Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Bariatric Surgery

The impact of preoperative vitamin administration on skeletal status following sleeve gastrectomy in young and middle-aged women: a randomized controlled trial

International Journal of Obesity volume 45, pages 1925–1936 (2021)Cite this article

Subjects

Abstract

Background

The appropriate strategies to minimize skeletal deterioration following bariatric surgeries are inconclusive. This randomized controlled trial evaluated the effect of preoperative vitamin supplementation on bone mineral density (BMD) and biochemical parameters in females post-sleeve gastrectomy (SG).

Methods

Participants were randomized to a 2-month preoperative treatment with a multivitamin and vitamin D 4000 IU/d (intervention arm) or 1200 IU/d (control arm). Preoperative and 12-month postoperative follow-up evaluations included anthropometrics, biochemical parameters, and dual energy X-ray absorptiometry (DEXA).

Results

Sixty-two females (median age 29.7 years and median BMI 43.4 kg/m2) were recruited, 87% completed the 12-month follow-up. For the intervention and control arms, significant and similar reductions at 12-months post-surgery were observed in BMD of the hip (−6.8 ± 3.7% vs. −6.0 ± 3.6%; P = 0.646) and of the femoral neck (−7.1 ± 5.8% vs. −7.2 ± 5.5%; P = 0.973). For the intervention compared to the control arm, the 25 hydroxyvitamin D (25(OH)D) increment was greater after 2 months treatment, and vitamin D deficiency rates were lower at 3 and 6-months follow-up (P < 0.016). However, at 12-months postoperative, 25(OH)D values and vitamin D deficiency were comparable between the arms (P > 0.339). Predictors for BMD decline in the total hip were the percentage of excess weight-loss, age>50 years, and lower initial BMI (P ≤ 0.003).

Conclusions

SG was associated with a significant decline in BMD of the hip and femoral neck in young and middle-aged women, and was unaffected by preoperative vitamin D supplementation. Females who are peri-menopausal or with greater postoperative weight-loss should be particularly followed for BMD decline.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Flow chart of the study population.
Fig. 2: Changes in bone mineral density from baseline (2 months preoperative) to 12 months post sleeve gastrectomy.
Fig. 3: Intake of specific nutrients during the year following sleeve gastrectomy.

Similar content being viewed by others

References

  1. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.

    Article  CAS  PubMed  Google Scholar 

  2. Angrisani L, Santonicola A, Iovino P, Vitiello A, Higa K, Himpens J, et al. IFSO Worldwide Survey 2016: primary, endoluminal, and revisional procedures. Obes Surg. 2018;28:3783–94.

    Article  PubMed  Google Scholar 

  3. Caron M, Hould FS, Lescelleur O, Marceau S, Lebel S, Julien F, et al. Long-term nutritional impact of sleeve gastrectomy. Surg Obes Relat Dis. 2017;13:1664–73.

    Article  CAS  PubMed  Google Scholar 

  4. Ben-Porat T, Elazary R, Yuval JB, Wieder A, Khalaileh A, Weiss R. Nutritional deficiencies after sleeve gastrectomy: can they be predicted preoperatively? Surg Obes Relat Dis. 2015;11:1029–36.

    Article  PubMed  Google Scholar 

  5. Moize V, Deulofeu R, Torres F, de Osaba JM, Vidal J. Nutritional intake and prevalence of nutritional deficiencies prior to surgery in a Spanish morbidly obese population. Obes Surg. 2011;21:1382–8.

    Article  PubMed  Google Scholar 

  6. Peterson LA, Cheskin LJ, Furtado M, Papas K, Schweitzer MA, Magnuson TH, et al. Malnutrition in bariatric surgery candidates: multiple micronutrient deficiencies prior to surgery. Obes Surg. 2016;26:833–8.

    Article  PubMed  Google Scholar 

  7. van Rutte PW, Aarts EO, Smulders JF, Nienhuijs SW. Nutrient deficiencies before and after sleeve gastrectomy. Obes Surg. 2014;24:1639–46.

