Severe Obesity and Vitamin D Deficiency Treatment Options before the Bariatric Surgery: A Randomized Clinical Trial
Surgery for Obesity and Related Diseases https://doi.org/10.1016/j.soard.2019.05.033
Masoud Sayadi Shahraki M.D.Noushin KhaliliM.D Shadi Yousefvand M.D Erfan Sheikhbahaei Shahab Shahabi Shahmiri M.D. MPH.
Comment: Oral Vitamin D is known to be far lower cost and act more quickly than injection
- 1) Vitamin D deficiency is a pandemic issue and has a lot of impacts on our health.
- 2) People with morbid obesity are more susceptible to be Vitamin D deficient.
- 3) Bariatric surgeries can worsen vitamin D deficiency postoperatively.
- 4) There are a lot of study about the prevalence of vitamin D deficiency in people with obesity and the treatment options postoperatively.
- 5) This research is registered RCT on 100 patients, which was presented orally in 23rd IFSO congress in Dubai 2018.
- 6) 6-week-oral treatment with 50000 IU Vitamin D3 capsule had the higher impacts on serum 25(OH) Vitamin D.
- 7) We recommend non-injection method for people with morbid obesity.
- 8) We recommend bariatric surgeons to check 25(OH) Vitamin D before the surgery and treat this condition preoperatively while the patient is on the waiting list for the surgery.
Obesity is an epidemic issue worldwide which has various complications and comorbidities. Vitamin D deficiency (VDD) is a well-known metabolic disorder among patients with severe obesity. While they are good candidates for bariatric surgery, this deficiency can affect the outcomes of surgery negatively.
Objectives: The aim of this study was to compare three different VDD treatment strategies, before the bariatric surgery and comparing serum Vitamin D levels after 7 weeks.
Settings: University Hospital, Isfahan, Iran
This was a single-blinded randomized clinical-trial on 100 patients who referred for bariatric surgery from 2016 to 2018. Vitamin D (VitD) level was checked before the surgery with the patients included in the study if their VitD level was <30 ng/ml. We rechecked their serum VitD in the 8th week after seven weeks of treatment. The participants were randomly allocated into three groups:
- 33 patients were treated with 50,000 units VitD3 capsule every week for seven weeks;
- 33 patients were treated with a single dose of 300,000 units VitD3 ampoule; and
- 34 patients were treated with a combination of a half of the injection dose followed by oral capsule for four weeks.
No case was lost during the follow-up time. No significant differences were found between the three groups in terms of their age (P=0.654), body mass index (P=0.434), gender (P=0.799), initial 25 (OH) VitD level (P=0.273), and history of supplement use (P=0.45). Mean serum VitD levels were 15.21, 13.16, and 13.37 ng/ml before the surgery and reached
- 24.74, and
- 29.49 ng/ml
after seven weeks of treatment in oral, injection, and combined groups respectively.
Finally, 7-week oral treatment option had significantly higher levels of VitD (P-value=0.034).
VDD treatment with 50,000 units VitD3 capsule every week for seven weeks before the bariatric surgery yields a higher level of VitD. Based on our findings, injecting products is not recommended for VDD treatment.