Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Department of Community Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran.
Obes Facts. 2023;16(6):519-539. doi: 10.1159/000533828. Epub 2023 Aug 28.
Managing nutritional deficiencies is an essential component in the treatment of severe obesity. Vitamin D deficiency is often reported in investigations in severely obese cohorts. However, no prior study has summarized findings on this topic. Consequently, the aim of this systematic review and meta-analysis was to investigate the 25-hydroxyvitamin D [25(OH)D] status in individuals with severe obesity in different regions worldwide. We also evaluated levels of calcium, parathyroid hormone (PTH), and magnesium as secondary outcome measures.
We searched Medline, PubMed, Scopus, the Cochrane Library, and EMBASE for relevant observational studies published in English from 2009 to October 2021. The heterogeneity index among the studies was determined using the Cochran (Q) and I2 tests. Based on the heterogeneity results, the random-effect model was applied to estimate the prevalence of vitamin D deficiency.
We identified 109 eligible observational studies. Overall, 59.44% of patients had vitamin D deficiency [25(OH)D <20 ng/mL], whereas 26.95% had vitamin D insufficiency [25(OH)D 20-30 ng/mL]. Moreover, the mean 25(OH)D level was 18.65 ng/mL in 96 studies. The pooled mean estimate of the serum calcium, PTH, and magnesium was 9.26 mg/dL (95% confidence interval [CI]: 9.19-9.32, I2 = 99.7%, p < 0.001), 59.24 pg/mL (95% CI: 54.98, 63.51, I2 = 99.7%, p < 0.001), and 0.91 mg/dL (95% CI: 0.84, 0.98, I2 = 100.0%, p < 0.001), respectively. The results of the subgroup analysis indicated that the mean estimates of 25(OH)D were highest in North America (21.71 ng/mL [19.69, 23.74], [I2 = 97.2%, p < 0.001]) and lowest in Southeast Asia (14.93 ng/mL [14.54, 15.33], [I2 = 0.0%, p = 0.778]).
The results obtained showed a significant prevalence of vitamin D deficiency among severely obese individuals in various geographical regions, whereas the highest and lowest mean estimates were reported for North America and Southeast Asia, respectively.
管理营养缺乏是严重肥胖症治疗的重要组成部分。在严重肥胖队列的研究中，常报告维生素 D 缺乏。然而，以前没有研究总结过这个主题的发现。因此，本系统评价和荟萃分析的目的是调查全球不同地区严重肥胖个体的 25-羟维生素 D [25(OH)D] 状况。我们还评估了钙、甲状旁腺激素 (PTH) 和镁作为次要结局指标的水平。
我们检索了 Medline、PubMed、Scopus、Cochrane 图书馆和 EMBASE，以查找 2009 年至 2021 年 10 月发表的英文观察性研究。使用 Cochran (Q) 和 I2 检验确定研究之间的异质性指数。根据异质性结果，应用随机效应模型估计维生素 D 缺乏的患病率。
我们确定了 109 项合格的观察性研究。总体而言，59.44%的患者存在维生素 D 缺乏[25(OH)D <20ng/mL]，而 26.95%的患者存在维生素 D 不足[25(OH)D 20-30ng/mL]。此外，96 项研究中 25(OH)D 的平均水平为 18.65ng/mL。血清钙、PTH 和镁的汇总平均估计值为 9.26mg/dL（95%置信区间 [CI]：9.19-9.32，I2 = 99.7%，p < 0.001）、59.24pg/mL（95%CI：54.98,63.51，I2 = 99.7%，p < 0.001）和 0.91mg/dL（95%CI：0.84,0.98，I2 = 100.0%，p < 0.001）。亚组分析结果表明，北美（21.71ng/mL[19.69,23.74]，[I2 = 97.2%，p < 0.001]）的 25(OH)D 平均估计值最高，而东南亚（14.93ng/mL[14.54,15.33]，[I2 = 0.0%，p = 0.778]）的最低。
研究结果表明，严重肥胖个体的维生素 D 缺乏患病率显著，而北美和东南亚的平均估计值最高和最低。
