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The effect of bariatric surgery on serum 25-OH vitamin D levels: a systematic review and meta-analysis.

ABSTRACT: BACKGROUND:Concerns have emerged about post-operative decreases in calcium and vitamin D following bariatric surgery. This review explores changes in metabolic bone health in persons with obesity undergoing gastric bypass surgery compared to non-surgical controls, providing an updated and comprehensive perspective on the literature. METHODS:An electronic search was conducted in MEDLINE, Pubmed, EMBASE and Cochrane databases to 8 November 2016. Eligible trials included randomized controlled trials or controlled observational studies of patients who have undergone laparoscopic gastric bypass surgery. Statistical analysis was carried out using the Cochrane Collaboration Review Manager (RevMan 5.0), and a random effects model was implemented. Outcomes were expressed as weighted mean difference (WMD). The primary outcome examined was change in 25-OH-D levels at 12 months post surgery, and secondary outcomes included change in bone mineral density (BMD) measurements at 12 months post surgery at the lumbar spine (LS) and total hip (TH). RESULTS:At 12 months, there was no significant difference in 25-OH vitamin D in the surgical group compared to controls (WMD = 6.79%; 95% CI: -9.01, 22.59; p = 0.40; I2 = 68%). There was no statistically significant difference between fracture risk in the surgical population compared to controls (RR = 1.24; 95% CI: 0.99, 1.56; p = 0.06; I2 = 0%). A significant BMD reduction was however shown at the TH (WMD, -7.33%, 95% CI = -8.70 to -5.97, p < .001, I2 = 0%), and a trend towards decline was observed at the LS (WMD, -1.73%, 95% CI = -3.56 to 0.11, p = 0.06, I2 = 0%). Changes at 24 months for applicable outcomes were similar to the results at 12 months. CONCLUSIONS:Bariatric surgery may compromise metabolic bone health, but the paucity of high-quality literature limits conclusions.

SUBMITTER: Kalani A

PROVIDER: S-EPMC5598026 | biostudies-literature | 2017 Sep

REPOSITORIES: biostudies-literature

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The effect of bariatric surgery on serum 25-OH vitamin D levels: a systematic review and meta-analysis.

Kalani A A Bami H H Tiboni M M Jaeschke R R Adachi J D JD Lau A N AN

Obesity science & practice 20170627 3

<h4>Background</h4>Concerns have emerged about post-operative decreases in calcium and vitamin D following bariatric surgery. This review explores changes in metabolic bone health in persons with obesity undergoing gastric bypass surgery compared to non-surgical controls, providing an updated and comprehensive perspective on the literature.<h4>Methods</h4>An electronic search was conducted in MEDLINE, Pubmed, EMBASE and Cochrane databases to 8 November 2016. Eligible trials included randomized c ...[more]

PMID: 29071108

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Project description:Background: Cardiovascular disease (CVD) risk factors are associated with low serum 25 hydroxyvitamin D (25(OH)D) concentrations in observational studies; however, clinical trial findings are inconsistent. Objective: We assessed the effect of vitamin D supplementation and increased serum 25(OH)D concentrations on CVD risk factors in a systemic review and meta-analysis of randomized controlled trials (RCTs). Design: MEDLINE, CINAHL, EMBASE, and Google Scholar were searched for RCTs that evaluated vitamin D supplementation and cardiovascular outcomes [blood pressure, parathyroid hormone (PTH), serum high-sensitivity C-reactive protein (hs-CRP), total cholesterol, high and low density lipoprotein (HDL and LDL, respectively), triglycerides, peak wave velocity (PWV) and Augmentation Index (AI)] from 1992 through 2017. Meta-analysis was based on a random-effects model and inverse variance method to calculate standardized mean difference (SMD) as effect sizes, followed by a leave-one-out method for sensitivity analysis. Risk of publication bias was assessed using Cochrane checklist and Begg funnel plots. The systematic review is registered as CRD42015025346. Results: We identified 2341 studies from which 81 met inclusion criteria. The meta-analysis indicated a significant reduction in systolic blood pressure (SMD = -0.102 ± 0.04 mmHg, 95% confidence interval (CI), -0.20 to -0.03), diastolic blood pressure (SMD = -0.07 ± 0.03 mmHg, 95% CI, -0.14 to -0.006), serum PTH (SMD = -0.66 ± 0.08 ng/L, 95% CI, -0.82 to -0.49), hs-CRP (SMD = -0.20 ± 0.07 mg/L, 95% CI, -0.34 to -0.06), total cholesterol (SMD = -0.15 ± 0.06 mmol/L, 95% CI, -0.25 to -0.04), LDL (SMD = -0.10 ± 0.05 mmol/L, 95% CI, -0.20 to -0.003), triglycerides (SMD = -0.12 ± 0.06 mmol/L, 95% CI, -0.23 to -0.003) and a significant increase in HDL (SMD = 0.09 ± 0.04 mmol/L, 95% CI, 0.00 to 0.17) with vitamin D supplementation. These findings remained significant in sensitivity analyses for blood pressure, lipid profile, serum PTH, and serum hs-CRP. There was no significant effect of vitamin D supplementation on PWV (SMD = -0.20 ± 0.13 m/s, 95% CI, -0.46 to 0.06, p = 0.14) and AI (SMD = -0.09 ± 0.14%, 95% CI, -0.37 to 0.19, p = 0.52) for vitamin D supplemented groups. Conclusion: These findings suggest that vitamin D supplementation may act to protect against CVD through improving risk factors, including high blood pressure, elevated PTH, dyslipidemia, and inflammation.

