Vitamin D Deficiency in Patients with Morbid Obesity before and after Metabolic Bariatric Surgery
Abstract
:1. Introduction
2. Methods
2.1. Patients and Data
2.2. Definition of Vitamin D Deficiency
- Vitamin D insufficiency—20–30 ng/mL
- Vitamin D deficiency—<20 ng/mL
2.3. Preoperative Evaluation
- Metabolic bariatric surgeon—Assessment of BMI, obesity-associated medical problems, indication for MBS, type of MBS, referral to blood work (complete blood count, full chemistry panel including micronutrient levels, coagulation studies, thyroid function, cortisol levels), upper gastrointestinal (GI) endoscopy, and/or upper GI series.
- Endocrinologist—All patients were assessed by an endocrinologist for obesity-associated medical problems evaluation and their optimization preoperatively. Patients are also assessed for secondary causes of obesity.
- Dietitian—All patients were assessed by a dietitian preoperatively and were recommended a protein-rich, low-carbohydrate diet preoperatively.
- Psychologist/Psychiatrist—All patients underwent psychologic evaluation to ensure their understanding of lifestyle changes that are associated with MBS, the importance of compliance to follow-up, and medical supplementation.
- Other disciplines—Patients were referred to other disciplines for further evaluation and optimization if other morbidities (such as cardiovascular, respiratory, neurologic, etc.) exist.
2.4. Surgical Technique
- SG—The omentum was dissected off the greater curvature of the stomach starting 4 cm proximal to the pylorus up to the Angle of His. A 36-F bougie was inserted along the lesser curvature for calibration, and the stomach was vertically transected with a linear stapler to create the gastric sleeve [16,17].
- OAGB—A 15–20 cm long gastric pouch was created with a linear stapler along a 36-Fr bougie for calibration. The bowel length was measured starting from the ligament of Treitz, and the anastomosis was performed 160–220 cm distal to the ligament of Treitz. The length of the biliopancreatic limb was fashioned according to the BMI, surgeons‘ preference, and indication of OAGB (primary or secondary for failed procedure or late complications). Prior to performing the anastomosis, it was verified that at least 300 cm bowel was present distally [18].
- RYGB—A 4–6 cm long gastric pouch was created with a linear stapler along a 36-Fr bougie for calibration. The bowel length was measured starting from the ligament of Treitz. The bowel was transected at 100 cm distal to the ligament of Treitz, defining the length of the biliopancreatic limb, the gastro-jejunal anastomosis was performed and the jejuno-jejunal anastomosis was performed 100 cm distal to it.
2.5. Postoperative Care
2.6. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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Characteristic | Sleeve Gastrectomy | Gastric Bypass | p Value |
---|---|---|---|
Age, mean ± SD, years | 37.77 ± 12.21 | 39.78 ± 10.78 | 0.23 |
Women, n (%) | 66 (78%) | 64 (65%) | 0.053 |
Preoperative BMI kg/m2 | 41.04 ± 4.61 | 47.11 ± 7.39 | <0.001 |
T2D, n (%) | 9 (11%) | 17 (17%) | 0.20 |
HTN, n (%) | 21 (25%) | 39 (39%) | 0.03 |
OSA, n (%) | 6 (7%) | 9 (9%) | 0.61 |
Dyslipidemia, n (%) | 8 (9%) | 8 (8%) | 0.75 |
GERD, n (%) | 1 (1%) | 20 (20%) | <0.001 |
Osteoarthritis, n (%) | 8 (9%) | 5 (5%) | 0.25 |
Previous bariatric procedure, n (%) | 2 (2%) | 15 (15%) | <0.001 |
Variable | Sleeve Gastrectomy | Gastric Bypass | p Value |
---|---|---|---|
Preoperative levels, mean ± SD (ng/ml) * | 18.00 ± 8.96 | 18.15 ± 8.71 | 0.92 |
Postoperative levels at 1 month, mean ± SD (ng/mL) | 20.70 ± 8.15 | 20.81 ± 8.70 | 0.94 |
Postoperative levels at 3 months, mean ± SD (ng/mL) | 25.19 ± 11.33 | 25.47 ± 8.91 | 0.89 |
Postoperative levels at 6 months, mean ± SD (ng/mL) | 30.18 ± 12.82 | 28.69 ± 10.25 | 0.53 |
Preoperative levels versus postoperative levels at 1 month ** | 0.02 | ||
Preoperative levels versus postoperative levels at 3 months ** | <0.001 | ||
Preoperative levels versus postoperative levels at 6 months ** | <0.001 |
Timing | Outcomes | Sleeve Gastrectomy | Gastric Bypass | p Value |
---|---|---|---|---|
Preoperative * | Vitamin D deficiency, n (%) | 33/56 (59%) | 39/51 (76%) | 0.054 |
Vitamin D insufficiency, n (%) | 16/56 (29%) | 16/51 (31%) | 0.75 | |
Postoperative one month | Vitamin D deficiency, n (%) | 28/56 (50%) | 25/51 (49%) | 0.92 |
Vitamin D insufficiency, n (%) | 20/56 (36%) | 16/51 (31%) | 0.63 | |
%TWL, mean ± SD | 11.07 ± 5.23 | 11.12 ± 4.72 | 0.94 | |
Postoperative three months | Vitamin D deficiency, n (%) | 17/54 (31%) | 12/42 (29%) | 0.45 |
Vitamin D insufficiency, n (%) | 20/54 (37%) | 20/42 (48%) | 0.71 | |
%TWL, mean ± SD | 20.85 ± 11.25 | 21.03 ± 5.95 | 0.90 | |
Postoperative 6 months | Vitamin D deficiency, n (%) | 8/49 (16%) | 6/45 (13%) | 0.68 |
Vitamin D insufficiency, n (%) | 16/49 (33%) | 16/45 (36%) | 0.76 | |
%TWL, mean ± SD | 30.24 ± 7.94 | 31.06 ± 9.01 | 0.57 |
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Musella, M.; Berardi, G.; Vitiello, A.; Dayan, D.; Schiavone, V.; Franzese, A.; Abu-Abeid, A. Vitamin D Deficiency in Patients with Morbid Obesity before and after Metabolic Bariatric Surgery. Nutrients 2022, 14, 3319. https://doi.org/10.3390/nu14163319
Musella M, Berardi G, Vitiello A, Dayan D, Schiavone V, Franzese A, Abu-Abeid A. Vitamin D Deficiency in Patients with Morbid Obesity before and after Metabolic Bariatric Surgery. Nutrients. 2022; 14(16):3319. https://doi.org/10.3390/nu14163319
Chicago/Turabian StyleMusella, Mario, Giovanna Berardi, Antonio Vitiello, Danit Dayan, Vincenzo Schiavone, Antonio Franzese, and Adam Abu-Abeid. 2022. "Vitamin D Deficiency in Patients with Morbid Obesity before and after Metabolic Bariatric Surgery" Nutrients 14, no. 16: 3319. https://doi.org/10.3390/nu14163319
APA StyleMusella, M., Berardi, G., Vitiello, A., Dayan, D., Schiavone, V., Franzese, A., & Abu-Abeid, A. (2022). Vitamin D Deficiency in Patients with Morbid Obesity before and after Metabolic Bariatric Surgery. Nutrients, 14(16), 3319. https://doi.org/10.3390/nu14163319