    Article  PubMed  Google Scholar 

  8. Muschitz C, Kocijan R, Haschka J, Zendeli A, Pirker T, Geiger C, et al. The impact of vitamin D, calcium, protein supplementation, and physical exercise on bone metabolism after bariatric surgery: the BABS study. J Bone Miner Res. 2016;31:672–82.

    Article  CAS  PubMed  Google Scholar 

  9. Schiavo L, Pilone V, Rossetti G, Romano M, Pieretti G, Schneck AS, et al. Correcting micronutrient deficiencies before sleeve gastrectomy may be useful in preventing early postoperative micronutrient deficiencies. Int J Vitam Nutr Res. 2019;89:22–8. https://doi.org/10.1024/0300-9831/a000532.

    Article  CAS  PubMed  Google Scholar 

  10. Sherf Dagan S, Goldenshluger A, Globus I, Schweiger C, Kessler Y, Kowen Sandbank G, et al. Nutritional recommendations for adult bariatric surgery patients: clinical practice. Adv Nutr. 2017;8:382–94.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  11. Parrott J, Frank L, Rabena R, Craggs-Dino L, Isom KA, Greiman L. American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient 2016 update: micronutrients. Surgery Obesity Relat Dis. 2017;13:727–41.

    Article  Google Scholar 

  12. Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity. 2013;21(Suppl 1):S1–27.

    Article  CAS  PubMed  Google Scholar 

  13. British Obesity and Metabolic Surgery Society. BOMSS guidelines on peri-operative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery [Internet]. http://www.bomss.org.uk/wp-content/uploads/2014/09/BOMSS-guidelines-Final-version1Oct14.pdf. 2014.

  14. Damms-Machado A, Friedrich A, Kramer KM, Stingel K, Meile T, Kuper MA, et al. Pre- and postoperative nutritional deficiencies in obese patients undergoing laparoscopic sleeve gastrectomy. Obes Surg. 2012;22:881–9.

    Article  PubMed  Google Scholar 

  15. Hakeam HA, O’Regan PJ, Salem AM, Bamehriz FY, Eldali AM. Impact of laparoscopic sleeve gastrectomy on iron indices: 1 year follow-up. Obes Surg. 2009;19:1491–6.

    Article  PubMed  Google Scholar 

  16. Snyder-Marlow G, Taylor D, Lenhard MJ. Nutrition care for patients undergoing laparoscopic sleeve gastrectomy for weight loss. J Am Diet Assoc. 2010;110:600–7.

    Article  PubMed  Google Scholar 

  17. P. S, M. B, K. S. Micronutrient deficiencies after bariatric surgery. Nutrition. 2010;26:1031–7.

    Article  CAS  Google Scholar 

  18. Ben-Porat T, Elazary R, Sherf-Dagan S, Goldenshluger A, Brodie R, Mintz Y, et al. Bone health following bariatric surgery: implications for management strategies to attenuate bone loss. Adv Nutr. 2018;9:114–27.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Thibault R, Huber O, Azagury DE, Pichard C. Twelve key nutritional issues in bariatric surgery. Clin Nutr. 2016;35:12–7.

    Article  PubMed  Google Scholar 

  20. Gregory NS. The effects of bariatric surgery on bone metabolism. Endocrinol Metab Clin North Am. 2017;46:105–16.

    Article  PubMed  Google Scholar 

  21. Jaruvongvanich V, Vantanasiri K, Upala S, Ungprasert P. Changes in bone mineral density and bone metabolism after sleeve gastrectomy: a systematic review and meta-analysis. Surg Obes Relat Dis. 2019;15:1252–60.

    Article  PubMed  Google Scholar 

  22. Gagnon C, Schafer AL. Bone health after bariatric surgery. JBMR Plus. 2018;2:121–33.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Yu EW. Bone metabolism after bariatric surgery. J Bone Miner Res. 2014;29:1507–18.

    Article  PubMed  Google Scholar 

  24. Nogues X, Goday A, Pena MJ, Benaiges D, de Ramon M, Crous X, et al. [Bone mass loss after sleeve gastrectomy: a prospective comparative study with gastric bypass]. Cir Esp. 2010;88:103–9.

