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Impact of Roux-en-Y gastric bypass versus sleeve gastrectomy on vitamin D metabolism: short-term results from a prospective randomized clinical trial

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Abstract

Purpose

To assess postoperative outcomes of sleeve gastrectomy (SG) versus Roux-en-Y gastric bypass (RYGB). Short-term results on vitamin D and parathormone (PTH) metabolism are reported.

Methods

One hundred patients were randomly assigned to RYGB (n = 45) or SG (n = 55). Vitamin D, PTH, and calcium were assessed at inclusion and after 1, 3, 6, and 12 months (M1, M3, M6, and M12). Eighty-eight patients completed 1-year follow-up.

Results

Mean postoperative excess weight loss (%EWL) at M1, M3, M6, and M12 was 25.39, 43.47, 63.75, and 80.38 % versus 25.25, 51.32, 64.67, and 82.97 % in RYGB and SG, respectively. Vitamin D values were statistically significantly higher after SG compared to RYGB at M3 (61.57 pmol/L, standard deviation [SD] 14.29 vs. 54.81 SD 7.65; p = 0.01) and M12 (59.83 pmol/L, SD 6.41 vs. 56.15 SD 8.18; p = 0.02). Vitamin D deficiency rate decreased from 84.62 to 35 % at M6 (p = 0.04) and 48 % at M12 (p = 0.01) in the SG group, while there was no significant improvement in the RYGB group. Serum parathyroid hormone (sPTH) level was decreased significantly in the SG group by M3 (44.8 ng/L vs. 28.6; p = 0.03), M6 (44.9 ng/L vs. 25.8; p = 0.017), and M12 (41.4 ng/L vs. 20.5; p = 0.017). Secondary hyperparathyroidism rate was 20.83 and 24 % at M1 (p = 1), 16.67 and 8 % at M3 (p = 0.41), 14.29 and 0 % at M6 (p = 0.08), and 15 and 0 % at M12 (p = 0.23) in the RYGB and SG groups, respectively.

Conclusions

Patients after RYGB had a significantly higher postoperative vitamin D deficiency and higher sPTH levels than after SG.

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References

  1. O’Brien PE (2010) Bariatric surgery: mechanisms, indications and outcomes. J Gastroenterol Hepatol 25:1358–1365

    Article  PubMed  Google Scholar 

  2. Shah M, Simha V, Garg A (2006) Review: long-term impact of bariatric surgery on body weight, comorbidities, and nutritional status. J Clin Endocrinol Metab 91:4223–4231

    Article  CAS  PubMed  Google Scholar 

  3. Franco JV, Ruiz PA, Palermo M, Gagner M (2011) A review of studies comparing three laparoscopic procedures in bariatric surgery: sleeve gastrectomy, Roux-en-Y gastric bypass and adjustable gastric banding. Obes Surg 21:1458–1468

    Article  PubMed  Google Scholar 

  4. Attiah MA, Halpern CH, Balmuri U, Vinai P, Mehta S, Baltuch GH, Williams NN, Wadden TA, Stein SC (2012) Durability of Roux-en-Y gastric bypass surgery: a meta-regression study. Ann Surg 256:251–254

    Article  PubMed  Google Scholar 

  5. Campos GM, Rabl C, Roll GR, Peeva S, Prado K, Smith J, Vittinghoff E (2011) Better weight loss, resolution of diabetes, and quality of life for laparoscopic gastric bypass vs banding: results of a 2-cohort pair-matched study. Arch Surg 146:149–155

    Article  PubMed  Google Scholar 

  6. Love AL, Billett HH (2008) Obesity, bariatric surgery, and iron deficiency: true, true, true and related. Am J Hematol 83:403–409

    Article  PubMed  Google Scholar 

  7. Pories WJ (2008) Bariatric surgery: risks and rewards. J Clin Endocrinol Metab 93:S89–S96

    Article  CAS  PubMed  Google Scholar 

  8. Avgerinos DV, Leitman IM, Martinez RE, Liao EP (2007) Evaluation of markers for calcium homeostasis in a population of obese adults undergoing gastric bypass operations. J Am Coll Surg 205:294–297

    Article  PubMed  Google Scholar 

  9. Johnson JM, Maher JW, Samuel I, Heitshusen D, Doherty C, Downs RW (2005) Effects of gastric bypass procedures on bone mineral density, calcium, parathyroid hormone, and vitamin D. J Gastrointest Surg 9:1106–1110

