Graduate Institute of Integrated Medicine, China Medical University, Taichung, 404, Taiwan.
Center for Personalized Medicine, China Medical University Hospital, Taichung, 404, Taiwan.
Obes Surg. 2021 Aug;31(8):3707-3714. doi: 10.1007/s11695-021-05484-w. Epub 2021 May 25.
Taking advantage of isomeric form of vitamin E in the supplement, adherence to supplement could be evaluated by changes in circulating α- and γ-tocopherol concentrations. Accordingly, effects of supplementation on postoperative nutrition and bone metabolism were studied in terms of adherence.
Thirty-eight SG patients were all prescribed a postoperative nutritional supplement containing a low dose of vitamin D (600 IU) and calcium (200 mg). Blood samples were collected prior to (M0) and 6 months after (M6) surgery and concentrations of nutrients and C-terminal telopeptide of type I collage (CTX), a marker of bone resorption, were measured. Adherence and non-adherence were stratified according to change (△, M6-M0) in serum α-tocopherol concentrations (> 0 vs. ≤ 0, respectively).
When M0 and M6 were compared, there were significant increases in serum concentrations of 25(OH)D, α-tocopherol and selenium, whereas there were reductions in parathyroid hormone, ferritin, and γ-tocopherol. At M6, the prevalence of vitamin D insufficiency (25(OH)D < 30 ng/mL) and high CTX were 72 and 26%, respectively. When comparison was made between adherence and non-adherence, only △25(OH)D concentrations, but no other nutrients nor postoperative CTX differed. Multiple linear regression demonstrated that postoperative vitamin D status was independently associated with its preoperative concentrations (β = 0.85, p < 0.001) and adherence (β = 0.52, p < 0.05).
SG patients' adherence to supplementation, even with a low dose of vitamin D and calcium, determined vitamin D status but not bone resorption marker concentrations, at least within 6 months after surgery.
利用补充剂中维生素 E 的异构体形式，可以通过循环 α-和 γ-生育酚浓度的变化来评估补充剂的依从性。因此，本研究从依从性的角度，研究了补充剂对术后营养和骨代谢的影响。
38 例 SG 患者均接受了含有低剂量维生素 D（600IU）和钙（200mg）的术后营养补充剂。在手术前（M0）和手术后 6 个月（M6）采集血样，并测量营养素和 I 型胶原 C 端肽（CTX）浓度，CTX 是骨吸收的标志物。根据血清 α-生育酚浓度的变化（△，M6-M0）（>0 与 ≤0）将依从性和不依从性分层。
与 M0 相比，M6 时血清 25(OH)D、α-生育酚和硒浓度显著升高，甲状旁腺激素、铁蛋白和 γ-生育酚浓度降低。M6 时，维生素 D 不足（25(OH)D < 30ng/mL）和高 CTX 的患病率分别为 72%和 26%。在依从性和不依从性之间进行比较时，只有△25(OH)D 浓度，而其他营养素和术后 CTX 没有差异。多元线性回归表明，术后维生素 D 状态与术前浓度（β=0.85，p<0.001）和依从性（β=0.52，p<0.05）独立相关。
即使补充剂中维生素 D 和钙的剂量较低，SG 患者的补充剂依从性也能决定维生素 D 状态，但不能决定骨吸收标志物浓度，至少在手术后 6 个月内是如此。
