Severe obesity is related to low vitamin D around the world

Created August 2023

A systematic review and meta-analysis of vitamin D status of patients with severe obesity in various regions worldwide

Obes Facts , DOI: 10.1159/000533828 August 28, 2023

Neda Haghighat1, Zahra Sohrabi2, Reza Bagheri3, Marzieh Akbarzadeh2, Zahra Esmaeilnezhad2, Damoon Ashtary- Larky1, Reza Barati-Boldaji2, Morteza Zare2, Masoud Amini1, Seyed Vahid Hosseini4, Alexei Wong5, Hamidreza Foroutan1 forotanh@sums.ac.ir

1 Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

2 Department of Community Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran

3 Department of Exercise Physiology, University of Isfahan, Isfahan, Iran.

4 Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

5 Department of Health and Human Performance, Marymount University, Arlington, VA, United States.

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Introduction: Managing nutritional deficiencies is an essential component in the treatment of severe obesity. Vitamin D deficiency is often reported in investigations in severe obese cohorts. However, no prior study has summarized findings on this topic. Consequently, the aim of this systematic review and meta-analysis was to investigate the 25- hydroxyvitamin D [25(OH)D] status in individuals with severe obesity in different regions worldwide. We also evaluated levels of calcium, PTH, and magnesium as secondary outcome measures.

Methods: We searched Medline, PubMed, Scopus, the Cochrane Library, and EMBASE for relevant observational studies published in English from 2009 to October 2021. The heterogeneity index among the studies was determined using the Cochran (Q) and I2 tests. Based on the heterogeneity results, the random-effect model was applied to estimate the prevalence of vitamin D deficiency.

Results: We identified 109 eligible observational studies. Overall,

  • 59.44% of patients had vitamin D deficiency [25(OH)D <20 ng/ml], whereas

  • 26.95% had vitamin D insufficiency [25(OH)D 20-30 ng/ml].

Moreover, the mean 25(OH)D levels was 18.65 ng/ml in 96 studies. The pooled mean estimate of the serum calcium, PTH and magnesium was

  • Calcium: 9.26 mg/dl (95% CI: 9.19-9.32, I2=99.7%, p<0.001)

  • PTH: 59.24 pg/ml (95% CI: 54.98, 63.51), I2= 99.7%, p < 0.001), and

  • magnesium: 0.91 mg/dl (0.84, 0.98, I2= 100.0%, p < 0.001), respectively.

The results of the sub-group analysis indicated that the mean estimates of 25(OH)D was highest in North America [21.71 ng/ml (19.69, 23.74), (I2=97.2%, p<0.001)] and lowest in Southeast Asia [14.93 ng/ml (14.54, 15.33), (I2=0.0%, p = 0.778)].

Conclusion: The results obtained showed a significant prevalence of vitamin D deficiency among severely obese individuals in various geographical regions, whereas the highest and lowest mean estimates were reported for North America and Southeast Asia, respectively.

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