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Meta-Analysis
. 2024 Oct 1;10(10):CD011800.
doi: 10.1002/14651858.CD011800.pub2.

Oral vitamin D supplementation for adults with obesity undergoing bariatric surgery

Marlene T Chakhtoura  1   2 , Nancy F Nakhoul  2   3 , Elie A Akl  4   5 , Bassem Y Safadi  6   7 , Christos S Mantzoros  8   9 , Maria-Inti Metzendorf  10 , Ghada El-Hajj Fuleihan  1   11
Affiliations
Meta-Analysis

Oral vitamin D supplementation for adults with obesity undergoing bariatric surgery

Marlene T Chakhtoura et al. Cochrane Database Syst Rev. .

Abstract

Background: Vitamin D deficiency following bariatric surgery is common and is expected to be associated with a deleterious impact on the skeleton. However, the benefits of vitamin D supplementation and the optimal dose in this population is currently unknown. The available guidelines on the topic are derived from experts' opinions, and are not evidence based.

Objectives: To compare the effects of different doses of vitamin D supplementation (low dose (less than 600 international units (IU)/day), moderate dose (600 IU/day to 3500 IU/day), high dose (greater than 3500 IU/day)) to each other or to placebo in adults living with obesity undergoing bariatric surgery.

Search methods: We searched CENTRAL, MEDLINE, Embase, LILACS, two trial registries, and the reference lists of systematic reviews, articles, and health technology assessment reports without language restrictions. The last search of all databases was 27 June 2023, except Embase, which we searched on 14 August 2015.

Selection criteria: We included randomised controlled trials or controlled clinical trials on vitamin D supplementation comparing different doses or comparing vitamin D to placebo in people undergoing bariatric surgery.

Data collection and analysis: We used standard Cochrane methods. Primary outcomes were fractures and adverse events. Secondary outcomes were vitamin D status, all-cause mortality, bone mineral change, secondary hyperparathyroidism, health-related quality of life, and muscle strength. We used GRADE to assess the certainty of the evidence for each outcome in each comparison.

Main results: We identified five trials with 314 participants. We included three trials in the quantitative analysis. Moderate-dose vitamin D compared to placebo One trial compared moderate-dose vitamin D (3200 IU/day) to placebo. Moderate-dose vitamin D, compared to placebo, may improve vitamin D status and may result in little to no difference in the achieved parathyroid hormone level (achieved 25-hydroxyvitamin D level: mean difference (MD) 13.60 ng/mL, 95% confidence interval (CI) 7.94 to 19.26; achieved parathyroid hormone level: -6.60 pg/mL, 95% CI -17.12 to 3.92; 1 study, 79 participants; low-certainty evidence). The trial reported no adverse events in the moderate-dose vitamin D arm, but did not provide any information on adverse events in the placebo arm. There were no data on fractures, all-cause mortality, bone density change, health-related quality of life, and muscle strength. High-dose vitamin D compared to moderate-dose vitamin D Two trials in Roux-en-Y gastric bypass compared moderate-dose (equivalent dose 800 IU/day to 2000 IU/day) to high-dose (equivalent dose 5000 IU/day to 7943 IU/day) vitamin D. The evidence of high-dose vitamin D on adverse events is very uncertain (risk ratio (RR) 5.18, 95% CI 0.23 to 116.56; 2 studies, 81 participants; very low-certainty evidence). High-dose vitamin D may increase 25-hydroxyvitamin D levels compared to a moderate dose at 12 months, but the evidence is very uncertain (MD 15.55 ng/mL, 95% CI 3.50 to 27.61; I2 = 62%; 2 studies, 73 participants; very low-certainty evidence). High-dose vitamin D may have little to no effect on parathyroid hormone levels compared to a moderate dose at 12 months, but the evidence is very uncertain (MD 2.15 pg/mL, 95% CI -21.31 to 17.01; I2 = 0%; 2 studies, 72 participants; very low-certainty evidence). High-dose vitamin D may have little to no effect on mortality and bone mineral density at the lumbar spine, hip, and forearm, but the evidence is very uncertain. There were no data on fractures, health-related quality of life, or muscle strength.

Authors' conclusions: No trials reported on fractures and the evidence available on adverse events is scarce. Moderate-dose vitamin D may improve vitamin D status and may result in little to no improvement in parathyroid hormone levels compared with placebo. High-dose vitamin D supplementation (greater than 3500 IU/day) may increase 25-hydroxyvitamin D levels, and may have little to no effect on parathyroid hormone levels, compared to a moderate dose, but the evidence for both is very uncertain. The currently available limited evidence may not have a significant impact on practice. Further studies are needed to explore the impact of vitamin D supplementation on fractures, adverse events, and musculoskeletal parameters in people undergoing bariatric surgery.