    Article  PubMed  Google Scholar 

  25. Pluskiewicz W, Buzga M, Holeczy P, Bortlik L, Smajstrla V, Adamczyk P. Bone mineral changes in spine and proximal femur in individual obese women after laparoscopic sleeve gastrectomy: a short-term study. Obes Surg. 2012;22:1068–76.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Carrasco F, Basfi-Fer K, Rojas P, Valencia A, Csendes A, Codoceo J, et al. Changes in bone mineral density after sleeve gastrectomy or gastric bypass: relationships with variations in vitamin D, ghrelin, and adiponectin levels. Obes Surg. 2014;24:877–84.

    Article  PubMed  Google Scholar 

  27. Hsin MC, Huang CK, Tai CM, Yeh LR, Kuo HC, Garg A. A case-matched study of the differences in bone mineral density 1 year after 3 different bariatric procedures. Surg Obes Relat Dis. 2015;11:181–5.

    Article  PubMed  Google Scholar 

  28. Bredella MA, Greenblatt LB, Eajazi A, Torriani M, Yu EW. Effects of Roux-en-Y gastric bypass and sleeve gastrectomy on bone mineral density and marrow adipose tissue. Bone. 2017;95:85–90.

    Article  PubMed  Google Scholar 

  29. Guglielmi V, Bellia A, Gentileschi P, Lombardo M, D’Adamo M, Lauro D, et al. Parathyroid hormone in surgery-induced weight loss: no glucometabolic effects but potential adaptive response to skeletal loading. Endocrine. 2018;59:288–95.

    Article  CAS  PubMed  Google Scholar 

  30. Carrasco F, Basfi-Fer K, Rojas P, Csendes A, Papapietro K, Codoceo J, et al. Calcium absorption may be affected after either sleeve gastrectomy or Roux-en-Y gastric bypass in premenopausal women: a 2-y prospective study. Am J Clin Nutr. 2018;108:24–32.

    Article  PubMed  Google Scholar 

  31. Ivaska KK, Huovinen V, Soinio M, Hannukainen JC, Saunavaara V, Salminen P, et al. Changes in bone metabolism after bariatric surgery by gastric bypass or sleeve gastrectomy. Bone. 2017;95:47–54.

    Article  CAS  PubMed  Google Scholar 

  32. Vilarrasa N, de Gordejuela AG, Gómez-Vaquero C, Pujol J, Elio I, San José P, et al. Effect of bariatric surgery on bone mineral density: comparison of gastric bypass and sleeve gastrectomy. Obes Surg. 2013;23:2086–91.

    Article  PubMed  Google Scholar 

  33. Shapses SA, Sukumar D. Bone metabolism in obesity and weight loss. Annual review of nutrition. 2012;32:287–309.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Campanha-Versiani L, Pereira DAG, Ribeiro-Samora GA, Ramos AV, de Sander Diniz MFH, De Marco LA, et al. The effect of a muscle weight-bearing and aerobic exercise program on the body composition, muscular strength, biochemical markers, and bone mass of obese patients who have undergone gastric bypass surgery. Obes Surg. 2017;27:2129–37.

    Article  PubMed  Google Scholar 

  35. Carlin AM, Rao DS, Yager KM, Parikh NJ, Kapke A. Treatment of vitamin D depletion after Roux-en-Y gastric bypass: a randomized prospective clinical trial. Surg Obes Relat Dis. 2009;5:444–9.

    Article  PubMed  Google Scholar 

  36. Doig GS, Simpson F. Randomization and allocation concealment: a practical guide for researchers. J Crit Care. 2005;20:187–91. discussion 91-3.

    Article  PubMed  Google Scholar 

  37. Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: Updated guidelines for reporting parallel group randomised trials. J Pharmacol Pharmacother. 2010;1:100–7.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Ho PM, Bryson CL, Rumsfeld JS. Medication adherence: its importance in cardiovascular outcomes. Circulation. 2009;119:3028–35.

    Article  PubMed  Google Scholar 

  39. Shepherd JA, Lu Y, Wilson K, Fuerst T, Genant H, Hangartner TN, et al. Cross-calibration and minimum precision standards for dual-energy X-ray absorptiometry: the 2005 ISCD official positions. J Clin Densitom. 2006;9:31–6.