    Article  PubMed  Google Scholar 

  10. Youssef Y, Richards WO, Sekhar N, Kaiser J, Spagnoli A, Abumrad N, Torquati A (2007) Risk of secondary hyperparathyroidism after laparoscopic gastric bypass surgery in obese women. Surg Endosc 21:1393–1396

    Article  CAS  PubMed  Google Scholar 

  11. Regan JP, Inabnet WB, Gagner M, Pomp A (2003) Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super–super obese patient. Obes Surg 13:861–864

    Article  CAS  PubMed  Google Scholar 

  12. Kehagias I, Karamanakos SN, Argentou M, Kalfarentzos F (2011) Randomized clinical trial of laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the management of patients with BMI <50 kg/m2. Obes Surg 21:1650–1656

    Article  PubMed  Google Scholar 

  13. Karamanakos SN, Vagenas K, Kalfarentzos F, Alexandrides TK (2008) Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg 247:401–407

    Article  PubMed  Google Scholar 

  14. Gehrer S, Kern B, Peters T, Christoffel-Courtin C, Peterli R (2010) Fewer nutrient deficiencies after laparoscopic sleeve gastrectomy (LSG) than after laparoscopic Roux-Y-gastric bypass (LRYGB)—a prospective study. Obes Surg 20:447–453

    Article  PubMed  Google Scholar 

  15. Peterli R, Wolnerhanssen B, Peters T, Devaux N, Kern B, Christoffel-Courtin C, Drewe J, von Flue M, Beglinger C (2009) Improvement in glucose metabolism after bariatric surgery: comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy: a prospective randomized trial. Ann Surg 250:234–241

    Article  PubMed  Google Scholar 

  16. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292:1724–1737

    Article  CAS  PubMed  Google Scholar 

  17. Ruiz-Tovar J, Oller I, Tomas A, Llavero C, Arroyo A, Calero A, Martinez-Blasco A, Calpena R (2012) Mid-term effects of sleeve gastrectomy on calcium metabolism parameters, vitamin D and parathormone (PTH) in morbid obese women. Obes Surg 22:797–801

    Article  PubMed  Google Scholar 

  18. Carlin AM, Rao DS, Yager KM, Genaw JA, Parikh NJ, Szymanski W (2006) Effect of gastric bypass surgery on vitamin D nutritional status. Surg Obes Relat Dis 2:638–642

    Article  PubMed  Google Scholar 

  19. Carlin AM, Rao DS, Meslemani AM, Genaw JA, Parikh NJ, Levy S, Bhan A, Talpos GB (2006) Prevalence of vitamin D depletion among morbidly obese patients seeking gastric bypass surgery. Surg Obes Relat Dis 2:98–103

    Article  PubMed  Google Scholar 

  20. Grethen E, McClintock R, Gupta CE, Jones R, Cacucci BM, Diaz D, Fulford AD, Perkins SM, Considine RV, Peacock M (2011) Vitamin D and hyperparathyroidism in obesity. J Clin Endocrinol Metab 96:1320–1326

    Article  CAS  PubMed  Google Scholar 

  21. Snijder MB, van Dam RM, Visser M, Deeg DJ, Dekker JM, Bouter LM, Seidell JC, Lips P (2005) Adiposity in relation to vitamin D status and parathyroid hormone levels: a population-based study in older men and women. J Clin Endocrinol Metab 90:4119–4123

    Article  CAS  PubMed  Google Scholar 

  22. Mahlay NF, Verka LG, Thomsen K, Merugu S, Salomone M (2009) Vitamin D status before Roux-en-Y and efficacy of prophylactic and therapeutic doses of vitamin D in patients after Roux-en-Y gastric bypass surgery. Obes Surg 19:590–594

    Article  PubMed  Google Scholar 

  23. Rosenstreich SJ, Rich C, Volwiler W (1971) Deposition in and release of vitamin D3 from body fat: evidence for a storage site in the rat. J Clin Invest 50:679–687

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Mawer EB, Backhouse J, Holman CA, Lumb GA, Stanbury SW (1972) The distribution and storage of vitamin D and its metabolites in human tissues. Clin Sci 43:413–431

    CAS  PubMed  Google Scholar 

  25. Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF (2000) Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr 72:690–693

    CAS  PubMed  Google Scholar 

  26. Bell NH, Epstein S, Greene A, Shary J, Oexmann MJ, Shaw S (1985) Evidence for alteration of the vitamin D–endocrine system in obese subjects. J Clin Invest 76:370–373

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  27. Compher CW, Badellino KO, Boullata JI (2008) Vitamin D and the bariatric surgical patient: a review. Obes Surg 18:220–224

