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Meta-Analysis
. 2023 Dec;24(6):1011-1029.
doi: 10.1007/s11154-023-09831-3. Epub 2023 Sep 4.

Vitamin D status and supplementation before and after Bariatric Surgery: Recommendations based on a systematic review and meta-analysis

Andrea Giustina  1 , Luigi di Filippo  2 , Antonio Facciorusso  3 , Robert A Adler  4 , Neil Binkley  5 , Jens Bollerslev  6 , Roger Bouillon  7 , Felipe F Casanueva  8 , Giulia Martina Cavestro  9 , Marlene Chakhtoura  10 , Caterina Conte  11 , Lorenzo M Donini  12 , Peter R Ebeling  13 , Angelo Fassio  14 , Stefano Frara  2 , Claudia Gagnon  15 , Giovanni Latella  16 , Claudio Marcocci  17 , Jeffrey I Mechanick  18 , Salvatore Minisola  19 , René Rizzoli  20 , Ferruccio Santini  21 , Joseph L Shaker  22 , Christopher Sempos  23 , Fabio Massimo Ulivieri  2 , Jyrki K Virtanen  24 , Nicola Napoli  25   26 , Anne L Schafer  27 , John P Bilezikian  28
Affiliations
Meta-Analysis

Vitamin D status and supplementation before and after Bariatric Surgery: Recommendations based on a systematic review and meta-analysis

Andrea Giustina et al. Rev Endocr Metab Disord. 2023 Dec.

Erratum in

Abstract

Bariatric surgery is associated with a postoperative reduction of 25(OH) vitamin D levels (25(OH)D) and with skeletal complications. Currently, guidelines for 25(OH)D assessment and vitamin D supplementation in bariatric patients, pre- and post-surgery, are still lacking. The aim of this work is to analyse systematically the published experience on 25(OH)D status and vitamin D supplementation, pre- and post-surgery, and to propose, on this basis, recommendations for management. Preoperatively, 18 studies including 2,869 patients were evaluated. Prevalence of vitamin D insufficiency as defined by 25(OH)D < 30 ng/mL (75 nmol/L) was 85%, whereas when defined by 25(OH)D < 20 ng/mL (50 nmol/L) was 57%. The median preoperative 25(OH)D level was 19.75 ng/mL. After surgery, 39 studies including 5,296 patients were analysed and among those undergoing either malabsorptive or restrictive procedures, a lower rate of vitamin D insufficiency and higher 25(OH)D levels postoperatively were observed in patients treated with high-dose oral vitamin D supplementation, defined as ≥ 2,000 IU/daily (mostly D3-formulation), compared with low-doses (< 2,000 IU/daily). Our recommendations based on this systematic review and meta-analysis should help clinical practice in the assessment and management of vitamin D status before and after bariatric surgery. Assessment of vitamin D should be performed pre- and postoperatively in all patients undergoing bariatric surgery. Regardless of the type of procedure, high-dose supplementation is recommended in patients after bariatric surgery.

Keywords: Bariatric surgery; Obesity; Vitamin D assay; Vitamin D insufficiency; Vitamin D supplementation.

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Conflict of interest statement

L.D.F.; A.F.; R.A.; N.B; R.B.; F.F.C.; G.M.C.; M.C.; C.C.; L.M.D.; C.G.; G.L.; J.L.S.; C.S.; N.N.; J.K.V: no conflict of interest to declare.

Figures

Fig. 1
Fig. 1
Flow diagram of studies included and excluded in the analyses. A Topic 1 “Assessment of vitamin D status pre- and post-bariatric surgery”. B Topic 2 “Supplementation with vitamin D post-bariatric surgery”
Fig. 2
Fig. 2
Pooled analysis of preoperative prevalence of vitamin D insufficiency, as defined by 25(OH)D < 30 ng/mL (A) and by < 20 ng/mL (B), in patients who underwent bariatric surgery
Fig. 3
Fig. 3
Forest plots comparing restrictive vs malabsorptive surgery in postoperative prevalence of vitamin D insufficiency, as defined by 25(OH)D < 30 ng/mL (A-C) and by < 20 ng/mL (D). Panel A analyses at 6-month; panel B analyses at 12-month; panel C analyses at 24-month; panel D analyses at 12-month
Fig. 4
Fig. 4
Pooled analysis of postoperative prevalence of vitamin D insufficiency, as defined by 25(OH)D < 30 ng/mL (A, B) and by < 20 ng/mL (C, D), in patients at 6–24 months after malabsorptive bariatric surgery treated with high- (A, C) and low-dose (B, D) of vitamin D supplementation
Fig. 5
Fig. 5
Pooled analysis of postoperative 25(OH)D levels (ng/mL) at < 6 months (A, B) and 6–24 months (C, D) after malabsorptive bariatric surgery in patients treated with high- (A, C) and low-dose (B, D) of vitamin D supplementation
Fig. 6
Fig. 6
Pooled analysis of postoperative prevalence of vitamin D insufficiency, as defined by 25(OH)D < 30 ng/mL (A, B) and by < 20 ng/mL (C, D), in patients at 6–24 months after restrictive bariatric surgery treated with high- (A, C) and low-dose (B, D) of vitamin D supplementation
Fig. 7
Fig. 7
Pooled analysis of postoperative 25(OH)D levels (ng/mL) in patients < 6 months (A, B) and 6–24 months (C, D) after restrictive bariatric surgery treated with high- (A, C) and low-dose (B, D) of vitamin D supplementation
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References

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