Abstract
Vitamin D deficiency is common after Roux-en-Y gastric bypass surgery, as malabsorptive component of the procedure affects its absorption, and dietary intake is inadequate due to restricted postoperative diet. Obesity itself is associated with low 25-hydroxy vitamin D levels due to larger volume of distribution with increased body fat mass, and studies have confirmed the presence of fat-soluble vitamin D in human adipose tissue. Massive weight loss after gastric bypass surgery is associated with an increase in serum 25-hydroxy vitamin D levels; however, the effect is small, and thus supplementation remains the mainstay of treatment and prevention of vitamin D deficiency in this population. Higher doses of vitamin D are often required, as most patients remain obese after bariatric surgery, and its absorption is reduced. Guidelines recommended supplementing bariatric patients with at least 3,000 IU per day of vitamin D, while doses as high as 50,000 IU 1–3 times weekly may be required in some patients.
Similar content being viewed by others
References
Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA. 2012;307(5):491–7.
Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet. 2011;377(9765):557–67.
Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation. 2014;129(25 Suppl 2):S102–38.
Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg. 2013;23(4):427–36.
Institute of Medicine. Dietary reference intakes for calcium and vitamin D. Dietary reference intakes for calcium and vitamin D. Washington, DC: The National Academies Press; 2011.
Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(7):1911–30.
Pramyothin P, Holick MF. Vitamin D supplementation: guidelines and evidence for subclinical deficiency. Curr Opin Gastroenterol. 2012;28(2):139–50.
Sanchez-Hernandez J, Ybarra J, Gich I, De Leiva A, Rius X, Rodriguez-Espinosa J, et al. Effects of bariatric surgery on vitamin D status and secondary hyperparathyroidism: a prospective study. Obes Surg. 2005;15(10):1389–95.
Johnson JM, Maher JW, DeMaria EJ, Downs RW, Wolfe LG, Kellum JM. The long-term effects of gastric bypass on vitamin D metabolism. Ann Surg. 2006;243(5):701–4; discussion 4–5.
Collazo-Clavell ML, Jimenez A, Hodgson SF, Sarr MG. Osteomalacia after Roux-en-Y gastric bypass. Endocr Pract. 2004;10(3):195–8.
Stein EM, Carrelli A, Young P, Bucovsky M, Zhang C, Schrope B, et al. Bariatric surgery results in cortical bone loss. J Clin Endocrinol Metab. 2013;98(2):541–9.
Nakamura KM, Haglind EG, Clowes JA, Achenbach SJ, Atkinson EJ, Melton LJ 3rd, et al. Fracture risk following bariatric surgery: a population-based study. Osteoporos Int. 2014;25(1):151–8.
Rosen CJ, Adams JS, Bikle DD, Black DM, Demay MB, Manson JE, et al. The nonskeletal effects of vitamin D: an Endocrine Society scientific statement. Endocr Rev. 2012;33(3):456–92.
Wang TJ, Pencina MJ, Booth SL, Jacques PF, Ingelsson E, Lanier K, et al. Vitamin D deficiency and risk of cardiovascular disease. Circulation. 2008;117(4):503–11.
Pittas AG, Lau J, Hu FB, Dawson-Hughes B. The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis. J Clin Endocrinol Metab. 2007;92(6):2017–29.
Macdonald HM. Contributions of sunlight and diet to vitamin D status. Calcif Tissue Int. 2013;92(2):163–76.
Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357(3):266–81.
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. Endocr Pract. 2013;19(2):337–72.
Shah M, Simha V, Garg A. Review: long-term impact of bariatric surgery on body weight, comorbidities, and nutritional status. J Clin Endocrinol Metab. 2006;91(11):4223–31.
Aarts E, van Groningen L, Horst R, Telting D, van Sorge A, Janssen I, et al. Vitamin D absorption: consequences of gastric bypass surgery. Eur J Endocrinol. 2011;164(5):827–32.
Bell NH, Epstein S, Greene A, Shary J, Oexmann MJ, Shaw S. Evidence for alteration of the vitamin D-endocrine system in obese subjects. J Clin Invest. 1985;76(1):370–3.
Liel Y, Ulmer E, Shary J, Hollis BW, Bell NH. Low circulating vitamin D in obesity. Calcif Tissue Int. 1988;43(4):199–201.
Parikh SJ, Edelman M, Uwaifo GI, Freedman RJ, Semega-Janneh M, Reynolds J, et al. The relationship between obesity and serum 1,25-dihydroxy vitamin D concentrations in healthy adults. J Clin Endocrinol Metab. 2004;89(3):1196–9.
Snijder MB, van Dam RM, Visser M, Deeg DJ, Dekker JM, Bouter LM, et al. Adiposity in relation to vitamin D status and parathyroid hormone levels: a population-based study in older men and women. J Clin Endocrinol Metab. 2005;90(7):4119–23.
Lenders CM, Feldman HA, Von Scheven E, Merewood A, Sweeney C, Wilson DM, et al. Relation of body fat indexes to vitamin D status and deficiency among obese adolescents. Am J Clin Nutr. 2009;90(3):459–67.
Saneei P, Salehi-Abargouei A, Esmaillzadeh A. Serum 25-hydroxy vitamin D levels in relation to body mass index: a systematic review and meta-analysis. Obes Rev. 2013;14(5):393–404.