    Article  PubMed  Google Scholar 

  40. Toolabi K, Arefanian S, Golzarand M, Arefanian H. Effects of laparoscopic Roux-en-Y gastric bypass (LRYGB) on weight loss and biomarker parameters in morbidly obese patients: a 12-month follow-up. Obes Surg. 2011;21:1834–42.

    Article  PubMed  Google Scholar 

  41. Jassil FC, Carnemolla A, Kingett H, Paton B, O’Keeffe AG, Doyle J, et al. Protocol for a 1-year prospective, longitudinal cohort study of patients undergoing Roux-en-Y gastric bypass and sleeve gastrectomy: the BARI-LIFESTYLE observational study. BMJ Open. 2018;8:e020659.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Josbeno DA, Jakicic JM, Hergenroeder A, Eid GM. Physical activity and physical function changes in obese individuals after gastric bypass surgery. Surg Obes Relat Dis. 2010;6:361–6.

    Article  PubMed  Google Scholar 

  43. King WC, Hsu JY, Belle SH, Courcoulas AP, Eid GM, Flum DR, et al. Pre- to postoperative changes in physical activity: report from the longitudinal assessment of bariatric surgery-2 (LABS-2). Surg Obes Relat Dis. 2012;8:522–32.

    Article  PubMed  Google Scholar 

  44. Herring LY, Stevinson C, Davies MJ, Biddle SJ, Sutton C, Bowrey D, et al. Changes in physical activity behaviour and physical function after bariatric surgery: a systematic review and meta-analysis. Obes Rev. 2016;17:250–61.

    Article  CAS  PubMed  Google Scholar 

  45. Santos D, Lopes T, Jesus P, Cruz S, Cordeiro A, Pereira S, et al. Bone metabolism in adolescents and adults undergoing Roux-En-Y gastric bypass: a comparative study. Obes Surg. 2019;29:2144–50.

    Article  PubMed  Google Scholar 

  46. McClung MR, Lewiecki EM, Cohen SB, Bolognese MA, Woodson GC, Moffett AH, et al. Denosumab in postmenopausal women with low bone mineral density. N Engl J Med. 2006;354:821–31.

    Article  CAS  PubMed  Google Scholar 

  47. Berry SD, McLean RR, Hannan MT, Cupples LA, Kiel DP. Changes in bone mineral density may predict the risk of fracture differently in older adults according to fall history. J Am Geriatr Soc. 2014;62:2345–9.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Mechanick JI, Apovian C, Brethauer S, Garvey WT, Joffe AM, Kim J. et al. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures — 2019 update: cosponsored by american association of clinical endocrinologists/american college of endocrinology, the obesity society, american society for metabolic & bariatric surgery, obesity medicine association, and american society of anesthesiologists. Endocr Pract. 2019;25:1346–59. https://doi.org/10.4158/GL-2019-0406.

    Article  PubMed  Google Scholar 

  49. Fleischer J, Stein EM, Bessler M, Della Badia M, Restuccia N, Olivero-Rivera L, et al. The decline in hip bone density after gastric bypass surgery is associated with extent of weight loss. J Clin Endocrinol Metab. 2008;93:3735–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Coates PS, Fernstrom JD, Fernstrom MH, Schauer PR, Greenspan SL. Gastric bypass surgery for morbid obesity leads to an increase in bone turnover and a decrease in bone mass. J Clin Endocrinol Metab. 2004;89:1061–5.

    Article  CAS  PubMed  Google Scholar 

  51. Tian Z, Fan XT, Li SZ, Zhai T, Dong J. Changes in bone metabolism after sleeve gastrectomy versus gastric bypass: a meta-analysis. Obes Surg. 2020;30:77–86.

    Article  PubMed  Google Scholar 

  52. Peterson LA, Zeng X, Caufield-Noll CP, Schweitzer MA, Magnuson TH, Steele KE. Vitamin D status and supplementation before and after bariatric surgery: a comprehensive literature review. Surg Obes Relat Dis. 2016;12:693–702.

