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- Hultin, Hella, et al.
(author)
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Cholecalciferol Injections Are Effective in Hypovitaminosis D After Duodenal Switch : a Randomized Controlled Study
- 2018
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In: Obesity Surgery. - : Springer Science and Business Media LLC. - 0960-8923 .- 1708-0428. ; 28:10, s. 3007-3011
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Journal article (peer-reviewed)abstract
- Background: By treating obesity, one of the major epidemics of this past century, through bariatric surgery, we may cause complications due to malnourishment in a growing population. At present, vitamin D deficiency is of interest, especially in patients with inferior absorption of fat-soluble nutrients after biliopancreatic diversion with duodenal switch (BPD/DS).Methods: Twenty BPD/DS patients, approximately 4 years postoperatively, were randomized to either intramuscular supplementation of vitamin D with a single dose of 600,000 IU cholecalciferol, or a control group. Patients were instructed to limit their supplementation to 1400 IU of vitamin D and to avoid the influence of UV-B radiation; the study was conducted when sunlight is limited (December to May).Results: Despite oral supplementation, a pronounced deficiency in vitamin D was seen (injection 19.3; control 23.2 nmol/l) in both groups. The cholecalciferol injection resulted in elevated 25[OH]D levels at 1 month (65.4 nmol/l), which was maintained at 6 months (67.4 nmol/l). This resulted in normalization of intact parathyroid hormone (PTH) levels. No changes in vitamin D or PTH occurred in the control group.Conclusions: In BPD/DS patients, having hypovitaminosis D despite full oral supplementation, a single injection of 600,000 IU of cholecalciferol was effective in elevating vitamin D levels and normalizing levels of intact PTH. The treatment is simple and highly effective and thus recommended, especially in cases of reduced UV-B radiation.
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| 2. |
- Hultin, Hella, et al.
(author)
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Left-Shifted Relation between Calcium and Parathyroid Hormone in Obesity
- 2010
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In: Journal of Clinical Endocrinology and Metabolism. - : The Endocrine Society. - 0021-972X .- 1945-7197. ; 95:8, s. 3973-3981
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Journal article (peer-reviewed)abstract
- Background: A condition resembling secondary hyperparathyroidism (HPT), including raised levels of PTH and normal levels of serum calcium, has been reported in obesity. A plausible reason may be vitamin D deficiency, but conflicting data have been reported. Objective: Our objective was to investigate calcium homeostasis in obese individuals with emphasis on the function of the parathyroid glands. Design and Intervention: Morbidly obese patients (mean body mass index = 46.6 +/- 6) were examined for their status of calcium homeostasis. A subset was thoroughly investigated with calcium-citrate (CiCa) clamping. Patients: Of 108 morbidly obese patients, 11 underwent CiCa clamping as well as 21 healthy volunteers of normal weight and 15 with primary HPT (pHPT). Large patient cohorts of normal individuals and pHPT patients were also used as comparisons. Outcome Measures and Results: All obese individuals had normal serum calcium and creatinine levels. Mean levels of 25-OH-vitamin D-3 in serum were low, 53 nmol/liter (reference range 75-250 nmol/liter). Mean intact plasma PTH was 5.1 pmol/liter (reference range 1.1-6.9 pmol/liter). There was a significant positive correlation between PTH and duration of obesity. CiCa clamping in obese subjects revealed a remarkably high sensitivity for calcium and a left-shifted relation between plasma calcium and PTH (set point) compared with the normal population. CiCa clamping in pHPT patients demonstrated a right-shifted PTH-Ca curve. Conclusion: Although vitamin D levels in the obese individuals were low, few displayed overt signs of secondary HPT. The CiCa clamping implied a disturbance in the calcium homeostasis comparable to early renal insufficiency, with a left-shifted Ca-PTH curve and a lower set point compared with the normal population.
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| 4. |
- Stevens, Katharina, et al.
(author)
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Continuous PPI Treatment after Gastric Bypass Increases the Risk of Pathological PTH Levels at Ten Years Postoperatively
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Other publication (other academic/artistic)abstract
- Introduction: Apart from massive weight loss, metabolic and bariatric surgery, especially gastric bypass (RYGBP), can cause nutritional deficiencies. Proton pump inhibitors (PPI), relatively often used after RYGBP, are associated with reduced calcium absorption. We have studied the long-term impact of PPI upon calcium homeostasis among RYGBP patients. Methods: In the Scandinavian Obesity Surgery Registry (SOReg), 550 primary RYGBP patients, with eGFR > 60 ml/min/1.73m2, had PTH and 25-OH D levels registered at 10 years. To avoid the impact of hypovitaminosis D, those with 25-OH D >75 nmol/L were selected.Results: At 10 years, 10.3% of patients reported continuous PPI treatment, i.e., daily use during the last month. In an age adjusted logistic regression model, continuous PPI treatment was associated with a tripled risk (OR: 3.97 [1.35-11.70]) of having a pathological PTH level (>7 pmol/L).Conclusion: This unique study has shown a correlation between continuous PPI use and pathological PTH levels, thereby inferring that the medication may have detrimental effects upon calcium homeostasis among gastric bypass patients. The risk of having pathological PTH levels was more than tripled among those with PPI treatment, highlighting the importance of specialized follow-up while also suggesting that a limited duration of PPI treatment is preferable.
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| 5. |
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| 6. |
- Stevens, Katharina, et al.
