Raw data for BASUN.

IntroductionPersons living with obesity treated with bariatric surgery are at a high risk of developing nutritional deficiencies. The primary aim of this observational cohort study was to compare vitamin D levels in patients two years after bariatric surgery (Roux-en-Y gastric bypass/RYGB and sleeve gastrectomy/SG) with a very low-energy diet (VLED). The same subjects were also compared with a population sample from the same region at baseline. The primary hypothesis was that surgery, especially RYGB, would lead to an increased prevalence of vitamin D deficiency compared to subjects treated with VLED. 971 individuals eligible for surgical, RYGB (n = 388), SG (n = 201), and medical treatment (n = 382), in routine care, were included consecutively between 2015 and 2017. A random population sample from the WHO-MONICA project was used as a reference, (n = 414). S-calcium, S-25(OH)D (vitamin D), and S-PTH (parathyroid hormone) were measured in all persons with obesity at baseline and two years after treatment (n = 713). Self-reported use of vitamin D and calcium supplementation was registered.ResultsVitamin D deficiency (S-25(OH)D 0.1). S-25(OH)D increased for all treatment groups but was higher in RYGB and SG (SMD>0.1, standardized mean difference). Thirteen subjects (1.8%) had vitamin D deficiency after obesity treatment.ConclusionSurgical intervention for obesity followed by vitamin D supplementation was not associated with a higher risk for vitamin D deficiency, irrespective of surgery type, compared to individuals on medical treatment. However, persons living with obesity seeking weight loss treatment are more likely to have deficient vitamin D levels compared to the general population.

研究背景
接受减重代谢手术（bariatric surgery）的肥胖人群，罹患营养缺乏症的风险显著升高。本项观察性队列研究的首要目标为：对比接受减重代谢手术（Roux-en-Y胃旁路术（Roux-en-Y gastric bypass，简称RYGB）与袖状胃切除术（sleeve gastrectomy，简称SG））治疗满2年的患者，与接受极低能量饮食（very low-energy diet，简称VLED）治疗患者的血清维生素D水平；同时将上述受试者与同地区基线人群样本进行对照。本研究的核心假设为：相较于接受极低能量饮食治疗的受试者，手术治疗（尤其是RYGB术）会导致维生素D缺乏的患病率上升。2015年至2017年间，本研究连续纳入971名符合常规诊疗指征的肥胖受试者，其中接受RYGB术者388例、SG术者201例，接受内科治疗者382例。本研究以世界卫生组织莫尼卡项目（WHO-MONICA）的随机人群样本作为对照队列，共纳入414例受试者。所有肥胖受试者在基线及治疗后2年时均接受了血清钙（S-calcium）、血清25-羟维生素D[S-25(OH)D，即维生素D（vitamin D）]以及血清甲状旁腺激素（S-PTH，parathyroid hormone）检测，最终有效纳入713例。研究同时记录了受试者自我报告的维生素D与钙剂补充剂服用情况。

研究结果
维生素D缺乏判定标准为S-25(OH)D 0.1。所有治疗组的S-25(OH)D水平均有所提升，但RYGB组与SG组的升高幅度更为显著（标准化均数差（standardized mean difference，简称SMD）>0.1）。共13名受试者（占比1.8%）在肥胖治疗后出现维生素D缺乏。

研究结论
与接受内科治疗的受试者相比，无论手术类型如何，肥胖手术治疗联合维生素D补充均未增加维生素D缺乏的风险。然而，相较于普通人群，寻求减重治疗的肥胖人群出现维生素D水平缺乏的概率更高。