Sánchez-Hernández Joan, Ybarra Juan, Gich Ignasi, De Leiva Alberto, Rius Xavier, Rodríguez-Espinosa Jose, Pérez Antonio
Department of Medicine, Universitat Autònoma de Barcelona, Spain.
Obes Surg. 2005 Nov-Dec;15(10):1389-95. doi: 10.1381/096089205774859182.
Morbidly obese patients have been reported to present with vitamin D insufficiency and secondary hyperparathyroidism. Scattered data are available regarding the effects of bariatric surgery on vitamin D status. We studied calcium metabolism and vitamin D status before and after bariatric surgery.
In this prospective study, 64 patients (M5/F59) fulfilled the inclusion criteria (i.e. 2 calcidiol serum determinations in the winter season) among 457 morbidly obese individuals who underwent Roux-en-Y gastric bypass (RYGBP) a mean of 36 months previously. Laboratory data (serum calcium, phosphorus, creatinine, alkaline phosphatase, albumin, calcidiol, albumin and iPTH) were determined before and after RYGBP. Pre- and postoperative calcidiol levels were categorized as being normal (>50 nmol/L), insufficient (25-50 nmol/L), and deficient (<25 nmol/L). Pre- and postoperative mild secondary hyperparathyroidism was defined as iPTH >7.3 pmol/L with simultaneous normal values for creatinine, calcium and phosphorus.
RYGBP produced a significant weight loss coupled with a simultaneous increase in calcidiol (+28%, P<0.0005) and decrements in total alkaline phosphatase (-53%, P<0.0005) and iPTH (-74%, P=0.001). Corrected serum calcium, phosphorus, and creatinine levels were indistinguishable before and after RYGBP. Additionally, 37.5% of the patients maintained their calcidiol category, while 42.2 % improved it and 20.3% lost one category.
RYGBP does not completely correct pre-existing vitamin D deficient states with secondary hyperparathyroidism. Low calcidiol bioavailability and or insufficient sunlight exposure do probably persist after bariatric surgery. While randomized controlled studies are warranted, it seems advisable to support vitamin D supplementation as well as increasing sunlight exposure in the morbidly obese population.
据报道，病态肥胖患者存在维生素D缺乏和继发性甲状旁腺功能亢进。关于减肥手术对维生素D状态影响的数据较为零散。我们研究了减肥手术前后的钙代谢和维生素D状态。
在这项前瞻性研究中，64例患者（男性5例/女性59例）符合纳入标准（即在冬季进行两次血清骨化二醇测定），这些患者来自457例平均在36个月前接受了Roux-en-Y胃旁路术（RYGBP）的病态肥胖个体。在RYGBP前后测定实验室数据（血清钙、磷、肌酐、碱性磷酸酶、白蛋白、骨化二醇、白蛋白和iPTH）。术前和术后骨化二醇水平分为正常（>50 nmol/L）、不足（25 - 50 nmol/L）和缺乏（<25 nmol/L）。术前和术后轻度继发性甲状旁腺功能亢进定义为iPTH>7.3 pmol/L，同时肌酐、钙和磷值正常。
RYGBP导致显著体重减轻，同时骨化二醇增加（+28%，P<0.0005），总碱性磷酸酶降低（-53%，P<0.0005）和iPTH降低（-74%，P = 0.001）。RYGBP前后校正后的血清钙、磷和肌酐水平无明显差异。此外，37.5%的患者维持其骨化二醇类别，42.2%的患者有所改善，20.3%的患者降低了一个类别。
RYGBP不能完全纠正既往存在的维生素D缺乏伴继发性甲状旁腺功能亢进状态。减肥手术后可能仍然存在骨化二醇生物利用度低和/或阳光照射不足的情况。虽然有必要进行随机对照研究，但在病态肥胖人群中支持补充维生素D以及增加阳光照射似乎是可取的。