    Article  PubMed  Google Scholar 

  28. Kamycheva E, Sundsfjord J, Jorde R (2004) Serum parathyroid hormone level is associated with body mass index. The 5th Tromso study. Eur J Endocrinol 151:167–172

    Article  CAS  PubMed  Google Scholar 

  29. Andersen T, McNair P, Hyldstrup L, Fogh-Andersen N, Nielsen TT, Astrup A, Transbol I (1988) Secondary hyperparathyroidism of morbid obesity regresses during weight reduction. Metabolism 37:425–428

    Article  CAS  PubMed  Google Scholar 

  30. Gunther CW, Legowski PA, Lyle RM, Weaver CM, McCabe LD, McCabe GP, Peacock M, Teegarden D (2006) Parathyroid hormone is associated with decreased fat mass in young healthy women. Int J Obes (Lond) 30:94–99

    Article  CAS  Google Scholar 

  31. Dolan K, Hatzifotis M, Newbury L, Lowe N, Fielding G (2004) A clinical and nutritional comparison of biliopancreatic diversion with and without duodenal switch. Ann Surg 240:51–56

    Article  PubMed  Google Scholar 

  32. Skroubis G, Anesidis S, Kehagias I, Mead N, Vagenas K, Kalfarentzos F (2006) Roux-en-Y gastric bypass versus a variant of biliopancreatic diversion in a non-superobese population: prospective comparison of the efficacy and the incidence of metabolic deficiencies. Obes Surg 16:488–495

    Article  PubMed  Google Scholar 

  33. Scopinaro N, Marinari G, Camerini G, Papadia F (2005) Biliopancreatic diversion for obesity: state of the art. Surg Obes Relat Dis 1:317–328

    Article  PubMed  Google Scholar 

  34. Valderas JP, Velasco S, Solari S, Liberona Y, Viviani P, Maiz A, Escalona A, Gonzalez G (2009) Increase of bone resorption and the parathyroid hormone in postmenopausal women in the long-term after Roux-en-Y gastric bypass. Obes Surg 19:1132–1138

    Article  PubMed  Google Scholar 

  35. Vilarrasa N, San Jose P, Garcia I, Gomez-Vaquero C, Miras PM, de Gordejuela AG, Masdevall C, Pujol J, Soler J, Gomez JM (2011) Evaluation of bone mineral density loss in morbidly obese women after gastric bypass: 3-year follow-up. Obes Surg 21:465–472

    Article  PubMed  Google Scholar 

  36. Signori C, Zalesin KC, Franklin B, Miller WL, McCullough PA (2010) Effect of gastric bypass on vitamin D and secondary hyperparathyroidism. Obes Surg 20:949–952

    Article  PubMed  Google Scholar 

  37. Melissas J, Koukouraki S, Askoxylakis J, Stathaki M, Daskalakis M, Perisinakis K, Karkavitsas N (2007) Sleeve gastrectomy: a restrictive procedure? Obes Surg 17:57–62

    Article  PubMed  Google Scholar 

  38. Damms-Machado A, Friedrich A, Kramer KM, Stingel K, Meile T, Kuper MA, Konigsrainer A, Bischoff SC (2012) Pre- and postoperative nutritional deficiencies in obese patients undergoing laparoscopic sleeve gastrectomy. Obes Surg 22:881–889

    Article  PubMed  Google Scholar 

  39. Maxwell CS, Wood RJ (2011) Update on vitamin D and type 2 diabetes. Nutr Rev 69:291–295

    Article  PubMed  Google Scholar 

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Disclosure

Michel Vix, Keng-Hao Liu, Michele Diana, Antonio D’Urso, Didier Mutter, and Jacques Marescaux have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of General, Digestive, and Endocrine Surgery, IRCAD-IHU, University of Strasbourg, 1, Place de l’Hôpital, 67091, Strasbourg Cedex, France

    Michel Vix, Keng-Hao Liu, Michele Diana, Antonio D’Urso, Didier Mutter & Jacques Marescaux

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  1. Michel Vix
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Correspondence to Jacques Marescaux.

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Vix, M., Liu, KH., Diana, M. et al. Impact of Roux-en-Y gastric bypass versus sleeve gastrectomy on vitamin D metabolism: short-term results from a prospective randomized clinical trial. Surg Endosc 28, 821–826 (2014). https://doi.org/10.1007/s00464-013-3276-x

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  • DOI: https://doi.org/10.1007/s00464-013-3276-x

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