Calcium Intake and Metabolic Bone Disease after Eight Years of Roux-en-Y Gastric Bypass

Campos, Camila Duran de; Dalcanale, Lorença; Pajecki, Dênis; Garrido, Arthur B.; Halpern, Alfredo

doi:10.1007/s11695-007-9393-7

Cited by 42 publications

(31 citation statements)

References 25 publications

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“…In accordance with other reports (5-12,30), hypercalciuria was not a frequent finding in this sample of post-BS patients. The lack of hypercalciuria may be ascribed to low protein, calcium, and salt intake, which is usually found in this population (14,15,31,32) and was detected in our patient cohort as well. It may also have occurred because calcium supplements were withdrawn 3 days before urine collection in our study.…”

Section: Discussionsupporting

confidence: 71%

“…The potential underlying mechanisms for hyperoxaluria have not yet been determined, but some degree of fat malabsorption is speculated to play a role through the binding of fatty acids to calcium, thereby inhibiting the formation of poorly soluble, nonabsorbable calcium oxalate in the intestinal lumen (11,13). Similarly, less calcium in the intestinal lumen as a result of lower dietary calcium intake after surgery (2,14,15) may also reduce these poorly soluble compounds, resulting in more free oxalate available for absorption and thereby increasing urinary oxalate. Increased net intestinal absorption of oxalate due to dysfunction of the anion exchanger SLC26A6, which acts as an oxalate secretor in the small bowel (16), warrants investigation.…”

Section: Introductionmentioning

confidence: 99%

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Response to Dietary Oxalate after Bariatric Surgery

Froeder

Arasaki

Malheiros³

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Bariatric surgery (BS) may be associated with increased oxalate excretion and a higher risk of nephrolithiasis. This study aimed to investigate urinary abnormalities and responses to an acute oxalate load as an indirect assessment of the intestinal absorption of oxalate in this population.Design, setting, participants, & measurements Twenty-four-hour urine specimens were collected from 61 patients a median of 48 months after BS (post-BS) as well as from 30 morbidly obese (MO) participants; dietary information was obtained through 24-hour food recalls. An oral oxalate load test (OLT), consisting of 2-hour urine samples after overnight fasting and 2, 4, and 6 hours after consuming 375 mg of oxalate (spinach juice), was performed on 21 MO and 22 post-BS patients 12 months after BS. Ten post-BS patients also underwent OLT before surgery (pre-BS).Results There was a higher percentage of low urinary volume (,1.5 L/d) in post-BS versus MO (P,0.001). Hypocitraturia and hyperoxaluria (P=0.13 and P=0.36, respectively) were more frequent in BS versus MO patients. The OLT showed intragroup (P,0.001 for all periods versus baseline) and intergroup differences (P,0.001 for post-BS versus MO; P=0.03for post-BS versus pre-BS). The total mean increment in oxaluria after 6 hours of load, expressed as area under the curve, was higher in both post-BS versus MO and in post-BS versus pre-BS participants (P,0.001 for both).Conclusions The mean oxaluric response to an oxalate load is markedly elevated in post-bariatric surgery patients, suggesting that increased intestinal absorption of dietary oxalate is a predisposing mechanism for enteric hyperoxaluria.

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Section: Discussionsupporting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Response to Dietary Oxalate after Bariatric Surgery

Froeder

Arasaki

Malheiros³

et al. 2012

Clinical Journal of the American Society of Nephrology

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“…(19). A frequência de deficiência de 25OHD relatada nos estudos oscilou de 50% a 80% (20,22,23). As baixas concentrações de 25OHD em pacientes submetidos à DGYR podem ocorrer por sequestro no tecido adiposo, redução na hidroxilação da pré-vitamina devido à esteatose hepática, menor exposição ao sol pelo sedentarismo ou secundária à inflamação que acompanha a obesidade (12,24).…”

Section: Discussionunclassified

Alterações de parâmetros relacionados ao metabolismo ósseo em mulheres submetidas à derivação gástrica em Y de Roux

