Obesity Surgery

, Volume 28, Issue 9, pp 2968–2975 | Cite as

Two-Year Nutrition Data in Terms of Vitamin D, Vitamin B12, and Albumin After Bariatric Surgery and Long-term Fracture Data Compared with Conservatively Treated Obese Patients: a Retrospective Cohort Study

  • Mervi JavanainenEmail author
  • Tuula Pekkarinen
  • Harri Mustonen
  • Tom Scheinin
  • Marja Leivonen
New Concept



Nutritional deficiencies may occur after bariatric surgery despite supplementation. Fracture risk may also be elevated after bariatric surgery.


To compare 25-hydroxyvitamin D [25(OH)D], vitamin B12, and albumin serum concentrations in severely obese patients who had undergone either Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Fracture data was compared with data for a conservatively treated group of severely obese patients.


We considered 253 RYGB and 142 SG performed between 2007 and 2010. At 1- and 2-year control follow-ups, weight was measured and blood samples were drawn. The control group of 199 obese patients received lifestyle intervention and weight was measured at 1 and 2 years post-intervention between 2002 and 2006. We retrospectively collected fracture data for all patients through the end of 2016.


At follow-ups, the mean serum 25(OH)D and albumin levels were within reference ranges and were similar between the RYGB and SG groups. Serum median vitamin B12 level was significantly higher in the SG group compared with the RYBG group, 319 versus 286 pmol/L at 2 years, respectively, p = 0.04. The cumulative risk for fracture was higher in the bariatric groups compared with the control group. The Cox multivariate model showed higher age, bariatric surgery, and lower body mass index (BMI) at the 2-year control increased the risk for fracture after obesity treatment.


Vitamin 25(OH)D, B12, and albumin levels were mainly within recommended levels during the 2 years after bariatric surgery. The cumulative fracture risk was higher in bariatric patients.


