Secondary hyperparathyroidism and vitamin D deficiency in patients after laparoscopic sleeve gastrectomy
DOI:
https://doi.org/10.32782/2415-8127.2024.69.3Keywords:
Bariatric surgery, obesity, laparoscopic sleeve gastrectomy, ionized calcium, 25 hydroxycalciferol, parathyroid hormone, vitamin D deficiency, secondary hyperparathyroidismAbstract
The purpose of this study is to investigate the vitamin D deficiency and secondary hyperparathyroidism (SHPT) in patients after laparoscopic sleeve gastrectomy (LSG). The study is based on a review of medical records and clinical data collected from patients with morbid obesity after laparoscopic sleeve gastrectomy. The materials and methods. A total of 79 patients (without SHPT at the baseline) after LSG were included in the study, with a mean age of 40,7±11,4 years. All patients were divided into 2 groups depending on the receipt of additional vitamin and mineral therapy in the postoperative period. The first group (n=38) who did not receive additional therapy in the postoperative period. The second group (n=41) who received vitamins and trace elements (cholecalciferol 2 000 IU, calcium 1,000 mg and a multivitamin 1 tablet per day). Anthropometric parameters, ionized calcium (Ca2+), 25 hydroxycalciferol (25(OH)D), parathyroid hormone (PTH), were compared before and 1 year after LSG. The prevalence of vitamin D deficiency (< 20 ng/ml) and secondary hyperparathyroidism (> 88 pg/mL) at different time points was calculated. Results. The median 25(OH)D levels in both groups were within normal limits, but in the first group the median was statistically significantly lower compared to the median of the same indicator in the second group (p=0.001). The number of cases of vitamin D hypovitaminosis was statistically significantly higher in the first group, 17 vs 5 patients, respectively (p=0.003). The overall prevalence of SHPT was recorded in 14 (17.7%) patients included in this study, with a statistically significant majority of cases in the first group 12 vs. 2 (p=0.005) patients, respectively. Post-operatively, PTH levels had a strong significant inverse relationship with 25(OH)D and Ca2+ levels (p<0.001). Conclusion. Patients after laparoscopic sleeve gastrectomy have a risk of secondary hyperparathyroidism and vitamin D deficiency in the postoperative period. The higher levels of parathyroid hormone post laparoscopic sleeve gastrectomy significantly related to vitamin D deficiency and lower calcium levels. Additional vitamin and mineral therapy in the postoperative period after laparoscopic sleeve gastrectomy significantly reduces the risk of developing secondary hyperparathyroidism and vitamin D deficiency. This study also emphasizes the importance of routine testing for hyperparathyroidism and vitamin deficiency after laparoscopic sleeve gastrectomy.
References
Swinburn B.A., Sacks G., Hall K.D., McPherson K., Finegood D.T., Moodie M.L., Gortmaker S.L. The global obesity pandemic: shaped by global drivers and local environments. Lancet. 2011;378(9793):804-814. https://doi.org/10.1016/s0140-6736(11)60813-1.
Gloy V.L., Briel M., Bhatt D.L., Kashyap S.R., Schauer P.R., Mingrone G., Bucher H.C., Nordmann A.J. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomized controlled trials. BMJ. 2013;347:f5934. https://doi.org/10.1136/bmj.f5934.
Angrisani L., Santonicola A., Iovino P., Vitiello A., Higa K., Himpens J., Buchwald H., Scopinaro N. IFSO Worldwide Survey 2016: Primary, Endoluminal, and Revision Procedures. Obes Surg. 2018;28(12):3783-3794. https://doi.org/10.1007/s11695-018-3450-2.
Gasmi A, Bjørklund G, Mujawdiya PK, et al. Micronutrient deficiencies in patients after bariatric surgery. Eur J Nutr. 2022;61(1):55-67. https://doi:10.1007/s00394-021-02619-8.
Gjessing H, Nielsen H, Mellgren G, et al. Energy intake, nutritional status and weight reduction in patients one year after laparoscopic sleeve gastrectomy. Springerplus. 2013;2(1):352. https://doi:10.1186/2193-1801-2-352.
Mussolino ME, Looker AC, Madans JH, Langlois JA, Orwoll ES. Risk factors for hip fracture in white men: the NHANES I Epidemiologic Follow-up Study. J Bone Miner Res. 1998;13(6):918-924. https://doi:10.1359/jbmr.1998.13.6.918.
Ensrud KE, Fullman RL, Barrett-Connor E, et al. Voluntary weight reduction in older men increases hip bone loss: the osteoporotic fractures in men study. J Clin Endocrinol Metab. 2005;90(4):1998-2004. https://doi:10.1210/jc.2004-1805.
Hewitt S, Søvik TT, Aasheim ET, et al. Secondary hyperparathyroidism, vitamin D deficiency, and serum calcium 5 years after gastric bypass and duodenal switch. Obes Surg. 2013;23(3):384-390. https://doi:10.1007/s11695-012-0772-3.
Chow A, Switzer NJ, Gill RS et al. Roux-en-Y gastric bypass in the elderly: a systematic review. Obes Surg 2016; 26: 626–630. https://doi:10.1007/s11695-015-2007-x
Yu EW, Bouxsein ML, Putman MS et al. Two-year changes in bone density after Roux-en-Y gastric bypass surgery. J Clin Endocrinol Metab 2015; 100: 1452–1459. https://doi:10.1210/jc.2014-4341
Carlin AM, Rao DS, Yager KM, Genaw JA, Parikh NJ, Szymanski W. Effect of gastric bypass surgery on vitamin D nutritional status. Surg Obes Relat Dis. 2006;2(6):638–42. https://doi:10.1016/j.soard.2006.09.003
Johnson JM, Maher JW, Samuel I, Heitshusen D, Doherty C, Downs RW. Effects of gastric bypass procedures on bone mineral density, calcium, parathyroid hormone, and vitamin D. J Gastrointest Surg 2005; 9: 1106–1110; discussion 1110-1. https://doi:10.1016/j.gassur.2005.07.012
Shapses SA, Sukumar D. Bone metabolism in obesity and weight loss. Annu Rev Nutr 2012; 32: 287–309. https://doi:10.1146/annurev.nutr.012809.104655
Liu C, Wu D, Zhang JF et al. Changes in bone metabolism in morbidly obese patients after bariatric surgery: a meta-analysis. Obes Surg 2016; 26: 91–97. https://doi:10.1007/s11695-015-1724-5
Riedt CS, Brolin RE, Sherrell RM, et al. True fractional calcium absorption is decreased after Roux-en-Y gastric bypass surgery. Obesity 2006;14:1940. https://doi:10.1038/oby.2006.226
Goldner WS, Stoner JA, Lyden E, Thompson J, Taylor K, Larson L, et al. Finding the optimal dose of vitamin D following Roux-en-Y gastric bypass: a prospective, randomized pilot clinical trial. Obes Surg. 2009;19(2):173–9. https://doi:10.1007/s11695-008-9680-y
Heber D, Greenway FL, Kaplan LM, Livingston E, Salvador J, Still C, et al. Endocrine and nutritional management of the post-bariatric surgery patient: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2010;95(11):4823–43. https://doi:10.1210/jc.2009-2128
