Vitamin D Status 10 Years After Primary Gastric Bypass: Gravely High Prevalence of Hypovitaminosis D and Raised PTH Levels

Karefylakis, Christos; Näslund, Ingmar; Edholm, David; Sundbom, Magnus; Karlsson, F A; Rask, Eva

doi:10.1007/s11695-013-1104-y

Cited by 68 publications

(63 citation statements)

References 29 publications

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Section: Vitamin Concentrations After Gastric Bypass E Aaseth Et Alcontrasting

confidence: 52%

“…37 The lower 25-hydroxyvitamin D concentrations than in our study could potentially be explained by a lower intake of vitamin D, with only 5% of patients reporting intake of vitamin D supplements. 37 A high deficiency rate of 25-hydroxyvitamin D in the long term after gastric bypass has been reported previously. 38,39 Despite vitamin D and calcium supplementation, we observed increased PTH 37,40 Perhaps the standard dose of 400 U vitamin D 3 is too low to prevent an increase in PTH concentrations in some patients.…”

Section: Vitamin Concentrations After Gastric Bypass E Aaseth Et Alcontrasting

confidence: 52%

“…37 A high deficiency rate of 25-hydroxyvitamin D in the long term after gastric bypass has been reported previously. 38,39 Despite vitamin D and calcium supplementation, we observed increased PTH 37,40 Perhaps the standard dose of 400 U vitamin D 3 is too low to prevent an increase in PTH concentrations in some patients. A paper reported that these patients may need up to 5000 U vitamin D 3 per day to maintain stable PTH concentrations.…”

Section: Vitamin Concentrations After Gastric Bypass E Aaseth Et Almentioning

confidence: 79%

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Vitamin concentrations 5 years after gastric bypass

et al. 2015

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Section: Vitamin Concentrations After Gastric Bypass E Aaseth Et Alcontrasting

confidence: 52%

Section: Vitamin Concentrations After Gastric Bypass E Aaseth Et Alcontrasting

confidence: 52%

Section: Vitamin Concentrations After Gastric Bypass E Aaseth Et Almentioning

confidence: 79%

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Vitamin concentrations 5 years after gastric bypass

et al. 2015

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“…Several studies used additional supplemental regimens in subjects who were deficient, as shown in Figure 3 and detailed in the Appendix. The timing of 25(OH)D status assessment also varied, from as early as 3 months [58–68], to as late as 11 years post operatively [87]. …”

Section: Resultsmentioning

confidence: 99%

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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“…Bariatric surgery leads to anatomical and physiological alterations in gastro-intestinal tract that impairs absorption of some essential nutrients. Vitamin D and calcium, two fundamental factors in bone formation, are among the substances that their intestinal absorption is highly compromised (4). In this report we will describe a patient with severe hypocalcemia and osteomalacia after bariatric surgery needing emergency visit and admission.…”

Section: Introductionmentioning

confidence: 98%

Hypocalcemia and osteomalacia after bariatric surgery

Ghazi¹

2017

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SummaryIntroduction. Obesity has become a major health problem not only in industrialized societies but also in developing countries. Multiple studies have shown that bariatric surgery has been effective in reducing substantial amount of weight and also the comorbidities and is being performed more frequently as an established treatment. Due to anatomical and physiological alterations after surgery that impairs absorption of vitamin D and calcium, two fundamental factors in bone formation, their intestinal absorption is highly compromised. Case report. We present a 48-year-old woman who was visited in emergency room for generalized bone pain, perioral paresthesia and carpopedal spasm. She had undergone bariatric surgery 15 years ago. Chvostek's sign and Trousseau's sign were positive. Examination of thoracic ribs elicited severe pain on palpation. Laboratory evaluation revealed: Ca = 6.1 mg/dL, P= 2.1 mg/dL, alkaline phosphatase = 432 (160-303), PTH=541 pg/mL, and 25(OH)D3= 3 ng/mL. Whole body bone scan showed increased uptake in the anterior arc of left 6 th rib, posterior arc of left 6 th and 12 th ribs with increased uptake of costochondral joints. Conclusion. Our case highlights the possible consequences that bariatric surgery may have on bone and mineral health and the need for regular and proactive follow-up of the patients.

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Vitamin D Status 10 Years After Primary Gastric Bypass: Gravely High Prevalence of Hypovitaminosis D and Raised PTH Levels

Cited by 68 publications

References 29 publications

Vitamin concentrations 5 years after gastric bypass

Vitamin concentrations 5 years after gastric bypass

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

Hypocalcemia and osteomalacia after bariatric surgery

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