Trial registration: ClinicalTrials.gov NCT01891591 NCT02092376 NCT01385098 NCT01330914.

PubMed Disclaimer

Conflict of interest statement

MC: none.

NFN: none.

EA: none.

BS: is a member of the board of Surgical Innovations, Leeds, UK (laparoscopic surgery manufacturing company, international advisory board) and consultant of Covidien Johnson and Johnson (organising workshops and giving lectures on laparoscopic surgery). The relationship with the stated companies has no competing interest with this review.

CM: none.

MIM: none. MIM is part of the editorial team of the Cochrane Metabolic and Endocrine Disorders Group, but was not involved in the editorial process of this manuscript.

GEF: has received funding as a primary investigator from the American University of Beirut to conduct an investigator‐initiated vitamin D trial in pregnancy. She is also a co‐primary investigator on an investigator‐initiated protocol to investigate vitamin D supplementation in people after bariatric surgery.

Note from the Cochrane Metabolic and Endocrine Disorders Group: the editorial office planned to extract and critically appraise all data for all ongoing and finished trials in which one of the review authors participated.

Figures

1
1
a. Laparoscopic banding
b. Gastric sleeve
c. Roux‐en‐Y gastric bypass Reprinted with permission, Cleveland Clinic Center for Medical Art & Photography © 2005‐2015. All Rights Reserved.
2
2
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included trials (blank cells indicate that the particular outcome was not measured in some trials).
4
4
Risk of bias summary: review authors' judgements about each risk of bias item for each included trial (blank cells indicate that the particular outcome was not measured in some trials)
1.1
1.1. Analysis
Comparison 1: Moderate‐dose vitamin D versus placebo, Outcome 1: Vitamin D status (achieved 25‐hydroxyvitamin D level)
1.2
1.2. Analysis
Comparison 1: Moderate‐dose vitamin D versus placebo, Outcome 2: Secondary hyperparathyroidism (achieved parathyroid hormone level)
2.1
2.1. Analysis
Comparison 2: High‐dose vitamin D + calcium versus moderate‐dose vitamin D + calcium, Outcome 1: Adverse events
2.2
2.2. Analysis
Comparison 2: High‐dose vitamin D + calcium versus moderate‐dose vitamin D + calcium, Outcome 2: Vitamin D status (change in 25OHD level from baseline)
2.3
2.3. Analysis
Comparison 2: High‐dose vitamin D + calcium versus moderate‐dose vitamin D + calcium, Outcome 3: All‐cause mortality
2.4
2.4. Analysis
Comparison 2: High‐dose vitamin D + calcium versus moderate‐dose vitamin D + calcium, Outcome 4: Bone mineral density change – lumbar spine
2.5
2.5. Analysis
Comparison 2: High‐dose vitamin D + calcium versus moderate‐dose vitamin D + calcium, Outcome 5: Bone mineral density change – hip
2.6
2.6. Analysis
Comparison 2: High‐dose vitamin D + calcium versus moderate‐dose vitamin D + calcium, Outcome 6: Bone mineral density change – forearm
2.7
2.7. Analysis
Comparison 2: High‐dose vitamin D + calcium versus moderate‐dose vitamin D + calcium, Outcome 7: Secondary hyperparathyroidism (change in parathyroid hormone level from baseline)
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Carlin 2009 {published data only}
    1. Carlin A, Rao S, Yager K, Parikh N, Kapke A. Treatment of vitamin D depletion after Roux-en-Y gastric bypass: a randomized prospective clinical trial. Surgery for Obesity and Related Diseases 2009;5:444-9. - PubMed
Cordeiro 2022 {published data only}
    1. Cordeiro A, Pereira SE, Saboya CJ, Ramalho A. Vitamin D supplementation and its relationship with loss of visceral adiposity. Obesity Surgery 2022;32(10):3419-25. [DOI: 10.1007/s11695-022-06239-x] - DOI - PubMed
Galyean 2022 {published data only}
    1. Galyean S, Syn D, Subih H, Boylan M. Improving vitamin D status in bariatric surgery subjects with monthly high-dose ergocalciferol. A randomized clinical trial. International Journal of Vitamin and Nutrition Research 2022;92(2):109-17. - PubMed
Goldner 2009 {published data only}
    1. Goldner WS, Stoner JA, Lyden E, Thompson J, Taylor K, Larson L, et al. Finding the optimal dose of vitamin D following Roux-en-Y gastric bypass: a prospective, randomised pilot clinical trial. Obesity Surgery 2009;19(2):173-9. - PubMed
Wolf 2016 {published data only}
    1. Wolf E, Utech M, Stehle P, Büsing M, Helfrich HP, Stoffel-Wagner B, et al. Oral high-dose vitamin D dissolved in oil raised serum 25-hydroxy-vitamin D to physiological levels in obese patients after sleeve gastrectomy – a double-blind, randomized, and placebo-controlled trial. Obesity Surgery 2016;26(8):1821-9. - PubMed

