Key result
Bariatric surgery followed by vitamin D supplementation was not associated with a higher risk for vitamin D deficiency at two years compared to medical treatment with a very low-energy diet.
Why the study?
Persons living with obesity treated with bariatric surgery face a high risk of nutritional deficiencies, and whether surgery increases vitamin D deficiency compared to dietary treatment was evaluated.
Does bariatric surgery with routine supplementation prevent vitamin D deficiency compared to medical treatment with a very low-energy diet in patients with obesity?
Observational (n=971)
No
Does bariatric surgery with routine supplementation prevent vitamin D deficiency compared to medical treatment with a very low-energy diet in patients with obesity?
Standardized Mean Difference: 0.11
Absolute Event Rate: 1.7% vs 2.7%
p-value: p=0.29
Bariatric surgery followed by routine supplementation is not associated with a higher risk of vitamin D deficiency at 2 years compared to medical weight loss treatment.
Bariatric surgery with supplementation showed no excess vitamin D deficiency risk versus VLED; extends observational data but prospective trials needed to guide protocols.
INTRODUCTION: Persons living with obesity treated with bariatric surgery are at a high risk of developing nutritional deficiencies. The primary aim of this observational cohort study was to compare vitamin D levels in patients two years after bariatric surgery (Roux-en-Y gastric bypass/RYGB and sleeve gastrectomy/SG) with a very low-energy diet (VLED). The same subjects were also compared with a population sample from the same region at baseline. The primary hypothesis was that surgery, especially RYGB, would lead to an increased prevalence of vitamin D deficiency compared to subjects treated with VLED. 971 individuals eligible for surgical, RYGB (n = 388), SG (n = 201), and medical treatment (n = 382), in routine care, were included consecutively between 2015 and 2017. A random population sample from the WHO-MONICA project was used as a reference, (n = 414). S-calcium, S-25(OH)D (vitamin D), and S-PTH (parathyroid hormone) were measured in all persons with obesity at baseline and two years after treatment (n = 713). Self-reported use of vitamin D and calcium supplementation was registered. RESULTS: Vitamin D deficiency (S-25(OH)D <25mmol/l) was found in 5.2% of the persons with obesity at baseline versus 1.7% of the general population (SMD>0.1). S-25(OH)D increased for all treatment groups but was higher in RYGB and SG (SMD>0.1, standardized mean difference). Thirteen subjects (1.8%) had vitamin D deficiency after obesity treatment. CONCLUSION: Surgical intervention for obesity followed by vitamin D supplementation was not associated with a higher risk for vitamin D deficiency, irrespective of surgery type, compared to individuals on medical treatment. However, persons living with obesity seeking weight loss treatment are more likely to have deficient vitamin D levels compared to the general population.
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Mejaddam et al. (2023) conducted an observational in Obesity (n=971). Bariatric surgery (Roux-en-Y gastric bypass or sleeve gastrectomy) vs. Medical treatment (very low-energy diet) was evaluated on Vitamin D deficiency (S-25(OH)D < 25 nmol/l) at 2 years (SMD 0.11, p=0.29). Bariatric surgery followed by vitamin D supplementation was not associated with a higher risk for vitamin D deficiency at two years compared to medical treatment with a very low-energy diet.
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