维生素D、钙、蛋白质补充剂及体育锻炼对减重手术后骨代谢的影响：BABS研究

The Impact of Vitamin D, Calcium, Protein Supplementation, and Physical Exercise on Bone Metabolism After Bariatric Surgery: The BABS Study.

作者信息

Muschitz Christian, Kocijan Roland, Haschka Judith, Zendeli Afrodite, Pirker Thomas, Geiger Corinna, Müller Andrea, Tschinder Bettina, Kocijan Annemarie, Marterer Christina, Nia Arastoo, Muschitz Gabriela Katharina, Resch Heinrich, Pietschmann Peter

机构信息

St. Vincent Hospital, Department II, Academic Teaching Hospital of the Medical University of Vienna, Vienna, Austria.

Karl Landsteiner Institute for Gastroenterology and Rheumatology, Vienna, Austria.

出版信息

J Bone Miner Res. 2016 Mar;31(3):672-82. doi: 10.1002/jbmr.2707. Epub 2015 Sep 30.

DOI:10.1002/jbmr.2707

PMID:26350034

Abstract

Laparoscopic Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are common and effective methods to treat severe obesity, but these procedures can adversely influence bone metabolism and areal bone mineral density (aBMD). This was a prospective 24-month single-center interventional two-arm study in 220 women and similarly aged men (median age 40.7 years) with a body mass index (BMI) >38 kg/m(2) after RYGB and SG procedures. Patients were randomized into: 1) an intervention group receiving: 28,000 IU cholecalciferol/wk for 8 weeks before bariatric surgery, 16,000 IU/wk and 1000 mg calciummonocitrate/d after surgery, daily BMI-adjusted protein supplementation and physical exercise (Nordic walking, strength perseverance, and equipment training); 2) a non-intervention group: no preoperative loading, nutritional supplementation, or obligatory physical exercise. At study endpoint, when comparing the intervention group to the non-intervention group, the relative percentage changes of serum levels of sclerostin (12.1% versus 63.8%), cross-linked C-telopeptide (CTX, 82.6% versus 158.3%), 25-OH vitamin D (13.4% versus 18.2%), phosphate (23.7% versus 32%, p < 0.001 for all), procollagen type 1 amino-terminal propeptide (P1NP, 12% versus 41.2%), intact parathyroid hormone (iPTH, -17.3% versus -7.6%), and Dickkopf-1 (-3.9% versus -8.9%, p < 0.05 for all) differed. The decline in lumbar spine, total hip and total body aBMD, changes in BMI, lean body mass (LBM), as well as changes in trabecular bone score (TBS) values (p < 0.005 for all) were less, but significantly, pronounced in the intervention group. We conclude that vitamin D loading and ongoing vitamin D, calcium, and BMI-adjusted protein supplementation in combination with physical exercise decelerates the loss of aBMD and LBM after bariatric surgery. Moreover, the well-known increases of bone turnover markers are less pronounced.

摘要

腹腔镜Roux-en-Y胃旁路术（RYGB）和袖状胃切除术（SG）是治疗重度肥胖的常用且有效的方法，但这些手术可能会对骨代谢和骨面积密度（aBMD）产生不利影响。这是一项前瞻性的、为期24个月的单中心干预双臂研究，研究对象为220名女性和年龄相仿的男性（中位年龄40.7岁），他们在接受RYGB和SG手术后的体重指数（BMI）>38 kg/m²。患者被随机分为：1）干预组，在减重手术前8周接受28,000 IU胆钙化醇/周，术后接受16,000 IU/周和1000 mg柠檬酸钙/天，每日进行BMI调整的蛋白质补充和体育锻炼（北欧健走、力量耐力和器械训练）；2）非干预组：不进行术前负荷、营养补充或强制性体育锻炼。在研究终点，将干预组与非干预组进行比较时，硬化蛋白、交联C端肽（CTX）、25-羟基维生素D、磷酸盐、I型前胶原氨基端前肽（P1NP）、完整甲状旁腺激素（iPTH）和Dickkopf-1的血清水平相对百分比变化（分别为12.1%对63.8%、82.6%对158.3%、13.4%对18.2%、23.7%对32%，所有p<0.001；12%对41.2%、-17.3%对-7.6%、-3.9%对-8.9%，所有p<0.05）存在差异。干预组腰椎、全髋和全身aBMD的下降、BMI、去脂体重（LBM）的变化以及骨小梁评分（TBS）值的变化（所有p<0.005）较小，但明显更显著。我们得出结论，在减重手术后，维生素D负荷以及持续的维生素D、钙和BMI调整的蛋白质补充与体育锻炼相结合，可减缓aBMD和LBM的流失。此外，众所周知的骨转换标志物的升高也不那么明显。