Povaliaeva Alexandra, Zhukov Artem, Tomilova Alina, Bondarenko Axenia, Ovcharov Maksim, Antsupova Mariya, Ioutsi Vitaliy, Shestakova Ekaterina, Shestakova Marina, Pigarova Ekaterina, Rozhinskaya Liudmila, Mokrysheva Natalia
The National Medical Research Centre for Endocrinology, 117292 Moscow, Russia.
J Clin Med. 2023 Dec 19;13(1):7. doi: 10.3390/jcm13010007.
findings from the previously conducted studies indicate altered regulatory mechanisms of calcium and vitamin D metabolism in obese patients and a role for bariatric surgery in regulating vitamin D metabolism; however, the available data is controversial and does not provide an adequate understanding of the subject.
we evaluated serum parameters of vitamin D and mineral metabolism (vitamin D metabolites (25(OH)D, 25(OH)D, 1,25(OH)D, 3-epi-25(OH)D, and 24,25(OH)D), vitamin D-binding protein (DBP), free 25(OH)D, fibroblast growth factor 23 (FGF-23), parathyroid hormone (PTH), total calcium, albumin, phosphorus, creatinine, magnesium) in 30 patients referred for bariatric surgery in comparison with 30 healthy volunteers of similar age, sex and baseline 25(OH)D. Patients were also followed up with repeated laboratory assessments 3 months and 6 months after surgery. During the first 3 months, patients were prescribed high-dose cholecalciferol therapy (50,000 IU per week), with subsequent correction based on the results of the 3-month visit examination.
Preoperatively, patients with morbid obesity were characterized by a high prevalence of vitamin D deficiency (median 25(OH)D level 11.9 (6.8; 22.2) ng/mL), significantly lower levels of active vitamin D metabolite 1,25(OH)D (20 (10; 37) vs. 39 (33; 50) pg/mL, < 0.001), lower serum albumin-adjusted calcium levels (2.24 (2.20; 2.32) vs. 2.31 (2.25; 2.35) mmol/L, = 0.009) and magnesium levels (0.79 (0.72; 0.82) vs. 0.82 (0.78; 0.85) mmol/L, = 0.043) with simultaneous similar PTH levels ( = 0.912), and higher DBP levels (328 (288; 401) vs. 248 (217; 284) mg/L, < 0.001). The 25(OH)D levels remained suboptimal (24.5 (14.7; 29.5) ng/mL at the 3-month visit and 17.9 (12.4; 21.0) ng/mL at the 6-month visit, = 0.052) despite recommended high-dose cholecalciferol supplementation. Patients also demonstrated an increase in 1,25(OH)D levels (38 (31; 52) pg/mL at the 3-month visit and 49 (29; 59) pg/mL at the 6-month visit, < 0.001) without a change in PTH or calcium levels during the follow-up.
our results of a comprehensive laboratory evaluation of vitamin D status and mineral metabolism in patients undergoing bariatric surgery highlight the importance of improving current clinical guidelines, as well as careful monitoring and education of patients.
先前进行的研究结果表明，肥胖患者钙和维生素D代谢的调节机制发生改变，减肥手术在调节维生素D代谢中发挥作用；然而，现有数据存在争议，未能充分阐明这一问题。
我们评估了30例接受减肥手术患者的维生素D和矿物质代谢血清参数（维生素D代谢物（25(OH)D、25(OH)D、1,25(OH)D、3-表-25(OH)D和24,25(OH)D）、维生素D结合蛋白（DBP）、游离25(OH)D、成纤维细胞生长因子23（FGF-23）、甲状旁腺激素（PTH）、总钙、白蛋白、磷、肌酐、镁），并与30名年龄、性别和基线25(OH)D相似的健康志愿者进行比较。患者在术后3个月和6个月还进行了重复实验室评估随访。在最初3个月内，患者接受高剂量胆钙化醇治疗（每周50,000 IU），随后根据3个月随访检查结果进行调整。
术前，病态肥胖患者维生素D缺乏患病率较高（25(OH)D水平中位数为11.9（6.8；22.2）ng/mL），活性维生素D代谢物1,25(OH)D水平显著较低（20（10；37）对39（33；50）pg/mL，P<0.001），血清白蛋白校正钙水平较低（2.24（2.20；2.32）对2.31（2.25；2.35）mmol/L，P = 0.009），镁水平较低（0.79（0.72；0.82）对0.82（0.78；0.85）mmol/L，P = 0.043），而PTH水平相似（P = 0.912），DBP水平较高（328（288；401）对248（217；284）mg/L，P<0.001）。尽管补充了推荐的高剂量胆钙化醇，但25(OH)D水平仍不理想（3个月随访时为24.5（14.7；29.5）ng/mL，6个月随访时为17.9（12.4；21.0）ng/mL，P = 0.052）。患者在随访期间1,25(OH)D水平也有所升高（3个月随访时为38（31；52）pg/mL，6个月随访时为49（29；59）pg/mL，P<0.001），而PTH或钙水平无变化。
我们对接受减肥手术患者维生素D状态和矿物质代谢进行的综合实验室评估结果突出了改进当前临床指南以及对患者进行仔细监测和教育的重要性。