Santos

Souza

Fonseca

et al. 2012

Arq Bras Endocrinol Metab

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RESUMOObjetivo: Avaliar o metabolismo ósseo e a densidade mineral óssea (DMO) em mulheres adultas pós-derivação gástrica em Y de Roux (DGYR). Sujeitos e métodos: Estudo transversal com 48 mulheres submetidas a DGYR há três anos e 41 saudáveis. Dados obtidos: índice de massa corporal (IMC), atividade física, consumo alimentar e DMO da coluna lombar, colo e fêmur total. Dosagem de cálcio, fósforo, magnésio, albumina, fosfatase alcalina, telopeptídeo-C (CTX), paratormônio (PTH), 25-hidroxivitamina D (25OHD), osteocalcina e cálcio urinário. Resultados: Maiores alterações no grupo DGYR observadas nos níveis de osteocalcina (p < 0,001), CTX (p < 0,001) e PTH (p < 0,001). Deficiência de 25OHD foi a mais frequente no grupo DGYR (p = 0,010). Deficiência/insuficiência de 25OHD associou-se com hiperparatiroidismo secundário (p = 0,025). Não houve diferença entre os grupos em relação à DMO. A ingestão de energia (p = 0,036) e proteína (p = 0,004) foi maior no grupo controle. Conclusão: Em mulheres pós-DGYR, encontraram-se alta frequência de deficiência de vitamina D, hiperparatireoidismo secundário e elevação nos marcadores de remodelação óssea, sem alteração na DMO quando comparado com o grupo controle não obeso. Arq Bras Endocrinol Metab. 2012;56(6):376-82 Descritores Cirurgia bariátrica; densidade mineral óssea; vitamina D; hiperparatiroidismo secundário; anastomose em-Y de Roux ABSTRACT Objective: To evaluate bone turnover markers and bone mineral density (BMD) in women after Roux-en-Y (RYGB) gastric bypass. Subjects and methods: In a cross-sectional study, 48 women post-RYGB after three years, and 41 healthy women were evaluated. Evaluations: body mass index (BMI); physical activity; food intake; serum levels of calcium, phosphorus, magnesium, alkaline phosphatase, C-terminal telopeptide (CTX), intact parathyroid hormone (PTH), 25-hydroxyvitamin D (25OHD), osteocalcin, urinary calcium and BMD. Results: Significantly higher levels were observed for osteocalcin (p < 0.001), CTX (p < 0.001), and PTH (p < 0.001) in the RYGB group when compared with the control group; 25OHD deficiency/insufficiency was more frequent in the RYGB group (p = 0.010), even after adjusted for nutritional status, and it was associated with secondary hyperparathyroidism (p = 0.025); there was no difference in BMD between the groups. Energy (p = 0.036) and protein intake (p = 0.004) were lower in the RYGB group. Conclusion: Patients submitted to RYGB showed a significantly higher frequency of vitamin D deficiency, secondary hyperparathyroidism, and increase in bone remodeling markers, with no difference in BMD status. Arq Bras Endocrinol Metab. 2012;56(6):376-82

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“…One study found that 8 years after RYGB although the vast majority showed a strong inverse correlation between vitamin D and PTH, 10% of patients had a vitamin D deficiency with normal PTH. They posed that whilst the vitamin D deficiency was due to malabsorption, the normalisation of PTH was "more intense in the first years" and would eventually resolve [14].…”

Section: Discussionmentioning

confidence: 99%

“…Up to 60-90% of the obese are known to have vitamin D deficiency, even without surgery [11,12] and an inverse correlation between serum vitamin D levels and obesity has been documented [13,14]. Despite this, the deficiency does not seem to translate to clinically relevant consequences such as osteoporosis.…”

Section: Inadequate Intake Of Vitamin D and Calciummentioning

confidence: 99%

Metabolic Bone Disease and Bariatric Surgery

Sanghera¹

2013

J Gastrointest Dig Syst

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The prevalence of obesity is increasing worldwide and the past decade has witnessed an exponential rise in the number of bariatric operations performed. As a consequence, it is expected that an increasing number of patients are likely to be at risk of long term complications that may not manifest until years or decades later. Several studies have investigated the short and long-term complications of bariatric surgery but there is little available data on the longterm consequences on bone metabolism and the consequences of this after bariatric surgery. This paper reviews the current literature for further information on this clinically relevant issue.

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Calcium Intake and Metabolic Bone Disease after Eight Years of Roux-en-Y Gastric Bypass

Abstract: These data suggest that metabolic bone disease could be a complication of this type of surgery.

Cited by 42 publications

References 25 publications

Response to Dietary Oxalate after Bariatric Surgery

Response to Dietary Oxalate after Bariatric Surgery

Alterações de parâmetros relacionados ao metabolismo ósseo em mulheres submetidas à derivação gástrica em Y de Roux

Metabolic Bone Disease and Bariatric Surgery

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