Skip to main content
SpringerLink
Log in

Serum Vitamin D Increases with Weight Loss in Obese Subjects 6 Months After Roux-en-Y Gastric Bypass

  • Clinical Research
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Malabsorptive surgical procedures lead to deficiencies in fat-soluble vitamins. However, results concerning serum vitamin D (25OHD) after gastric bypass (GBP) are controversial. The aim of the study was to assess the influence of GBP on 25OHD and calcium metabolism.

Methods

Parameters of calcium metabolism were evaluated in 202 obese subjects before and 6 months after GBP. Thirty of them were matched for age, gender, weight, skin color, and season with 30 subjects who underwent sleeve gastrectomy (SG). A multivitamin preparation that provides 200 to 500 IU vitamin D3 per day was systematically prescribed after surgery.

Results

In the 202 patients after GBP, serum 25OHD significantly increased from 13.4 ± 9.1 to 22.8 ± 11.3 ng/ml (p < 0.0001), whereas parathyroid hormone (PTH) did not change. Despite a decrease in calcium intake (p < 0.0001) and urinary calcium/creatinine ratio (p = 0.015), serum calcium increased after GBP (p < 0.0001). Preoperatively, 91 % of patients had 25OHD insufficiency (<30 ng/ml), 80 % deficiency (<20 ng/ml), and 19 % secondary hyperparathyroidism (>65 pg/ml) vs. 76, 44, and 17 %, respectively, following GBP. Serum 25OHD was negatively correlated with BMI at 6 months after GBP (R = −0.299, p < 0.0001). In the two groups of 30 subjects, serum 25OHD and PTH did not differ at 6 months after GBP or SG.

Conclusions

At 6 months after GBP, serum 25OHD significantly increased in subjects supplemented with multivitamins containing low doses of vitamin D. These data suggest that weight loss at 6 months after surgery has a greater influence on vitamin D status than malabsorption induced by GBP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Sjöström L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–93.

    Article  PubMed  Google Scholar 

  2. Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122:248–56.e5.

    Article  PubMed  Google Scholar 

  3. Shah M, Simha V, Garg A. Review: long-term impact of bariatric surgery on body weight, comorbidities, and nutritional status. J Clin Endocrinol Metab. 2006;91:4223–31.

    Article  PubMed  CAS  Google Scholar 

  4. Alvarez-Leite JI. Nutrient deficiencies secondary to bariatric surgery. Curr Opin Clin Nutr Metab Care. 2004;7:569–75.

    Article  PubMed  Google Scholar 

  5. Coupaye M, Puchaux K, Bogard C, et al. Nutritional consequences of adjustable gastric banding and gastric bypass: a 1-year prospective study. Obes Surg. 2009;19:56–65.

    Article  PubMed  Google Scholar 

  6. Goldner WS, Stoner JA, Thompson J, et al. Prevalence of vitamin D insufficiency and deficiency in morbidly obese patients: a comparison with non-obese controls. Obes Surg. 2008;18:145–50.

    Article  PubMed  Google Scholar 

  7. DiGiorgi M, Daud A, Inabnet WB, et al. Markers of bone and calcium metabolism following gastric bypass and laparoscopic adjustable gastric banding. Obes Surg. 2008;18:1144–8.

    Article  PubMed  Google Scholar 

  8. Grethen E, McClintock R, Gupta CE, et al. Vitamin D and hyperparathyroidism in obesity. J Clin Endocrinol Metab. 2011;96:1320–6.

    Article  PubMed  CAS  Google Scholar 

  9. Flores L, Osaba MJ, Andreu A, et al. Calcium and vitamin D supplementation after gastric bypass should be individualized to improve or avoid hyperparathyroidism. Obes Surg. 2010;20:738–43.

    Article  PubMed  Google Scholar 

  10. Yanoff LB, Parikh SJ, Spitalnik A, et al. The prevalence of hypovitaminosis D and secondary hyperparathyroidism in obese Black Americans. Clin Endocrinol (Oxf). 2006;64:523–9.

    Article  CAS  Google Scholar 

  11. Snijder MB, van Dam RM, Visser M, et al. Adiposity in relation to vitamin D status and parathyroid hormone levels: a population-based study in older men and women. J Clin Endocrinol Metab. 2005;90:4119–23.

    Article  PubMed  CAS  Google Scholar 

  12. Cheng S, Massaro JM, Fox CS, et al. Adiposity, cardiometabolic risk, and vitamin D status: the Framingham Heart Study. Diabetes. 2010;59:242–8.

