Vitamin D3 Loading Is Superior to Conventional Supplementation After Weight Loss Surgery in Vitamin D-Deficient Morbidly Obese Patients: a Double-Blind Randomized Placebo-Controlled Trial

Abstract

BackgroundBariatric patients often suffer from vitamin D deficiency (VDD), and both, morbid obesity and VDD, are related to non-alcoholic fatty liver disease. However, limited data are available regarding best strategies for treating VDD, particularly, in bariatric patients undergoing omega-loop gastric bypass (OLGB). Therefore, we examined the efficacy and safety of a forced vitamin D dosing regimen and intervention effects in liver fibrotic patients.MethodsIn this double-blind, randomized, placebo-controlled trial, 50 vitamin D-deficient patients undergoing OLGB were randomly assigned to receive, in the first month postoperatively, oral vitamin D3 (≤3 doses of 100,000 IU; intervention group) or placebo as loading dose (control group) with subsequent maintenance dose (3420 IU/day) in both groups until 6-month visit.ResultsCompared with control group, higher increase of 25(OH)D (67.9 (21.1) vs. 55.7 nmol/L (21.1); p = 0.049) with lower prevalence of secondary hyperparathyroidism (10 vs. 24 %; p = 0.045) was observed in intervention group. No (serious) adverse events related to study medication were found. The loading dose regimen was more effective in increasing 25(OH)D in patients with significant liver fibrosis while this was not the case for conventional supplementation (placebo with maintenance dose) (71.5 (20.5) vs. 22.5 nmol/L (13.8); p = 0.022; n = 14).ConclusionsOur findings indicate that a high vitamin D3 loading dose, in the first month postoperatively, with subsequent maintenance dose is effective and safe in achieving higher vitamin D concentrations in OLGB patients. Unexpectedly, it is more effective in patients with significant liver fibrosis which is of potentially high clinical relevance and requires further investigation.Electronic supplementary materialThe online version of this article (doi:10.1007/s11695-016-2437-0) contains supplementary material, which is available to authorized users.

Relationships of serum 25‐hydroxyvitamin D, ionized calcium and parathyroid hormone after obesity surgery

“…According to two recent studies, high doses of vitamin D supplementation may help to reduce the prevalence of SHPT and resist bone loss after gastric bypass . A large number of vitamin D supplementation studies in different populations have, however, not shown benefits on end‐points such as fractures, and some well‐designed high‐dose vitamin D studies have resulted in increased number of falls and fractures .…”

Changes in Bone Mineral Density Following Weight Loss Induced by One-Anastomosis Gastric Bypass in Patients with Vitamin D Supplementation

“…Regarding the first, second, and third loading doses in the first month postoperatively, 100, 100, and 96% of the participants took their assigned study drug (cholecalciferol) or placebo. Adherence to the subsequent maintenance dose was at 2, 3, 4, 5, and 6 months after surgery at 67, 70, 71, 63, and 61%, respectively, without statistically significant differences between the study groups [21]. The reason given by the patients was that they "have forgotten to take the vitamin D supplementation every week", despite a reminder on a regular basis.…”

“…The study participants were scheduled for OAGB surgery and all of them gave written, informed consent preoperatively. Subjects were participants in a 6-month double-blind, placebo-controlled, randomized trial of vitamin D supplementation, the LOAD-study ("Link between Obesity And Vitamin D") [21]. The study protocol was previously published [23].…”

“…As part of a randomized controlled trial of vitamin D 3 supplementation after OAGB, safety and efficacy of high-dose vitamin D supplementation were previously reported [21]; however, changes of BMD have not been investigated so far. As achieving sufficient 25(OH)D concentrations postoperatively has been challenging, it was hypothesized that highdose oral vitamin D 3 supplementation leading higher 25(OH)D concentrations would result in a deceleration or prevention of bone loss.…”

Proceedings of the 2017 ASPEN Research Workshop—Gastric Bypass: Role of the Gut

“…Use of dietary supplements is also an effective way to manage status of protein 142 , calcium, iron 141,143 , and vitamins D 115 and B 12 144 after gastric bypass. For treatment of deficiencies, although clinical trial are limited, data suggest that high-dose supplementation of iron 145 , vitamins D 142,146 and B 12 and protein 117 is effective. Taken together, since oral ingestion of food and supplements can be used to prevent and treat malnutrition, this suggests that sufficient capacity of the gut remains for digestion and absorption of micronutrients after surgery.…”