Abstract
Background
Biliopancreatic diversion (BPD) is a form of bariatric surgery that produces substantial and sustained weight loss, improved co-morbidities, and a higher quality of life. However, it does have associated sequelae such as vitamin D deficiency. With limited published data, a comprehensive review of vitamin D levels in BPD patients was warranted.
Methods
All available 25-hydroxyvitamin D (25-OH-D) levels were assessed from 219 BPD patients. The dates of 25-OH-D levels were compared to each individual patent's surgery date. Data was analyzed according to patient sex, ethnicity, age, and time from surgery.
Results
The majority (72.3%) of 25-OH-D levels (n = 607) in BPD patients were insufficient (≤30 ng/ml), and 46.8% were deficient (≤20 ng/ml). Statistical analysis revealed that 25-OH-D levels decrease over time with BPD patients (n = 0.0468), and no significant relationship exists with patient sex, ethnicity, or age.
Conclusions
This study gives evidence that vitamin D deficiency and insufficiency is prevalent in BPD patients. Despite excess weight loss and oral vitamin D supplementation, the data shows that vitamin D levels continue to decrease over time in BPD patients. Since the current method of vitamin D supplementation is not producing ideal results, other protocol needs to be developed.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Buchwald H. The future of bariatric surgery. Obes Surg. 2004;15:589–605.
Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in swedish obese subjects. N Engl J Med. 2007;357:741–52.
Sampalis JS, Liberman M, Auger S, et al. The impact of weight reduction surgery on health-care costs in morbidly obese patients. Obes Surg. 2004;14:939–48.
Scopinaro NS, Adami GF, Marinari GM, et al. Biliopancreatic diversion. World J Surg. 1998;22:936–46.
Farrell TM, Haggerty SP, Overby DW, et al. Clinical application of laparoscopic bariatric surgery: an evidence-based review. Surg Endosc. 2009;23:930–49.
Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266–81.
Aasheim ET, Bjorkman S, Sovik 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.
Capin BL, LeMar HJ, Knodel DH, et al. Secondary hyperparathyroidism following biliopancreatic diversion. Arch Surg. 1996;113:1048–52.
Slater GH, Ren CJ, Siegel N, et al. Serum fat-soluble vitamin deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery. J Gastrointest Surg. 2004;8:48–55.
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.
Dawson-Hughes B, Heaney R, Holick M, et al. Estimates of optimal vitamin D status. Osteoporos Int. 2005;16:713–6.
Yetley EA. Assessing the vitamin D status of the US population. Am J Clin Nutr. 2008;88:558–64.
Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142:547–59.
Apovian CM, Cummings S, Anderson W, et al. Best practice updates for multidisciplinary care in weight loss surgery. Obesity. 2009;17:871–9.
Carlin AM, Rao DS, Yager KM, et al. Effect of gastric bypass surgery on vitamin D nutritional status. Surg Obes Relat Dis. 2006;2:638–42.
Goldner WS, Stoner JA, Lyden E, et al. Finding the optimal dose of vitamin D following Roux-en-Y gastric bypass: a prospective, randomized pilot clinical trial. Obes Surg. 2009;19:173–9.
Armas LA, Hollis BW, Heaney RP. Vitamin D2 is much less effective than vitamin D3 in humans. J Clin Endocrinol Metab. 2004;89:5387–91.
Holick MF, Biancuzzo RM, Chen TC, et al. Vitamin D2 is as effective as vitamin D3 in maintaining circulating concentrations of 25-hydroxyvitamin D. J Clin Endocrinol Metab. 2008;93:677–68.
Mechanick JI, Kushner RF, Sugerman HJ, et al. Perioperative bariatric guidelines. Obesity. 2009;17:S1–7.
Acknowledgments
The student research in this project received a stipend from the Nebraska Medical Association.
Disclosure statement
No conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Khandalavala, B.N., Hibma, P.P. & Fang, X. Prevalence and Persistence of Vitamin D Deficiency in Biliopancreatic Diversion Patients: A Retrospective Study. OBES SURG 20, 881–884 (2010). https://doi.org/10.1007/s11695-010-0185-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-010-0185-0