Alteration of the vitamin D endocrine system in obesity: the role in patients undergoing bariatric surgery

[摘要] We knew that: 1) vitamin D (VitD) deficiency is a burgeoning problem; 2) a major risk factor for VitD deficiency is obesity—also escalating; and 3) VitD deficiency is a side effect of some bariatric surgeries—the most durable treatment for obesity. We investigated the alteration of the VitD endocrine system in obesity as it relates to bariatric surgery patients.We used two proxy measures, seasonality and latitude, to assess group VitD status in the Nationwide Inpatient Sample (NIS). We found that adverse outcomes following bariatric surgery are most common from January to March when VitD status is lowest (VitD Winter). The largest increased odds from VitD Summer (highest VitD status) to Winter were for wound infection. The strongest correlations were for dehiscence and extended length of stay (LOS). Adverse outcomes appeared to be more common in the North with LOS reaching significance (p<0.001). We replicated these findings in adolescents, a growing subset in bariatric surgery. We were only sufficiently powered to detect a difference in LOS by latitude, yielding a significant negative correlation between VitD status and LOS (p=0.012). VitD supplementation, an easy and inexpensive treatment, could potentially mitigate risks following bariatric surgery.To assess pre-operative nutritional status in bariatric candidates at our center, we measured vitamins A, B-12, D, E-α, E-β/γ, thiamine, folate, and iron—the deficiencies seen most commonly post-operatively. We found that malnutrition in one or multiple micronutrients is pervasive, especially VitD and iron. VitD deficiency was present in 71.4% of candidates (81.3% in blacks). Minorities tended to have greater malnutrition overall. The effect of pre-operative supplementation should be explored.We investigated VitD testing and therapy in our bariatric candidates. VitD testing was lower than clinically indicated. At least 44.5% have more than one risk factor for VitD deficiency, since these patients have high melanin concentration. However, we had serum 25(OH)D concentration for only 18.5% of candidates. A significant proportion had not been tested but are likely to be VitD deficient. Candidates who were tested were not different from those who were not. We would like to improve the rate of VitD testing in our candidates.

[发布机构] Johns Hopkins University

[效力级别] Nutrition

[关键词] Vitamin D;Nutrition;Bariatric surgery;Wound healing;Infection;not listed