绝经前女性行袖状胃切除术或 Roux-en-Y 胃旁路术后钙吸收可能受到影响：一项 2 年前瞻性研究。
Calcium absorption may be affected after either sleeve gastrectomy or Roux-en-Y gastric bypass in premenopausal women: a 2-y prospective study.
机构信息
Department of Nutrition, Faculty of Medicine and Surgery, Clinical Hospital, University of Chile, Santiago, Chile.
Department of Surgery, Clinical Hospital, University of Chile, Santiago, Chile.
出版信息
Am J Clin Nutr. 2018 Jul 1;108(1):24-32. doi: 10.1093/ajcn/nqy071.
BACKGROUND
Although Roux-en-Y gastric bypass (RYGBP) is known to reduce calcium absorption (CA), the effects of vertical sleeve gastrectomy (SG) and its long-term implications on CA have not yet been studied.
OBJECTIVE
The aim of this study was to evaluate changes in CA and its relation with modifications of bone mineral density (BMD), intakes of calcium and vitamin D, vitamin D status, and parathyroid hormone (PTH) concentrations ≤24 mo after SG and RYGBP, respectively.
DESIGN
Twenty-six premenopausal women undergoing SG [mean ± SD body mass index (BMI; kg/m2): 37.3 ± 3.2; age: 34.2 ± 10.2 y] and 32 undergoing RYGBP (BMI: 42.0 ± 4.2; age: 37.3 ± 8.1 y) were studied at baseline (presurgery) and followed up at 12 and 24 mo after surgery. BMD, bone alkaline phosphatase activity, and serum PTH, 25-hydroxyvitamin D [25(OH)D], calcium, magnesium, and phosphorus concentrations were determined. Food and supplement intakes were recorded. CA was measured by using a dual stable isotope method.
RESULTS
In premenopausal women, CA was significantly reduced from 36.5% ± 2.0% preoperatively to 21.0% ± 2.3% and 18.8% ± 3.4% at 12 and 24 mo post-SG surgery, respectively. CA also decreased significantly from 41.5% ± 2.8% preoperatively to 27.9% ± 3.8% and 18.5% ± 2.2% 12 and 24 mo after RYGBP, respectively. No difference was found between type of surgery (time × group interaction, P = 0.60). Considering both groups combined, 56.6% of the variance in CA at the 12-mo but not at the 24-mo follow-up was explained by serum PTH and 25(OH)D concentrations, together with vitamin D and calcium intakes.
CONCLUSIONS
CA was similarly reduced in both SG and RYGBP compared with baseline, and it was not associated with changes in BMD or body weight loss. This reduction in CA could be explained only partially by calcium intake increase. This trial is registered at http://www.isrctn.com as ISRCTN31937503.
背景
虽然已知 Roux-en-Y 胃旁路术（RYGBP）可降低钙吸收（CA），但垂直袖状胃切除术（SG）及其对 CA 的长期影响尚未得到研究。
目的
本研究旨在评估 SG 和 RYGBP 后≤24 个月 CA 的变化及其与骨密度（BMD）改变、钙和维生素 D 摄入量、维生素 D 状态和甲状旁腺激素（PTH）浓度的关系。
设计
26 名接受 SG 的绝经前妇女[平均体重指数（BMI；kg/m2）：37.3 ± 3.2；年龄：34.2 ± 10.2 y]和 32 名接受 RYGBP 的妇女（BMI：42.0 ± 4.2；年龄：37.3 ± 8.1 y）分别在基线（术前）和术后 12 和 24 个月进行研究。测定骨密度、骨碱性磷酸酶活性和血清 PTH、25-羟维生素 D [25（OH）D]、钙、镁和磷浓度。记录食物和补充剂的摄入量。通过双稳定同位素法测量 CA。
结果
在绝经前妇女中，CA 从术前的 36.5%±2.0%显著降低至 SG 术后 12 和 24 个月时的 21.0%±2.3%和 18.8%±3.4%。CA 也从术前的 41.5%±2.8%显著降低至 RYGBP 术后 12 和 24 个月时的 27.9%±3.8%和 18.5%±2.2%。两种手术之间无差异（时间×组交互作用，P=0.60）。考虑到两组联合，CA 在 12 个月时的 56.6%变化可以通过血清 PTH 和 25（OH）D 浓度以及维生素 D 和钙摄入量来解释，但在 24 个月时不能解释。
结论
与基线相比，SG 和 RYGBP 均可降低 CA，且与 BMD 变化或体重减轻无关。CA 的这种减少只能部分通过钙摄入量的增加来解释。本试验在 http://www.isrctn.com 注册，编号为 ISRCTN31937503。
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