash and loss of night vision. Laboratory testing confirmed hypoalbuminaemia, deficiencies of vitamins A, E and D and of the trace elements copper, zinc and selenium. Bone densitometry confirmed osteoporosis. The skin rash was thought to be due to zinc deficiency and improved with conservative measures and trace element replacement. Her night blindness resolved 48 hours after receiving high dose parenteral vitamin A. Six months later she was readmitted to our intensive care unit with wound dehiscence at her fracture site and clinical features of sepsis and encephalopathy. This case highlights the importance of devising treatment and follow-up guidance prior to surgery and multidisciplinary team involvement including the patient so that long-term metabolic complications are avoided.

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“…8,9 Parenteral replacement is quick and effective in treating visual disturbance as was evident in our patient. Thiamine deficiency has been described in up to 49% of RYGB patients.…”

Section: Discussionsupporting

confidence: 62%

Complications from micronutrient deficiency following bariatric surgery

Wilson

Datta

2014

Ann Clin Biochem

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“…The conflicting findings of increasing 25-OH Vit D and decreasing PTH in comparison with studies in obese adults with weight loss could be explained by the fact that weight loss was achieved in these studies by gastric surgery (17,18). It is well known that, for example, Roux-Y bypass is associated with alterations in the vitamin D endocrine system such as secondary hyperparathyroidism due to disturbed resorption of vitamin D (16,18).…”

Section: Discussionmentioning

confidence: 98%

“…It is well known that, for example, Roux-Y bypass is associated with alterations in the vitamin D endocrine system such as secondary hyperparathyroidism due to disturbed resorption of vitamin D (16,18).…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, studies support a direct role for PTH in suppressing lipid oxidation in the muscle (14). However, these hypotheses are discussed controversially since in obese adults with weight loss, increasing and decreasing 25-OH Vit D as well as decreasing and increasing PTH concentrations have been reported (15)(16)(17)(18)(19)(20), so that the question whether the alterations of these hormones are a consequence or cause of overweight remains open.Vitamin D also acts as a necessary cofactor for insulin secretion (21-24). Vitamin D repletion improves insulin This study is registered at clinicaltrials.gov (NCT00435734).…”

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confidence: 99%

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Vitamin D status and parathyroid hormone in obese children before and after weight loss

Reinehr¹,

Sousa²,

Alexy³

et al. 2007

eur j endocrinol

181

114

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Objective: The roles of vitamin D and parathyroid hormone (PTH) are discussed controversially in obesity, and studies of these hormones in obese children are limited. Therefore, we studied the relationships between PTH, 1,25-dihydroxy-vitamin D (1,25-OH Vit D), 25-hydroxy-vitamin D (25-OH Vit D), weight status, and insulin sensitivity before and after weight loss in obese children. Methods: Fasting serum PTH, 1,25-OH Vit D, 25-OH Vit D, inorganic phosphate, calcium, alkaline phosphatase (AP), insulin, glucose, and weight status (SDS-BMI and percentage body fat) were determined in 133 obese children (median age 12.1 years) and compared with 23 non-obese children. Furthermore, these parameters were analyzed in 67 obese children before and after participating in a 1-year obesity intervention program. Results: Obese children had significantly (P!0.001) higher PTH and lower 25-OH Vit D concentrations compared with non-obese children, while calcium, phosphate, AP, and 1,25-OH Vit D did not differ significantly. Changes of PTH (rZ0.23, PZ0.031) and 25-OH Vit D (rZK0.27, PZ0.013) correlated significantly with changes of SDS-BMI, but not with changes of insulin sensitivity (homeostasis model assessment; HOMA-B%). Reduction of overweight in 35 children led to a significant (P!0.01) decrease of PTH concentrations and an increase in 25-OH Vit D levels. Conclusions: PTH levels were positively and 25-OH Vit D concentrations were negatively related to weight status. Since these alterations normalized after weight loss, these changes are consequences rather than causes of overweight. A relationship between PTH, vitamin D, and insulin sensitivity based on the HOMA index was not found in obese children. Further longitudinal clamp studies are neccessary to study the relationship between vitamin D and insulin sensitivity. European Journal of Endocrinology 157 225-232Introduction Vitamin D and parathyroid hormone (PTH) are well known for their essential role in bone metabolism and calcium homeostasis. The main sources of vitamin D are ergocalciferol and cholecalciferol, the former normally available in food and the latter produced in the skin by u.v. radiation of 7-dehydrocholesterol. Both of these compounds are hydroxylated in the liver to 25-hydroxyvitamin D (25-OH Vit D), which is the major circulating metabolite precursor to the hormonally active form, 1,25-dihydroxy-vitamin D (1,25-OH Vit D).It has become increasingly clear that the vitamin D endocrine system is related to obesity in adults. Obesity has been found to be associated with lower levels of serum 25-OH Vit D (1-5) and higher levels of serum PTH (1,(5)(6)(7)(8). A low vitamin D intake was associated with increased body mass index (BMI) (9). PTH has been postulated as an independent predictor of obesity (7). Overweight as a consequence of elevated serum PTH was explained by several mechanisms (10, 11): PTH stimulates the renal hydroxylation of 25-OH Vit D to its active form, 1,25-OH Vit D, which in turn elevates the calcium influx into adipocytes. In these cell...

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“…6 Additionally, this deficiency state is exacerbated after bariatric surgery. [7][8][9] Vitamin D has been linked with important anti-inflammatory and immunomodulatory roles where it regulates cytokines and profibrotic and pro-inflammatory pathways that play an important role in pain perception and propagation. [10][11][12][13][14][15] Clinically, vitamin D deficiency has been associated with chronic non-specific musculoskeletal pain syndromes and migraines.…”

Section: Résumémentioning

confidence: 99%

Low serum vitamin D levels are not associated with increased postoperative pain and opioid requirements: a historical cohort study

Bose

Khanna

You

et al. 2015

Can J Anesth/J Can Anesth

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Purpose Vitamin D deficiency has been associated with chronic non-specific musculoskeletal pain syndromes; however, studies are lacking with respect to its relationship with postoperative pain. We tested the hypothesis that a lower preoperative vitamin D level is associated with increased postoperative pain and/or opioid consumption in morbidly obese patients who had laparoscopic bariatric surgery.

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Serum fat-soluble vitamin deficiency andabnormal calcium metabolism after malabsorptivebariatric surgery

Cited by 423 publications

References 14 publications

Complications from micronutrient deficiency following bariatric surgery

Complications from micronutrient deficiency following bariatric surgery

Vitamin D status and parathyroid hormone in obese children before and after weight loss

Low serum vitamin D levels are not associated with increased postoperative pain and opioid requirements: a historical cohort study

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