(author)
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Low bone mineral density following gastric bypass is not explained by lifestyle and lack of exercise
- 2021
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In: BMC Surgery. - : BioMed Central (BMC). - 1471-2482. ; 21:1
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Journal article (peer-reviewed)abstract
- BackgroundBariatric surgery, Roux-en-Y gastric bypass (RYGBP) in particular, is associated with weight loss as well as low bone mineral density. Bone mineral density relies upon multiple factors, some of which are lifestyle factors. The aim of this study was to compare lifestyle factors in order to eliminate them as culprits of the suspected difference in BMD in RYGBP operated and controls.Materials and methodsStudy participants included 71 RYGBP-operated women (42.3 years, BMI 33.1 kg/m2) and 94 controls (32.4 years, BMI 23.9 kg/m2). Each completed a DEXA scan, as well as survey of lifestyle factors (e.g. physical activity in daily life, corticosteroid use, and calcium intake). All study participants were premenopausal Caucasian women living in the same area. Blood samples were taken in RYGBP-patients.ResultsBMD was significantly lower in RYGBP, femoral neck 0.98 vs. 1.04 g/cm2 compared to controls, despite higher BMI (present and at 20 years of age) and similar physical activity and calcium intake. In a multivariate analysis, increased time since surgery and age were negatively associated with BMD of the femoral neck and total hip in RYGBP patients.ConclusionDespite similar lifestyle, RYGBP was followed by a lower BMD compared to controls. Thus, the reduced BMD in RYGBP cannot be explained, seemingly nor prevented, by lifestyle factors. As the reduction in BMD was associated with time since surgery, strict follow-up is a lifelong necessity after bariatric surgery, and especially important in younger bariatric patients.
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| 7. |
- Stevens, Katharina, 1988-
(author)
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The Effects of Bariatric Surgery upon the Maintenance of Calcium and Vitamin D Levels
- 2024
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Doctoral thesis (other academic/artistic)abstract
- Obesity is a growing pandemic, and consequently the population that has undergone a bariatric procedure is steadily rising. Through various mechanisms, bariatric surgery alters the gastrointestinal anatomy, thereby obtaining weight loss while being associated with various nutrient deficiencies including vitamin D. Over time, vitamin D deficiency may lead to elevated levels of parathyroid hormone (PTH) and the depletion of bone, in order to maintain circulating calcium levels. The aim of this thesis was to study the effects of bariatric surgery upon calcium homeostasis. In paper I we sought to investigate whether lifestyle factors could explain the difference in bone mineral density (BMD) seen among Roux-en-Y gastric bypass (RYGBP) patients. The second paper is a population-based study that examines the postoperative trends of vitamin D and PTH among patients that have undergone either a RYGBP or a sleeve gastrectomy (SG) (the two currently most popular bariatric procedures worldwide). In paper III the purpose was to explore whether medications to treat dyspepsia had an impact upon calcium homeostasis postoperatively among RYGBP patients. And finally, the purpose of the fourth paper was to study an intramuscular injection as an alternative method for the treatment of vitamin D deficiency among patients who had undergone a biliopancreatic diversion/duodenal switch (BPD/DS) procedure. The results from paper I do not indicate that lifestyle factors are a cause of the reduced BMD observed after a RYGBP, therefore the procedure itself is a likely cause of reduced BMD. The analysis conducted in paper II points to the impact that bariatric procedures (specifically RYGBP and SG) have over time regarding vitamin D deficiency. The results showed both differences between procedures as well as a successive decline in vitamin D parallelled by a rise in PTH with time after surgery. In paper III our results indicate that regular PPI therapy is strongly associated with a much higher incidence of pathological PTH levels, suggesting that the combination of the procedure and the medication may have deleterious effects upon calcium homeostasis. Finally, when managing vitamin D deficiency after a BPD/DS procedure, we showed that intramuscular injections had a substantial effect upon both vitamin D levels and PTH levels.
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| 8. |
- Sundbom, Magnus, et al.
(author)
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Short-Term UVB Treatment or Intramuscular Cholecalciferol to Prevent Hypovitaminosis D After Gastric Bypass-a Randomized Clinical Trial
- 2016
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In: Obesity Surgery. - : Springer Science and Business Media LLC. - 0960-8923 .- 1708-0428. ; 26:9, s. 2198-2203
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Journal article (peer-reviewed)abstract
- Gastric bypass is increasingly used worldwide to treat morbidly obese patients with good results. However, several studies have reported low levels of vitamin D in spite of supplementation. In this randomized clinical trial, we have evaluated two principally different interventions, short-term UVB treatment or a single cholecalciferol injection, to prevent hypovitaminosis D. Seventy-three patients, randomly treated by UVB (n = 26) or injection (n = 20), and compared to controls (n = 27), were followed for 6 months. Both interventions, 12 treatments of whole-body narrowband UVB and an intramuscular injection of 600,000 IU cholecalciferol, were given in December, when natural sunlight is limited. Blood samples for 25-OH-vitamin D (25[OH]D), intact PTH, calcium, and albumin were obtained at baseline, after 1 and 3 months, and after 6 months for the intervention groups. 25[OH]D was analyzed using a HPLC method. At baseline, 77.2 % of the patients had 25[OH]D < 75 nmol/L. At 3 months, both UVB and cholecalciferol injection resulted in significantly higher 25[OH]D levels than controls (71.6 and 77.9 vs. 48.6 nmol/L, p < 0.05). The levels remained rather constant at 6 months (69.0 and 76.7 nmol/L, respectively); however, only injection therapy resulted in improved levels compared to baseline (55.7 nmol/L, p < 0.001). No toxic effects, nor significant changes in PTH or albumin-adjusted calcium, were seen. In this randomized trial, both interventions, UVB and cholecalciferol, given as an adjunct to oral supplementation in gastric bypass patients, increased the levels of 25[OH]D. Simplicity makes injection therapy suitable for maintaining vitamin D levels during the Nordic winter.
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