Vitamin D supplementation for the prevention of vitamin D deficiency after bariatric surgery: a systematic review and meta-analysis

Abstract

Objective

To evaluate the efficacy of vitamin D supplementation on the prevention of postoperative vitamin D deficiency.

Methods

PubMed, Embase, Web of Science, and Cochrane library were searched. Prospective studies evaluating the effects of vitamin D supplementation in patients who had undergone bariatric surgery were included. Meta-regression was performed to explore heterogeneity, and assess the relationship between dosage of vitamin D supplementation, study design, and prevalence of vitamin D depletion.

Results

Twelve studies enrolling 1285 patients met the inclusion criteria, and were included. Vitamin D supplementation was associated with significant improvements in 1-year Vitamin D depletion and 1-year 25-OHD level. A daily supplement of more than 800 IU vitamin D significantly reduced the prevalence of 1-year Vitamin D depletion, but the dosage of less than 800 IU did not. Significant decrease in prevalence of 1-year Vitamin D depletion was observed in randomized controlled trials (RCTs), but not in non-RCTs. For the 1-year 25-OHD level, significant elevation was found in the studies irrespective of the study design and dosage of vitamin D supplementation. Meta-regression showed that there was significant relationship between vitamin D depletion and study design, but not between vitamin D depletion and the dosage of vitamin D supplementation.

Conclusion

Vitamin D supplementation with a daily dosage of more than 800 IU is effective in preventing postoperative vitamin D deficiency and improving the 25-OHD level. However, the results should be interpreted cautiously since there was significant heterogeneity among the studies.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. 1.

    Nair R, Maseeh A. Vitamin D: the “sunshine” vitamin. J Pharmacol Pharmacother. 2012;3:118–26.

    CAS  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Imes CC, Burke LE, The obesity epidemic: the United States as a cautionary tale for the rest of the world. Curr Epidemiol Rep. 2014;1:82–8.

    Article  Google Scholar 

  3. 3.

    Stevens GA, Singh GM, Lu Y, Danaei G, Lin JK, Finucane MM, et al. National, regional, and global trends in adult overweight and obesity prevalences. Popul Health Metr. 2012;10:22.

    Article  Google Scholar 

  4. 4.

    Organization. WH. Obesity and overweight. Fact sheet no 311. http://www.who.int/mediacentre/factsheets/fs311/en/. (2015). Accessed 19 Aug 2015.

  5. 5.

    Haslam DW, James WP, Obesity. Lancet. 2005;366:1197–209.

    Article  Google Scholar 

  6. 6.

    McTigue KM, Harris R, Hemphill B, Lux L, Sutton S, Bunton AJ, et al. Screening and interventions for obesity in adults: summary of the evidence for the U.S. preventive services task force. Ann Intern Med. 2003;139:933–49.

    Article  Google Scholar 

  7. 7.

    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.

    CAS  Article  Google Scholar 

  8. 8.

    Angrisani L, Lorenzo M, Borrelli V. Laparoscopic adjustable gastric banding versus Roux-en-Y gastric bypass: 5-year results of a prospective randomized trial. Surg Obes Relat Dis J Am Soc Bariatr. 2007;3:127–32.

    Article  Google Scholar 

  9. 9.

    Blume CA, Boni CC, Casagrande DS, Rizzolli J, Padoin AV, Mottin CC. Nutritional profile of patients before and after Roux-en-Y gastric bypass: 3-year follow-up. Obes Surg. 2012;22: 1676–85.

    Article  Google Scholar 

  10. 10.

    Maggard MA, Shugarman LR, Suttorp M, Maglione M, Sugerman HJ, Livingston EH, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142:547–59.

    Article  Google Scholar 

  11. 11.

    Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23:427–36.

    Article  Google Scholar 

  12. 12.

    Levinson R, Silverman JB, Catella JG, Rybak I, Jolin H, Isom K. Pharmacotherapy prevention and management of nutritional deficiencies post Roux-en-Y gastric bypass. Obes Surg. 2013;23: 992–1000.

    Article  Google Scholar 

  13. 13.

    Sawaya RA, Jaffe J, Friedenberg L, Friedenberg FK. Vitamin, mineral, and drug absorption following bariatric surgery. Curr Drug Metab. 2012;13:1345–55.

    CAS  Article  Google Scholar 

  14. 14.

    Alvarez-Leite JI. Nutrient deficiencies secondary to bariatric surgery. Curr Opin Clin Nutr Metab care. 2004;7:569–75.

    Article  Google Scholar 

  15. 15.

    Bloomberg RD, Fleishman A, Nalle JE, Herron DM, Kini S. Nutritional deficiencies following bariatric surgery: what have we learned? Obes Surg. 2005;15:145–54.

    Article  Google Scholar 

  16. 16.