    Article  PubMed  Google Scholar 

  53. Ben-Porat T, Elazary R, Goldenshluger A, Sherf Dagan S, Mintz Y, Weiss R. Nutritional deficiencies four years after laparoscopic sleeve gastrectomy-are supplements required for a lifetime? Surg Obes Relat Dis. 2017;13:1138–44.

    Article  PubMed  Google Scholar 

  54. Paccou J, Martignene N, Lespessailles E, Babykina E, Pattou F, Cortet B, et al. Gastric Bypass But Not Sleeve Gastrectomy Increases Risk of Major Osteoporotic Fracture: French Population-Based Cohort Study. J Bone Miner Res. 2020;35:1415–23. https://doi.org/10.1002/jbmr.4012.

    Article  CAS  PubMed  Google Scholar 

  55. Zhang Q, Dong J, Zhou D, Liu F. Comparative risk of fracture for bariatric procedures in patients with obesity: a systematic review and Bayesian network meta-analysis. Int J Surg. 2020;75:13–23.

    Article  PubMed  Google Scholar 

  56. Chandler PD, Giovannucci EL, Scott JB, Bennett GG, Ng K, Chan AT, et al. Effects of vitamin D supplementation on C-peptide and 25-hydroxyvitamin D concentrations at 3 and 6 months. Sci Rep. 2015;5:10411.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Bassatne A, Chakhtoura M, Saad R, Fuleihan GE. Vitamin D supplementation in obesity and during weight loss: a review of randomized controlled trials. Metabolism. 2019;92:193–205.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank Prof. Rivka Polack, Prof. Jacob Bar Tana, Ms. Rivki Harari, Ms. Ariela Goldenshluger and the Linda Joy Poland Women’s Heart Health Center in Hadassah Ein Kerem for their consistent advice throughout this study.

Author information

Authors and Affiliations

  1. Department of Human Metabolism and Nutrition, Braun School of Public Health, Hebrew University, Jerusalem, Israel

    Tair Ben-Porat

  2. Department of Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

    Tair Ben-Porat & Dunia Kaluti

  3. Technion School of Medicine and the Department of Pediatrics, Rambam Medical Center, Haifa, Israel

    Ram Weiss

  4. Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

    Abed Khalaileh, Mahmud Abu Gazala, Yoav Mintz, Ronit Brodie, Alon J. Pikarsky & Ram Elazary

  5. Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

    Abed Khalaileh, Mahmud Abu Gazala, Yoav Mintz, Amihai Rottenstreich & Ram Elazary

  6. Department of Nutritional Sciences, School of Health Sciences, Ariel University, Ariel, Israel

    Shiri Sherf-Dagan

  7. Department of Nutrition, Assuta Medical Center, Tel Aviv, Israel

    Shiri Sherf-Dagan

  8. The Jesse Z and Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel

    Michal Yackobovitch-Gavan

  9. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Michal Yackobovitch-Gavan

  10. Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

    Amihai Rottenstreich

Authors
  1. Tair Ben-Porat
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ram Weiss
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Abed Khalaileh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mahmud Abu Gazala
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dunia Kaluti
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yoav Mintz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shiri Sherf-Dagan
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Michal Yackobovitch-Gavan
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Amihai Rottenstreich
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ronit Brodie
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Alon J. Pikarsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Ram Elazary
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

The authors’ responsibilities were as follows—TBP, RW, YM, SSD, AR, and RE designed the research; TBP, DK, MAG, AK, RB, AJP, and RE performed the research; TBP, RW, and RE analyzed the data; and TBP, RW, and RE wrote the manuscript. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Tair Ben-Porat.

Ethics declarations

Conflict of interest

All authors declare they have no conflicts of interest related to this work. This research did not receive any support or specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ben-Porat, T., Weiss, R., Khalaileh, A. et al. The impact of preoperative vitamin administration on skeletal status following sleeve gastrectomy in young and middle-aged women: a randomized controlled trial. Int J Obes 45, 1925–1936 (2021). https://doi.org/10.1038/s41366-021-00845-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41366-021-00845-y

This article is cited by

Search

Advanced search

Quick links