Nutritional Status of Obese Taiwanese Before Bariatric-Metabolic Surgery and Their Serum 25-Hydroxyvitamin D Concentrations for Maximal Suppression of Parathyroid Hormone

Abstract

Background

This is the first report from Taiwan using laboratory tests to assess nutritional status of patients with obesity before bariatric-metabolic surgery. Moreover, the 25(OH)D threshold for maximal suppression of parathyroid hormone (PTH) was evaluated to offer a reference value for preoperative nutritional care.

Methods

Inclusion criteria were Taiwanese, 18–65 years old, and with BMI ≥ 27.5 kg/m2 awaiting bariatric-metabolic surgery. Anthropometric data and blood samples were collected before surgery. Serum concentrations of protein; vitamins B1, B12, folate, A, D, and E; calcium; iron; zinc; copper; selenium; PTH; and erythrocyte glutathione reductase activity coefficient (vitamin B2 status) were measured.

Results

For 52 participants with a mean BMI 37.6 ± 6.4 kg/m2, vitamin D deficiency (25(OH)D < 20 ng/mL) and insufficiency (20 < 25(OH)D < 30 ng/mL) were at 73 and 22% prevalence, respectively. Secondary hyperparathyroidism (PTH ≧ 65 pg/mL) was 24% and hypocalcemia was 50% (ionized Ca < 4.5 mg/dL). Deficiency of other nutrients was sporadic (< 10%) or nil. When participants were stratified according to 25(OH)D concentrations (< 10, 10–15, 15–20, and ≥ 20 ng/mL), PTH increased at 25(OH)D < 10 ng/mL (β = 48.34, p = 0.001) after adjusting for age, gender, and BMI.

Conclusion

For patients with obesity before bariatric-metabolic surgery, vitamin D/calcium deficiency was the only nutritional issue that needs to be addressed in Taiwan. However, a lower cutoff point of 25(OH)D, i.e., 10 ng/mL, for vitamin D deficiency may be considered for patients before surgery.

Trial Registration

ClinicalTrials.gov Identifier: NCT03915158

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Funding

Financial support for this study was provided by the China Medical University, Taiwan (grant number CMU108-S-24).

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Correspondence to Chih-Kun Huang or Pei-Min Chao.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Lin, CH., Liao, WL., Wu, CC. et al. Nutritional Status of Obese Taiwanese Before Bariatric-Metabolic Surgery and Their Serum 25-Hydroxyvitamin D Concentrations for Maximal Suppression of Parathyroid Hormone. OBES SURG 30, 3940–3946 (2020). https://doi.org/10.1007/s11695-020-04759-y

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Keywords

  • Bariatric-metabolic surgery
  • Obesity
  • 25-Hydroxyvitamin D
  • Parathyroid hormone
  • Nutritional assessment