    Brolin RE, Gorman JH, Gorman RC, Petschenik AJ, Bradley LJ, Kenler HA, et al. Are vitamin B12 and folate deficiency clinically important after roux-en-Y gastric bypass? J Gastrointest Surg J Soc Surg Aliment Tract. 1998;2:436–42.

    CAS  Article  Google Scholar 

  17. 17.

    Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Guven S, et al. American association of clinical endocrinologists, the obesity society, and American society for metabolic and bariatric surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Endocr Pract J Am Coll Endocrinol Am Assoc Clin Endocrinol. 2008;14 Suppl 1:1–83.

    Google Scholar 

  18. 18.

    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 J Am Soc Bariatr Surg. 2006;2:638–42.

    Article  Google Scholar 

  19. 19.

    Aasheim ET, Bjorkman S, Sovik TT, Engstrom M, Hanvold SE, Mala T, et al. Vitamin status after bariatric surgery: a randomized study of gastric bypass and duodenal switch. Am J Clin Nutr. 2009;90:15–22.

    Article  Google Scholar 

  20. 20.

    Carlin AM, Rao DS, Meslemani AM, Genaw JA, Parikh NJ, Levy S, et al. Prevalence of vitamin D depletion among morbidly obese patients seeking gastric bypass surgery. Surg Obes Relat Dis J Am Soc Bariatr Surg. 2006;2:98–103.

    Article  Google Scholar 

  21. 21.

    Flores L, Osaba MJ, Andreu A, Moize V, Rodriguez L, Vidal J. Calcium and vitamin D supplementation after gastric bypass should be individualized to improve or avoid hyperparathyroidism. Obes Surg. 2010;20:738–43.

    Article  Google Scholar 

  22. 22.

    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  Google Scholar 

  23. 23.

    Vilarrasa N, de Gordejuela AG, Gomez-Vaquero C, Pujol J, Elio I, San Jose 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  Google Scholar 

  24. 24.

    Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.

    Article  Google Scholar 

  25. 25.

    Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.

    Article  Google Scholar 

  26. 26.

    Wells G, Shea B, O’connell D, Peterson J, Welch V. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. 3rd Symposium on Systematic Reviews: Beyond the Basics. 2000:3–5.

  27. 27.

    Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60.

    Article  Google Scholar 

  28. 28.

    DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–88.

    CAS  Article  Google Scholar 

  29. 29.

    Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50:1088–101.

    CAS  Article  Google Scholar 

  30. 30.

    Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–34.

    CAS  Article  Google Scholar 

  31. 31.

    Silva JS, Chaves GV, Stenzel AP, Pereira SE, Saboya CJ, Ramalho A, Improvement of anthropometric and biochemical, but not of vitamin A, status in adolescents who undergo Roux-en-Y gastric bypass: a 1-year follow up study. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2016;13:227–33.

    Article  Google Scholar 

  32. 32.

    Moore CE, Sherman V. Effectiveness of B vitamin supplementation following bariatric surgery: rapid increases of serum vitamin B12. Obes Surg. 2015;25:694–9.

    Article  Google Scholar 

  33. 33.

    Smelt HJ, Pouwels S, Said M, Berghuis KA, Boer AK, Smulders JF. Comparison between different intramuscular vitamin B12 supplementation regimes: a retrospective matched Cohort study. Obes Surg. 2016;26:2873–9.

    CAS  Article  Google Scholar 

  34. 34.

    Dogan K, Aarts EO, Koehestanie P, Betzel B, Ploeger N, de Boer H, et al. Optimization of vitamin suppletion after Roux-en-Y gastric bypass surgery can lower postoperative deficiencies: a randomized controlled trial. Medicine. 2014;93:e169.

    CAS  Article  Google Scholar 

  35. 35.

    Donadelli SP, Junqueira-Franco MV, de Mattos Donadelli CA, Salgado W Jr., Ceneviva R, Marchini JS, et al. Daily vitamin supplementation and hypovitaminosis after obesity surgery. Nutrition. 2012;28:391–6.

    CAS  Article  Google Scholar 

  36. 36.

    Ramos NM, Magno FC, Cohen L, Rosado EL, Carneiro JR. Weight loss and nutritional anemia in patients submitted to Roux-en-Y gastric bypass on use of vitamin and mineral supplementation. Arq Bras De Cir Dig ABCD=Braz Arch Dig Surg. 2015;28:44–7.

    Article  Google Scholar 

  37. 37.

    Luger M, Kruschitz R, Vitamin D3 loading is superior to conventional supplementation after weight loss surgery in vitamin D-deficient morbidly obese patients: a double-blind randomized placebo-controlled trial. Obes Surg. 2016;27:1196–207.

    Article  Google Scholar 

  38. 38.