    Article  PubMed  CAS  Google Scholar 

  13. Lin E, Armstrong-Moore D, Liang Z, et al. Contribution of adipose tissue to plasma 25-hydroxyvitamin D concentrations during weight loss following gastric bypass surgery. Obesity (Silver Spring). 2011;19:588–94.

    Article  CAS  Google Scholar 

  14. Bellia A, Garcovich C, D'Adamo M et al. Serum 25-hydroxyvitamin D levels are inversely associated with systemic inflammation in severe obese subjects. Intern Emerg Med. 2011. doi:10.1007/s11739-011-0559-x.

  15. Duncan A, Talwar D, McMillan DC, et al. Quantitative data on the magnitude of the systemic inflammatory response and its effect on micronutrient status based on plasma measurements. Am J Clin Nutr. 2012;95:64–71.

    Article  PubMed  CAS  Google Scholar 

  16. Dewey M, Heuberger R. Vitamin D and calcium status and appropriate recommendations in bariatric surgery patients. Gastroenterol Nurs. 2011;34:367–74.

    Article  PubMed  Google Scholar 

  17. Earthman CP, Beckman LM, Masodkar K et al. The link between obesity and low circulating 25-hydroxyvitamin D concentrations: considerations and implications. Int J Obes (Lond) 2012;36:387–96.

    Google Scholar 

  18. Riedt CS, Brolin RE, Sherrell RM, et al. True fractional calcium absorption is decreased after Roux-en-Y gastric bypass surgery. Obesity (Silver Spring). 2006;14:1940–8.

    Article  CAS  Google Scholar 

  19. Jin J, Stellato TA, Hallowell PT, et al. Utilization of preoperative patient factors to predict postoperative vitamin D deficiency for patients undergoing gastric bypass. J Gastrointest Surg. 2009;13:1052–7.

    Article  PubMed  Google Scholar 

  20. Goode LR, Brolin RE, Chowdhury HA, et al. Bone and gastric bypass surgery: effects of dietary calcium and vitamin D. Obes Res. 2004;12:40–7.

    Article  PubMed  CAS  Google Scholar 

  21. McKenna MJ. Differences in vitamin D status between countries in young adults and the elderly. Am J Med. 1992;93:69–77.

    Article  PubMed  CAS  Google Scholar 

  22. Johnson LK, Hofsø D, Aasheim ET, et al. Impact of gender on vitamin D deficiency in morbidly obese patients: a cross-sectional study. Johnson LK, Hofsø D. Eur J Clin Nutr. 2012;66:83–90.

    Article  PubMed  CAS  Google Scholar 

  23. Fried M, Hainer V, Basdevant A, et al. Inter-disciplinary European guidelines on surgery of severe obesity. Int J Obes (Lond). 2007;31:569–77.

    CAS  Google Scholar 

  24. Souberbielle JC, Prié D, Courbebaisse M, et al. Update on vitamin D and evaluation of vitamin D status. Ann Endocrinol (Paris). 2008;69:501–10.

    Article  CAS  Google Scholar 

  25. Msika S. Surgical treatment of morbid obesity by gastrojejunal bypass using laparoscopic Roux-en-Y (gastric short circuit). J Chir (Paris). 2002;139:214–7.

    CAS  Google Scholar 

  26. Ferrer-Márquez M, Belda-Lozano R, Ferrer-Ayza M. Technical controversies in laparoscopic sleeve gastrectomy. Obes Surg. 2012;22:182–7.

    Article  PubMed  Google Scholar 

  27. Wallace TM, Levy JC, Matthews DR. Use and abuse of HOMA modeling. Diabetes Care. 2004;27:1487–95.

    Article  PubMed  Google Scholar 

  28. Holick MF, Binkley NC, Bischoff-Ferrari HA et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011; 96: 1911-30. Erratum in: J Clin Endocrinol Metab. 2011; 96: 3908.

    Google Scholar 

  29. Roth HJ, Schmidt-Gayk H, Weber H, et al. Accuracy and clinical implications of seven 25-hydroxyvitamin D methods compared with liquid chromatography–tandem mass spectrometry as a reference. Ann Clin Biochem. 2008;45:153–9.

    Article  PubMed  CAS  Google Scholar 

  30. Signori C, Zalesin KC, Franklin B, et al. Effect of gastric bypass on vitamin D and secondary hyperparathyroidism. Obes Surg. 2010;20:949–52.

    Article  PubMed  Google Scholar 

  31. Fish E, Beverstein G, Olson D, et al. Vitamin D status of morbidly obese bariatric surgery patients. J Surg Res. 2010;164:198–202.

