Goldner Whitney S, Stoner Julie A, Lyden Elizabeth, Thompson Jon, Taylor Karen, Larson Luann, Erickson Judi, McBride Corrigan
Section of Diabetes, Endocrinology, and Metabolism, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, 68198-3020, USA.
Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
Obes Surg. 2009 Feb;19(2):173-179. doi: 10.1007/s11695-008-9680-y. Epub 2008 Sep 16.
Vitamin D deficiency is common following bariatric surgery and is due to a combination of baseline deficiency and postoperative malabsorption. There are few prospective studies evaluating the appropriate dose of vitamin D to prevent and treat vitamin D deficiency following bariatric surgery.
We evaluated three doses of vitamin D3 (800, 2,000, and 5,000 IU/day) in a prospective, randomized pilot trial of 45 patients undergoing Roux-en-Y gastric bypass. Serum 25 hydroxy Vitamin D (25OHD), intact PTH (iPTH), calcium, and urine calcium/creatinine ratios were measured at 6, 12, and 24 months postoperatively. Due to a high dropout rate at 24 months, we focus on the 12-month data.
At 12 months, the 800-, 2,000-, and 5,000-IU groups had a mean +/- SD increase in 25OHD of 27.5 +/- 40.0, 60.2 +/- 37.4, and 66.1 +/- 42.2 nmol/L, respectively (p = 0.09) with a maximum increase in each group of 87.4, 114.8, and 129.8 nmol/L. Forty-four percent, 78%, and 70% achieved 25OHD levels >or=75 nmol/L (p = 0.38). Results for the 6- and 24-month time points were similar to the 12-month results. Mean weight loss at 24 months of the study was not different among groups (p = 0.52). Serum calcium did not change significantly, and there were no cases of hypercalcemia or sustained hypercalciuria.
Higher doses of vitamin D supplementation trend towards higher levels of 25OHD. Vitamin D replacement as high as 5,000 IU /day is safe and necessary in many patients to treat vitamin D deficiency following Roux-en-Y gastric bypass yet is still suboptimal in others.
减肥手术后维生素D缺乏很常见，这是由基线缺乏和术后吸收不良共同导致的。很少有前瞻性研究评估预防和治疗减肥手术后维生素D缺乏的合适维生素D剂量。
我们在一项针对45例行Roux-en-Y胃旁路手术患者的前瞻性随机试验中评估了三种剂量的维生素D3（800、2000和5000国际单位/天）。在术后6、12和24个月测量血清25羟维生素D（25OHD）、完整甲状旁腺激素（iPTH）、钙和尿钙/肌酐比值。由于24个月时失访率高，我们重点关注12个月的数据。
在12个月时，800、2000和5000国际单位组的25OHD平均增加量（±标准差）分别为27.5±40.0、60.2±37.4和66.1±42.2nmol/L（p = 0.09），每组最大增加量分别为87.4、114.8和129.8nmol/L。44%、78%和70%的患者25OHD水平达到或≥75nmol/L（p = 0.38）。6个月和24个月时间点的结果与12个月的结果相似。研究24个月时各组间平均体重减轻无差异（p = 0.52）。血清钙无显著变化，无高钙血症或持续性高钙尿症病例。
更高剂量的维生素D补充剂会使25OHD水平有升高趋势。对于许多接受Roux-en-Y胃旁路手术的患者，每天高达5000国际单位的维生素D替代治疗维生素D缺乏是安全且必要的，但对其他一些患者仍不理想。