Project description:BACKGROUND:The beneficial adaptation of skeletal muscle function to strenuous exercise is partially attributable to the improvement of vitamin D status. The present study aimed to evaluate the effects of a 3-week vitamin D supplementation on serum 25(OH)D levels and skeletal muscle biomarkers (i.e. troponin, myoglobin, creatine kinase and lactic dehydrogenase) of endurance runners. METHODS:A double-blind placebo-controlled study design was used and vitamin D supplementation was compared to a non-treatment control group. Twenty-four runners, competitors of the ultra-marathons held during the National Running Championships, were randomly assigned into two groups supplemented with the dose of 2000?IU vitamin D or placebo for three weeks. All subjects participated in three exercise protocols: (a) incremental exercise test (to determine the maximum oxygen uptake and the intensity of eccentric exercise), (b) eccentric exercise before and (c) after two dietary protocols. Venous blood samples were drawn at rest, immediately after the exercise and after 1?h and 24?h of recovery in order to estimate serum 25(OH)D levels, skeletal muscle biomarkers, proinflammatory cytokines and tumor necrosis factor-alpha (TNF-?) levels. A two-way ANOVA was used to test main effects and their interactions and Pearson correlation coefficients were analyzed to determine the effects of inter-variable relationships. RESULTS:Significant differences between pre- and post-intervention in baseline 25(OH)D levels were observed (34.9?±?4.7 versus 40.3?±?4.9?ng/ml, p?= 0.02) in supplemented group. A higher post intervention 25(OH)D level was observed after vitamin D diet compared to placebo (40.3?±?4.9 versus 31.8?±?4.2?ng/mL, respectively; p?< 0.05). The vitamin D supplementation decreased post-exercise (TN max) and 1?h post-exercise troponin (p?= 0.004, p?=?0.03, respectively), 1?h post-exercise myoglobin concentration (p?=?0.01) and TNF-? levels(p?<?0.03). 24?h post exercise creatine kinase activity was significantly lower in supplemented group compared to placebo (p?<?0.05). A negative correlation was observed between post exercise 25(OH)D levels and myoglobin levels (r?=?-?0.57; p?=?0.05), and 25(OH)D levels and TNF? (r?=?-?0.58; p?=?0.05) in vitamin D supplemented group. CONCLUSIONS:Three weeks of vitamin D supplementation had a positive effect on serum 25(OH)D levels in endurance trained runners and it caused a marked decrease in post-exercise biomarkers levels. We concluded that vitamin D supplementation might play an important role in prevention of skeletal muscle injuries following exercise with eccentric muscle contraction in athletes.

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The effect of bariatric surgery on serum 25-OH vitamin D levels: a systematic review and meta-analysis.

Publications

The effect of bariatric surgery on serum 25-OH vitamin D levels: a systematic review and meta-analysis.

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