Vitamin D Status Before and After Bariatric Surgery in Obese Hispanics and African-Americans

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 660-676-Clinical Obesity Treatment
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-675
Tirissa J Reid*1, Saqib Saeed2, Amrita Persaud2, Shiranda McCoy2, Ruchi Bhutani-Kapoor2, Monqidh Al-Sawwaf2 and Leaque Ahmed1
1Columbia University at Harlem Hospital, New York, NY, 2Harlem Hospital, New York, NY
Background: Increased rates of Vitamin D (Vit D) deficiency have been documented in Hispanics and African-Americans (AA) compared with non-Hispanic Caucasians (1,2) and in the morbidly obese compared to normal weight patients (3,4).  Our goal was to evaluate Vit D status in a group of white Hispanic and AA patients who are morbidly obese and changes in Vit D after bariatric surgery.

Design and Methods: A retrospective study of Vit D status in a predominately Hispanic and AA morbidly obese population undergoing bariatric surgery from 2007-2011 at a New York City hospital.  Serum levels of calcium, 25(OH)Vit D, parathyroid hormone and creatinine were obtained pre-op and at 1 and 2 years post-op.  Inclusion criteria: patients with all serum values pre-op and at 1 or 2 yrs post-op.  Exclusion criteria: patients with a diagnosis of 1° or 3° hyperparathyroidism or CKD stage 3 or greater.  Primary outcomes:  % of patients with Vit D deficiency, 25(OH)D under 20 ng/mL, or insufficiency, 25(OH)D of 21-29 ng/mL, at pre-specified time points.  Data are expressed as mean ± SE.

Results:  257 patients met inclusion criteria.  Mean age at surgery was 41.8 ± 0.7 yrs (range 18.3 - 69.8 yrs); 91.9% females; 81.5% white Hispanics and 15.6% AA.  Roux-en-Y gastric bypass (RYGB) was performed in 71.5%, sleeve gastrectomy (SG) in 25% and laparoscopic adjustable gastric banding (LAGB) in 3.5%.  The mean Vit D level of the group was 21.6 ± 0.8 ng/mL pre-op, 28.9 ± 0.8 ng/mL at 1 year post-op and 28.0 ± 1.0 ng/mL at 2 years post-op.  There was no difference in Vit D levels between white Hispanics and AA’s at baseline, 21.7 ± 0.9 vs 21.1 ± 2.1 ng/mL (p=0.79) or at 1 or 2 years post-op.  RYGB patients had 50% Vit D deficiency and 28% Vit D insufficiency pre-op; 17% Vit D deficiency and 45% Vit D insufficiency at 1 year post-op; 21% Vit D deficiency and 42% Vit D insufficiency at 2 years post-op.  Sleeve gastrectomy patients had 61% Vit D deficiency and 30% Vit D insufficiency pre-op; 8% Vit D deficiency and 41% Vit D insufficiency at 1 year post-op; 10% Vit D deficiency and 70% Vit D insufficiency at 2 years post-op.  LAGB patients had 33% Vit D deficiency and 44% Vit D insufficiency pre-op; 33% Vit D deficiency and 33% Vit D insufficiency at 1 year post-op, 0% Vit D deficiency and 100% Vit D insufficiency at 2 years post-op.

Conclusion:  Pre-op mean Vit D levels in this group of morbidly obese Hispanic and AA patients were higher than levels noted in NHANES for patients of similar race/ethnicity (19.5 ng/ml in Mexican-Americans and 14.8 ng/ml in AAs) (1) likely due to routine monitoring and repletion of vitamin D in bariatric patients prior to surgery.  Rates of Vit D deficiency were decreased in all groups at 2 years compared with pre-op rates.  At 2 years post-op, RYGB patients had the highest rates of Vit D deficiency and 66% of patients were not Vit D replete.  This study is limited by its retrospective nature.  Further research is needed to determine optimal repletion guidelines for bariatric patients.

(1) Gutierrez O et al., Osteoporos Int 2011; 22: 1745-1753. (2) Engelman C et al., JCEM 2008; 93(9): 3381-3388. (3) Wortsman J et al., Am J Clin Nutr 2000; 72: 690-3. (4) Lagunova Z et al., Anticancer Research 2009; 29: 3713-3720.

Nothing to Disclose: TJR, SS, AP, SM, RB, MA, LA

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