Vimaleswaran KS, Berry DJ, Lu C, Tikkanen E, Pilz S, Hiraki LT, et al. Causal relationship between obesity and vitamin D status: bi-directional Mendelian randomization analysis of multiple cohorts. PLoS Med. 2013;10(2):e1001383.
Blum M, Dallal GE, Dawson-Hughes B. Body size and serum 25 hydroxy vitamin D response to oral supplements in healthy older adults. J Am Coll Nutr. 2008;27(2):274–9.
Rajakumar K, Fernstrom JD, Holick MF, Janosky JE, Greenspan SL. Vitamin D status and response to vitamin D(3) in obese vs. non-obese African American children. Obesity (Silver Spring). 2008;16(1):90–5.
Lee P, Greenfield JR, Seibel MJ, Eisman JA, Center JR. Adequacy of vitamin D replacement in severe deficiency is dependent on body mass index. Am J Med. 2009;122(11):1056–60.
Drincic A, Fuller E, Heaney RP, Armas LA. 25-hydroxyvitamin D response to graded vitamin D3 supplementation among obese adults. J Clin Endocrinol Metab. 2013;98(12):4845–51.
Gallagher JC, Yalamanchili V, Smith LM. The effect of vitamin D supplementation on serum 25(OH)D in thin and obese women. J Steroid Biochem Mol Biol. 2013;136:195–200.
Mawer EB, Backhouse J, Holman CA, Lumb GA, Stanbury SW. The distribution and storage of vitamin D and its metabolites in human tissues. Clin Sci. 1972;43(3):413–31.
Rosenstreich SJ, Rich C, Volwiler W. Deposition in and release of vitamin D3 from body fat: evidence for a storage site in the rat. J Clin Invest. 1971;50(3):679–87.
Lawson DE, Douglas J, Lean M, Sedrani S. Estimation of vitamin D3 and 25-hydroxyvitamin D3 in muscle and adipose tissue of rats and man. Clin Chim Acta. 1986;157(2):175–81.
Avioli LV, Lee SW, McDonald JE, Lund J, DeLuca HF. Metabolism of vitamin D3-3H in human subjects: distribution in blood, bile, feces, and urine. J Clin Invest. 1967;46(6):983–92.
Blum M, Dolnikowski G, Seyoum E, Harris SS, Booth SL, Peterson J, et al. Vitamin D3 in fat tissue. Endocrine. 2008;33(1):90–4.
Heaney RP, Horst RL, Cullen DM, Armas LA. Vitamin D3 distribution and status in the body. J Am Coll Nutr. 2009;28(3):252–6.
Heaney RP, Recker RR, Grote J, Horst RL, Armas LAG. Vitamin D3 is more potent than vitamin D2 in humans. J Clin Endocrinol Metab. 2011;96(3):E447–52.
Tzotzas T, Papadopoulou FG, Tziomalos K, Karras S, Gastaris K, Perros P, et al. Rising serum 25-hydroxy-vitamin D levels after weight loss in obese women correlate with improvement in insulin resistance. J Clin Endocrinol Metab. 2010;95(9):4251–7.
Mason C, Xiao L, Imayama I, Duggan CR, Bain C, Foster-Schubert KE, et al. Effects of weight loss on serum vitamin D in postmenopausal women. Am J Clin Nutr. 2011;94(1):95–103.
Rock CL, Emond JA, Flatt SW, Heath DD, Karanja N, Pakiz B, et al. Weight loss is associated with increased serum 25-hydroxyvitamin D in overweight or obese women. Obesity (Silver Spring). 2012;20(11):2296–301.
Coupaye M, Breuil MC, Riviere P, Castel B, Bogard C, Dupre T, et al. Serum vitamin D increases with weight loss in obese subjects 6 months after Roux-en-Y gastric bypass. Obes Surg. 2013;23(4):486–93.
Lin E, Armstrong-Moore D, Liang Z, Sweeney JF, Torres WE, Ziegler TR, et al. Contribution of adipose tissue to plasma 25-hydroxyvitamin D concentrations during weight loss following gastric bypass surgery. Obesity (Silver Spring). 2011;19(3):588–94.
Pramyothin P, Biancuzzo RM, Lu Z, Hess DT, Apovian CM, Holick MF. Vitamin D in adipose tissue and serum 25-hydroxyvitamin D after Roux-en-Y gastric bypass. Obesity (Silver Spring). 2011;19(11):2228–34.
Beckman LM, Earthman CP, Thomas W, Compher CW, Muniz J, Horst RL, et al. Serum 25(OH) vitamin D concentration changes after Roux-en-Y gastric bypass surgery. Obesity (Silver Spring). 2013;21(12):E599–606.
Sjostrom L, Narbro K, Sjostrom CD, Karason K, Larsson B, Wedel H, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52.
Schauer PR, Kashyap SR, Wolski K, Brethauer SA, Kirwan JP, Pothier CE, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366(17):1567–76.
Mingrone G, Panunzi S, De Gaetano A, Guidone C, Iaconelli A, Leccesi L, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366(17):1577–85.
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(4):444–9.
Disclosures
Conflict of interest
Pornpoj Pramyothin and Michael F. Holick declare that they have no conflict of interest.
Animal/Human studies
This article does not contain any studies with human or animal subjects performed by the any of the authors.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pramyothin, P., Holick, M.F. Serum 25-Hydroxyvitamin D Levels After Bariatric Surgery. Clinic Rev Bone Miner Metab 12, 234–239 (2014). https://doi.org/10.1007/s12018-014-9172-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12018-014-9172-7