    Gasteyger C, Suter M, Gaillard RC, Giusti V. Nutritional deficiencies after Roux-en-Y gastric bypass for morbid obesity often cannot be prevented by standard multivitamin supplementation. Am J Clin Nutr. 2008;87:1128–33.

    CAS  Article  Google Scholar 

  39. 39.

    Homan J, Schijns W, Aarts EO, van Laarhoven CJ, Janssen IM, Berends FJ. An optimized multivitamin supplement lowers the number of vitamin and mineral deficiencies three years after Roux-en-Y gastric bypass: a cohort study. Surg Obes Relat Dis J Am Soc Bariatr Surg. 2016;12:659–67.

    Article  Google Scholar 

  40. 40.

    Wolf E, Utech M, Stehle P, Busing M, Helfrich HP, Stoffel-Wagner B, et al. Oral high-dose vitamin D dissolved in oil raised serum 25-hydroxy-vitamin D to physiological levels in obese patients after sleeve gastrectomy—a double-blind, randomized, and placebo-controlled trial. Obes Surg. 2016;26:1821–9.

    Article  Google Scholar 

  41. 41.

    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: J Am Soc Bariatr Surg. 2009;5:444–9.

    Article  Google Scholar 

  42. 42.

    Aasheim ET, Johnson LK, Hofso D, Bohmer T, Hjelmesaeth J. Vitamin status after gastric bypass and lifestyle intervention: a comparative prospective study. Surg Obes Relat Dis: J Am Soc Bariatr Surg. 2012;8:169–75.

    Article  Google Scholar 

  43. 43.

    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;19:173–9.

    Article  Google Scholar 

  44. 44.

    Flores L, Moize V, Ortega E, Rodriguez L, Andreu A, Filella X, et al. Prospective study of individualized or high fixed doses of vitamin D supplementation after bariatric surgery. Obes Surg. 2015;25:470–6.

    Article  Google Scholar 

  45. 45.

    Boyce SG, Goriparthi R, Clark J, Cameron K, Roslin MS. Can composite nutritional supplement based on the current guidelines prevent vitamin and mineral deficiency after weight loss surgery? Obes Surg. 2016;26:966–71.

    Article  Google Scholar 

  46. 46.

    Capoccia D, Coccia F, Paradiso F, Abbatini F, Casella G, Basso N, et al. Laparoscopic gastric sleeve and micronutrients supplementation: our experience. J Obes. 2012;2012:672162.

    CAS  Article  Google Scholar 

  47. 47.

    da Rosa CL, Dames Olivieri, Saubermann AP, Jacqueline J, Pereira SE, Saboya C, Ramalho A. Routine supplementation does not warrant the nutritional status of vitamin D adequate after gastric bypass Roux-en-Y. Nutr Hosp. 2013;28:169–72.

    PubMed  Google Scholar 

  48. 48.

    Mahlay NF, Verka LG, Thomsen K, Merugu S, Salomone M. Vitamin D status before Roux-en-Y and efficacy of prophylactic and therapeutic doses of vitamin D in patients after Roux-en-Y gastric bypass surgery. Obes Surg. 2009;19:590–4.

    Article  Google Scholar 

  49. 49.

    Lanzarini E, Nogues X, Goday A, Benaiges D, de Ramon M, Villatoro M, et al. High-dose vitamin D supplementation is necessary after bariatric surgery: a prospective 2-year follow-up study. Obes Surg. 2015;25:1633–8.

    Article  Google Scholar 

  50. 50.

    Chakhtoura MT, Nakhoul NN, Shawwa K, Mantzoros C, El Hajj Fuleihan GA. Hypovitaminosis D in bariatric surgery: a systematic review of observational studies. Metab Clin Exp. 2016;65:574–85.

    CAS  Article  Google Scholar 

  51. 51.

    Dix CF, Bauer JD, Wright OR. A systematic review: vitamin D status and sleeve gastrectomy. Obes Surg. 2017;27:215–25.

    Article  Google Scholar 

  52. 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 J Am Soc Bariatr Surg. 2016;12:693–702.

    Article  Google Scholar 

  53. 53.

    Holick MF. Vitamin D deficiency. New Engl J Med. 2007;357:266–81.

    CAS  Article  Google Scholar 

  54. 54.

    Ioannidis JP, Patsopoulos NA, Evangelou E. Uncertainty in heterogeneity estimates in meta-analyses. BMJ. 2007;335:914–6.

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Wei Fu.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Li, Z., Zhou, X. & Fu, W. Vitamin D supplementation for the prevention of vitamin D deficiency after bariatric surgery: a systematic review and meta-analysis. Eur J Clin Nutr 72, 1061–1070 (2018). https://doi.org/10.1038/s41430-017-0059-9

Download citation

Further reading

Search

Quick links