Abstract
Background
Vitamin D deficiency is common in patients after bariatric surgery. However, obesity itself has also been associated with decreased vitamin D. The prevalence of vitamin D deficiency in obese persons has not previously been compared to non-obese controls when controlling for factors that could affect vitamin D status.
Methods
We evaluated 25 hydroxy vitamin D, iPTH, calcium, albumin, and creatinine in 41 patients undergoing Roux-en-Y gastric bypass. We then compared them to healthy non-obese controls matched for age, sex, race/ethnicity, and season of vitamin D measurement.
Results
Ninety percent of the pre-bariatric surgery patients had 25-OH-D levels <75 nmol/l, and 61% had 25-OH-D levels <50 nmol/l versus 32 and 12% in controls, respectively. Additionally, 49% of the pre-bariatric surgery patients had secondary hyperparathyroidism versus 2% of controls. These differences persisted after controlling for sunlight exposure and dietary intake of calcium and vitamin D. Mean calcium, corrected for albumin, and creatinine were not significantly different between the groups, but mean albumin levels were significantly lower among surgery patients.
Conclusion
Vitamin D deficiency is common in obese patients at the time of bariatric surgery and is also accompanied by secondary hyperparathyroidism approximately half the time. These findings suggest that vitamin D deficiency after bariatric surgery is multifactorial and in part caused by preoperative vitamin D deficiency rather than postoperative malabsorption alone. In this study, increased vitamin D deficiency in obese persons cannot be explained by a difference in calcium/vitamin D intake or sunlight exposure.
Similar content being viewed by others
References
Holick M. The vitamin D epidemic and its health consequences. J Nutr 2005;135:2739S–48S.
Newbury L, Dolan K, Hatzifotis M, et al. Calcium and vitamin D depletion and elevated parathyroid hormone following biliopancreatic diversion. Obes Surg 2003;13(6):893–5.
Slater GH, Ren CJ, Siegel N, et al. Serum fat-soluble vitamin D deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery. J Gastrointest Surg 2004;8(1):48–55.
Ybarra J, Sanchez-Hernancez J, Gich I, et al. Unchanged hypovitaminosis D and secondary hyperparathyroidism in morbid obesity after bariatric surgery. Obes Surg 2005;15:330–5.
Johnson J, Maher J, DeMaria E, et al. The long-term effects of gastric bypass on vitamin D metabolism. Ann Surg 2006;243(5):701–5.
Goldner WS, O’Dorisio TM, Dillon JS, et al. Severe metabolic bone disease as a long-term complication of obesity surgery. Obes Surg 2002;12:685–92.
Collazo-Clavell ML, Jiminez A, Hodgson SF, et al. Osteomalacia after Roux-en-Y gastric bypass. Endocr Pract 2004;10:195–8.
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.
Arunabh S, Pollack S, Yeh J, et al. Body fat content and 25-hydroxyvitamin D levels in healthy women. J Clin Endocrinol Metab 2003;88(1):157–61.
Buffington C, Walker B, Cowan GS, et al. Vitamin D deficiency in the morbidly obese. Obes Surg 1993;3:421–4.
Hamoui N, Anthone G, Crookes PF. Calcium metabolism in the morbidly obese. Obes Surg 2004;14:9–12.
Ybarra J, Snachez-Hernandez J, Gich I, et al. Unchanged hypovitaminosis D and secondary hyperparathyroidism in morbid obesity after bariatric surgery. Obes Surg 2005;15:330–5.
Carlin AM, Sudhaker R, Meslemani AM, et al. Prevalence of vitamin D depletion among morbidly obese patients seeking gastric bypass surgery. Surg Obes Relat Diseases 2006;2:98–103.
Dawson-Hughes B, Harris SS, Krall EA, et al. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 1997;337:670–6.
Webb AR, Kline L, Holick MF. Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. J Clin Endocrinol Metab 1988;67:373–8.
Holick MF, Matsuoka LY, Wortsman J. Age, vitamin D, and solar ultraviolet. Lancet 1989;2:1104–5.
Looker AC, Dawson-Hughes B, Calvo MS, et al. Serum 25-hydoxyvitamin D status of adolescents and adults in two seasonal subpopulations from NHANES III. Bone 2002;30:771–7.
Giovannucci E, Mchaud D. The role of obesity and related metabolic disturbances in cancers of the colon, prostate, and pancreas. Gastroenterology 2007;132(6):2208–25.
Larsson S, Wolk A. Obesity and the risk of gallbladder cancer: a meta-analysis. Br J Cancer 2007;96(9):1457–61.
Seewaldt V, Goldenberg V, Jones L, et al. Overweight and obese perimenopausal and postmenopausal women exhibit increased abnormal mammary epithelial cytology. Cancer Epidemiol Biomarkers Prev 2007;16(3):613–6.
Dawson-Hughes B, Heaney R, Holick M, et al. Estimates of optimal vitamin D status. Osteoporos Int 2005;16:713–6.
Wortsman J, Matsuoka LY, Chen TC, et al. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr 2000;72:690–3.
Atreja A, Abacan C, Licata A. A 51 year old woman with debilitating cramps 12 years after bariatric surgery. Clev Clin J Med 2003;70:417–26.
Acknowledgment
This work was funded by a grant of the Clinical Research Center at the University of Nebraska Medical Center.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Goldner, W.S., Stoner, J.A., Thompson, J. et al. Prevalence of Vitamin D Insufficiency and Deficiency in Morbidly Obese Patients: A Comparison with Non-Obese Controls. OBES SURG 18, 145–150 (2008). https://doi.org/10.1007/s11695-007-9315-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-007-9315-8