    Article  PubMed  CAS  Google Scholar 

  32. Ruiz-Tovar J, Oller I, Tomas A, et al. Mid-term effects of sleeve gastrectomy on calcium metabolism parameters, vitamin D and parathormone (PTH) in morbid obese women. Obes Surg. 2012;22:797–801.

    Article  PubMed  Google Scholar 

  33. Van der Schueren B, Green N, Gorroochurn P, et al. Low vitamin D in candidates for bariatric surgery: are the Americans better off than the French? Obes Surg. 2011;21:948–9. author reply 950.

    Article  PubMed  Google Scholar 

  34. Sinha N, Shieh A, Stein EM, et al. Increased PTH and 1.25(OH)(2)D levels associated with increased markers of bone turnover following bariatric surgery. Obesity (Silver Spring). 2011;19:2388–93.

    Article  CAS  Google Scholar 

  35. Aasheim ET, Björkman S, Søvik TT et al. Vitamin status after bariatric surgery: a randomized study of gastric bypass and duodenal switch. Am J Clin Nutr. 2009; 90: 15-22. Erratum in: Am J Clin Nutr. 2010; 91: 239-40.

    Google Scholar 

  36. Pramyothin P, Biancuzzo RM, Lu Z, et al. Vitamin D in adipose tissue and serum 25-hydroxyvitamin D after Roux-en-Y gastric bypass. Obesity (Silver Spring). 2011;19:2228–34.

    Article  CAS  Google Scholar 

  37. Allied Health Sciences Section Ad Hoc Nutrition Committee, Aills L, Blankenship J, et al. ASMBS Allied Health nutritional guidelines for the surgical weight loss patient. Surg Obes Relat Dis. 2008;4:S73–108.

    Article  PubMed  Google Scholar 

  38. Gehrer S, Kern B, Peters T, et al. Fewer nutrient deficiencies after laparoscopic sleeve gastrectomy (LSG) than after laparoscopic Roux-Y-gastric bypass (LRYGB)—a prospective study. Obes Surg. 2010;20:447–53.

    Article  PubMed  Google Scholar 

  39. Aarts EO, Janssen IM, Berends FJ. The gastric sleeve: losing weight as fast as micronutrients? Obes Surg. 2011;21:207–11.

    Article  PubMed  Google Scholar 

  40. Bruno C, Fulford AD, Potts JR, et al. Serum markers of bone turnover are increased at six and 18 months after Roux-en-Y bariatric surgery: correlation with the reduction in leptin. J Clin Endocrinol Metab. 2010;95:159–66.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors would like to thank India Meschack for her helpful assistance in reviewing the manuscript.

Disclosure

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Service des Explorations Fonctionnelles, Hôpital Louis Mourier (AP-HP), Centre de référence de prise en charge de l’obésité, Université Paris 7 Denis Diderot, 178 rue des Renouillers, 92701, Colombes Cedex, France

    Muriel Coupaye & Séverine Ledoux

  2. Unité de diététique, Hôpital Louis Mourier (AP-HP), Centre de référence de prise en charge de l’obésité, 178 rue des Renouillers, 92701, Colombes Cedex, France

    Marie Christine Breuil & Pauline Rivière

  3. Service de Chirurgie, Hôpital Louis Mourier (AP-HP), Centre de référence de prise en charge de l’obésité, Université Paris 7 Denis Diderot, 178 rue des Renouillers, 92701, Colombes Cedex, France

    Benjamin Castel & Simon Msika

  4. Service de Biochimie, Hôpital Louis Mourier (AP-HP), Université Paris 7 Denis Diderot, 178 rue des Renouillers, 92701, Colombes Cedex, France

    Catherine Bogard

  5. Service de Biochimie, Hôpital Bichat (AP-HP), Université Paris 7 Denis Diderot, 46 rue Henri-Huchard, 75008, Paris, France

    Thierry Dupré

Authors
  1. Muriel Coupaye
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marie Christine Breuil
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pauline Rivière
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Benjamin Castel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Catherine Bogard
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Thierry Dupré
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Simon Msika
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Séverine Ledoux
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Muriel Coupaye.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Coupaye, M., Breuil, M.C., Rivière, P. et al. Serum Vitamin D Increases with Weight Loss in Obese Subjects 6 Months After Roux-en-Y Gastric Bypass. OBES SURG 23, 486–493 (2013). https://doi.org/10.1007/s11695-012-0813-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-012-0813-y

Keywords

Search

Navigation