Moore Carolyn E, Sherman Vadim
Department of Nutrition and Foods Sciences, Texas Woman's University, 6700 Fannin, Houston, TX, 77030, USA,
Obes Surg. 2014 Dec;24(12):2055-60. doi: 10.1007/s11695-014-1261-7.
Vitamin D deficiency is common with bariatric surgery, and few prospective studies comparing different surgical procedures have evaluated appropriate vitamin D supplementation levels. Therefore, vitamin D3 and calcium supplementation were evaluated following gastric bypass and sleeve gastrectomy.
Women consumed 2,000 international units (IU) of vitamin D3 and 1,500 mg calcium citrate daily for 3 months following gastric bypass (n=11) and sleeve gastrectomy (n=12). Height, weight, body mass index (BMI), serum 25-hydroxyvitamin D [25(OH)D], and serum PTH concentrations were measured preoperatively and at 3 months. Wilcoxon signed rank analyses compared body weight parameters, serum 25(OH)D and PTH concentrations, and dietary intakes of vitamin D and calcium preoperatively and at 3 months. Vitamin D deficiency was defined as a serum 25(OH)D concentration <20 ng/mL (50 nmol/L).
Vitamin D deficiency decreased from 60.6 % preoperatively to 26.1 % after 3 months (P<0.005). Serum 25(OH)D concentrations increased an average of 8 ng/mL (P<0.001), and PTH concentrations decreased an average of 9 ng/L, although reductions were not significant. Overall, the response to supplementation following gastric bypass and sleeve gastrectomy did not differ.
Reduced food intake increased the risk of vitamin D deficiency following bariatric surgery. However, daily supplementation with 2,000 IU of vitamin D3 and 1,500 mg calcium citrate significantly increased 25(OH)D concentrations and reduced the percent of women who were vitamin D deficient. Although serum 25(OH)D concentrations did not reach levels associated with detrimental health effects, several women remained vitamin D deficient and more aggressive supplementation may be indicated.
维生素D缺乏在减肥手术后很常见，很少有比较不同手术方法的前瞻性研究评估过合适的维生素D补充水平。因此，对胃旁路手术和袖状胃切除术之后维生素D3和钙补充剂进行了评估。
胃旁路手术组（n = 11）和袖状胃切除术组（n = 12）的女性在术后3个月内每天服用2000国际单位（IU）的维生素D3和1500毫克柠檬酸钙。术前及术后3个月测量身高、体重、体重指数（BMI）、血清25-羟维生素D [25(OH)D]以及血清甲状旁腺激素（PTH）浓度。采用Wilcoxon符号秩和分析比较术前及术后3个月的体重参数、血清25(OH)D和PTH浓度，以及维生素D和钙的膳食摄入量。维生素D缺乏定义为血清25(OH)D浓度<20 ng/mL（50 nmol/L）。
维生素D缺乏率从术前的60.6%降至术后3个月的26.1%（P<0.005）。血清25(OH)D浓度平均升高8 ng/mL（P<0.001），PTH浓度平均降低9 ng/L，尽管降低幅度不显著。总体而言，胃旁路手术和袖状胃切除术后补充剂的反应没有差异。
食物摄入量减少增加了减肥手术后维生素D缺乏的风险。然而，每天补充2000 IU维生素D3和1500毫克柠檬酸钙可显著提高25(OH)D浓度，并降低维生素D缺乏女性的比例。虽然血清25(OH)D浓度未达到对健康有不利影响的水平，但仍有几名女性维生素D缺乏，可能需要更积极的补充。