Bariatric surgery Fracture risk Vitamin D Albumin Vitamin B12 


Compliance with Ethical Standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Smith KB, Smith MS. Obesity Statistics. Prim Care. 2016;43(1).
  2. 2.
    Qi L, Cho YA. Gene-environment interaction and obesity. Nutr Rev. 2008;66(12).
  3. 3.
    Swinburn BA, Sacks G, Hall KD, McPherson K, Finegood DT, Moodie ML, et al. The global obesity pandemic: shaped by global drivers and local environments. Lancet (London, England). England:Elsevier Ltd. 2011;378(9793).
  4. 4.
    Golzarand M, Toolabi K, Farid R. The bariatric surgery and weight losing: a meta-analysis in the long- and very long-term effects of laparoscopic adjustable gastric banding, laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy on weight loss in adults. Surg Endosc. 2017;31(11).
  5. 5.
    Ricci C, Gaeta M, Rausa E, Asti E, Bandera F, Bonavina L. Long-term effects of bariatric surgery on type II diabetes, hypertension and hyperlipidemia: a meta-analysis and meta-regression study with 5-year follow-up. Obes Surg. 2015;25(3).
  6. 6.
    Yu EW. Bone metabolism after bariatric surgery. J Bone Miner Res OffJ Am Soc Bone Min Res. 2014;29(7).
  7. 7.
    Via MA, Mechanick JI. Nutritional and Micronutrient Care of Bariatric Surgery Patients: Current Evidence Update. Curr Obes Rep. 2017;6(3).
  8. 8.
    Aasheim ET, Hofso D, Hjelmesaeth J, Birkeland KI, Bohmer T. Vitamin status in morbidly obese patients: a cross-sectional study. Am J Clin Nutr. 2008;87(2).Google Scholar
  9. 9.
    Moize V, Deulofeu R, Torres F, de Osaba JM, Vidal J. Nutritional intake and prevalence of nutritional deficiencies prior to surgery in a Spanish morbidly obese population. Obes Surg. 2011;21(9).
  10. 10.
    Stein J, Stier C, Raab H, Weiner R. Review article: The nutritional and pharmacological consequences of obesity surgery. Aliment Pharmacol Ther. England:John Wiley & Sons Ltd. 2014;40(6).
  11. 11.
    Nakamura KM, Haglind EG, Clowes JA, et al. Fracture risk following bariatric surgery: a population-based study. Osteoporos Int. 2014;25(1):151–8. Scholar
  12. 12.
    Lu CW, Chang YK, Chang HH, Kuo CS, Huang CT, Hsu CC, et al. Fracture Risk After Bariatric Surgery: A 12-Year Nationwide Cohort Study. Medicine. 2015;94(48).
  13. 13.
    Zhang Q, Chen Y, Li J, Chen D, Cheng Z, Xu S, et al. A meta-analysis of the effects of bariatric surgery on fracture risk. Obes Rev: Off J Int Assoc Study of Obes. England:World Obesity Federation. 2018a.
  14. 14.
    Lalmohamed A, de Vries F, Bazelier MT, et al. Risk of fracture after bariatric surgery in the United Kingdom: population based, retrospective cohort study. BMJ. 2012;345:e5085. Scholar
  15. 15.
    Parfitt AM, Podenphant J, Villanueva AR, Frame B. Metabolic bone disease with and without osteomalacia after intestinal bypass surgery: a bone histomorphometric study. Bone. 1985;6(4).Google Scholar
  16. 16.
    Fried M, Yumuk V, Oppert JM, Scopinaro N, Torres A, Weiner R, et al. Interdisciplinary European guidelines on metabolic and bariatric surgery. Obes Surg. 2014;24(1).
  17. 17.
    Helmio M, Victorzon M, Ovaska J, Leivonen M, Juuti A, Jaser N, et al. SLEEVEPASS: a randomized prospective multicenter study comparing laparoscopic sleeve gastrectomy and gastric bypass in the treatment of morbid obesity: preliminary results. Surg Endosc. 2012;26(9).
  18. 18.
    Pekkarinen T, Kaukua J, Mustajoki P. Long-term weight maintenance after a 17-week weight loss intervention with or without a one-year maintenance program: a randomized controlled trial. J Obes. 2015;2015.
  19. 19.
    Turpeinen U, Hohenthal U, Stenman UH. Determination of 25-hydroxyvitamin D in serum by HPLC and immunoassay. Clin Chem. 2003;49(9).Google Scholar
  20. 20.
    Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Obesity (Silver Spring, Md.). Obes Soc. 2013;21(1).
  21. 21.
    O'Kane M, Barth J, Batterham RL, Pinkney J, Aasheim E, Welbourn R. BOMSS Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery. Review date September 2016. [cited 2017 Nov 4]. Available from:
  22. 22.
    SOReg-Sverige, SOReg-Norge, Svensk Förening för obesitaskirurgi, Finsk Förening för Metabol kirurgi och Norsk forening for fedmekirurgi Nordiska riktlinjer för monitorering och supplementering med vitaminer/mineraler samt uppföljning efter obesitaskirurg [cited 2017 Nov 4]. Available from:
  23. 23.
    Gehrer S, Kern B, Peters T, Christoffel-Courtin C, Peterli R. Fewer nutrient deficiencies after laparoscopic sleeve gastrectomy (LSG) than after laparoscopic Roux-Y-gastric bypass (LRYGB)-a prospective study. Obes Surg. 2010a;20(4).
  24. 24.
    Lanzarini E, Nogues X, Goday A, Benaiges D, de Ramon M, Villatoro M, et al. High-Dose Vitamin D Supplementation is Necessary After Bariatric Surgery: A Prospective 2-Year Follow-up Study. Obes Surg. 2015;25(9).
  25. 25.
    Vilarrasa N, de Gordejuela AG, Gomez-Vaquero C, Pujol J, Elio I, San Jose P, et al. Effect of bariatric surgery on bone mineral density: comparison of gastric bypass and sleeve gastrectomy. Obes Surg. 2013;23(12).
  26. 26.
    Majumder S, Soriano J, Louie Cruz A, Dasanu CA. Vitamin B12 deficiency in patients undergoing bariatric surgery: preventive strategies and key recommendations. Surg Obes Relat Dis: Off J Am Soc Bariatric Surg. United States:American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. 2013;9(6).
  27. 27.
    Dai Z, Koh WP. B-vitamins and bone health--a review of the current evidence. Nutrients. 2015;7(5).
  28. 28.
    Visser M, Kritchevsky SB, Newman AB, Goodpaster BH, Tylavsky FA, Nevitt MC, et al. Lower serum albumin concentration and change in muscle mass: the Health, Aging and Body Composition Study. Am J Clin Nutr. 2005;82(3).Google Scholar
  29. 29.
    D'Erasmo E, Pisani D, Ragno A, Raejntroph N, Letizia C, Acca M. Relationship between serum albumin and bone mineral density in postmenopausal women and in patients with hypoalbuminemia. Horm Metab Res = Hormon- und Stoffwechselforschung = Hormones et metabolisme. 1999;31(6).
  30. 30.
    Maleckas A, Gudaityte R, Petereit R, Venclauskas L, Velickiene D. Weight regain after gastric bypass: etiology and treatment options. Gland Surg. China (Republic : 1949). 2016;5(6).
  31. 31.
    Lima TP, Nicoletti CF, Marchini JS, Junior WS, Nonino CB. Effect of weight loss on bone mineral density determined by ultrasound of phalanges in obese women after Roux-en-y gastric bypass: conflicting results with dual-energy X-ray absorptiometry J Clin Densitom: Off J Int Soc Clin Densitom Int Soc Clin Densitom. Published by Elsevier Inc. 2014;17(4).
  32. 32.
    Ikramuddin S, Billington CJ, Lee WJ, Bantle JP, Thomas AJ, Connett JE, et al. Roux-en-Y gastric bypass for diabetes (the Diabetes Surgery Study): 2-year outcomes of a 5-year, randomised, controlled trial. Lancet Diabetes Endocrinol. England:Elsevier Ltd. 2015;3(6).Google Scholar
  33. 33.
    Ensrud KE. Epidemiology of fracture risk with advancing age. J Gerontol A Biol Sci Med Sci. 2013;68(10).
  34. 34.
    Compston JE, Wyman A, FitzGerald G, Adachi JD, Chapurlat RD, Cooper C, et al. Increase in Fracture Risk Following Unintentional Weight Loss in Postmenopausal Women: The Global Longitudinal Study of Osteoporosis in Women. J Bone Miner Res Off J Am Soc Bone Miner Res. 2016;31(7).
  35. 35.
    Hernandez CJ. Bone Mechanical Function and the Gut Microbiota. Adv Exp Med Biol. 2017;1033.
  36. 36.
    Guo Y, Huang ZP, Liu CQ, Qi L, Sheng Y, Zou DJ. Modulation of the gut microbiome: a systematic review of the effect of bariatric surgery. Eur J Endocrinol. England:European Society of Endocrinology. 2018;178(1).
  37. 37.
    Bruno C, Fulford AD, Potts JR, McClintock R, Jones R, Cacucci BM, 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(1).

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Jorvi HospitalEspooFinland
  2. 2.Satakunta Central HospitalPoriFinland
  3. 3.Biomedicum Helsinki, Department of SurgeryHelsinki University Central HospitalHelsinkiFinland
  4. 4.Seinäjoki Central HospitalSeinäjokiFinland

Personalised recommendations