References to studies excluded from this review

Aarts 2017 {published data only}
    1. Aarts E, Schijns W, Cooiman M, Boerboom A, Ploeger N, Janssen I, et al. Vitamin and mineral deficiencies after sleeve gastrectomy: four year results of an RCT. Obesity Surgery 2017;27(1):284.
Aasheim 2010 {published data only}
    1. Aasheim ET, Johnson LK, Hofso D, Bohmer T, Hjelmesaeth J. Vitamin status after gastric bypass and lifestyle intervention: a comparative prospective study. Endocrine Abstracts 2010;21:99. - PubMed
ACTRN12615000579594 {published data only}
    1. ACTRN12615000579594. Development of a broader understanding of vitamin D levels in patients undergoing sleeve gastrectomy to inform guidelines for post-surgery supplementation [Effects of vitamin D supplementation on the vitamin D status of morbidly obese patients post gastric sleeve surgery]. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12615000579594 (first received 10 April 2015).
Alhava 1975 {published data only}
    1. Alhava E, Aukee S, Karjalainen P, Kettunen K, Juuti M. The influence of calcium and calcium + vitamin D2 treatment on bone mineral after partial gastrectomy. Scandinavian Journal of Gastroenterology 1975;10(7):689-93. - PubMed
Alhava 1977 {published data only}
    1. Alhava E, Aukee S, Juuti M, Karjalainen P, Kettunen K. The effect of vitamin D2 treatment on bone mineral after partial gastrectomy. Scandinavian Journal of Gastroenterology 1977;12(4):497-9. - PubMed
Ali 2023 {published data only}
    1. Ali RF, Ismail KA, Ismail TA, Ahmed Saleh AL, Aouf AM, Tolba ElKhopy MA. Effect of laparoscopic sleeve gastrectomy on vitamin D, parathormone hormone, and serum calcium levels. Journal of the Pakistan Medical Association 2023;73(Suppl 4):S174-8. [PMID: ] - PubMed
Allard 2007 {published data only}
    1. Allard J. Should nutritional status be routinely assessed and corrected before bariatric surgery? Nature Clinical Practice Gastroenterology & Hepatology 2007;4(3):130-1. - PubMed
Anonymous 1978 {published data only}
    1. Anonymous. Vitamin D and jejunoileal bypass. Lancet 1978;2(8083):264-5. - PubMed
Anonymous 1986 {published data only}
    1. Anonymous. Osteomalacia after gastrectomy. Lancet 1986;1(8472):77-8. - PubMed
Arvold 2009 {published data only}
    1. Arvold DS, Odean MJ, Dornfeld MP, Regal RR, Arvold JG, Karwoski GC, et al. Correlation of symptoms with vitamin D deficiency and symptom response to cholecalciferol treatment: a randomized controlled trial. Endocrine Practice 2009;15(3):203-12. - PubMed
Ben‐Porat 2021 {published data only}
    1. Ben-Porat T, Weiss R, Khalaileh A, Abu Gazala M, Kaluti D, Mintz Y, et al. The impact of preoperative vitamin administration on skeletal status following sleeve gastrectomy in young and middle-aged women: a randomized controlled trial. International Journal of Obesity 2021;45(9):1925-36. - PubMed
Borges 2018 {published data only}
    1. Borges J, M Miranda I, Sarquis M, Borba V, Maeda S, Lazaretti-Castro M, et al. Obesity, bariatric surgery, and vitamin D. Journal of Clinical Densitometry: Assessment & Management of Musculoskeletal Health 2018;21(2):157-62. - PubMed
Brody 2013 {published data only}
    1. Brody F, Flood M, Richards NG, Vaziri K, Garey C, LeBrun C. A novel single agent for nutritional supplementation following roux-en-Y gastric bypass. Journal of Laparoendoscopic Advances in Surgical Techniques 2013;23(7):596-600. - PubMed
Buhler 2021 {published data only}
    1. Buhler J, Rast S, Beglinger C, Peterli R, Peters T, Gebhart M, et al. Long-term effects of laparoscopic sleeve gastrectomy and roux-en-Y gastric bypass on body composition and bone mass density. Obesity Facts 2021;14(1):131-40. - PMC - PubMed
Carrasco 2014 {published data only}
    1. Carrasco F, Basfi-Fer K, Rojas P, Valencia A, Csendes A, Codoceo J, et al. Changes in bone mineral density after sleeve gastrectomy or gastric bypass: relationships with variations in vitamin D, ghrelin, and adiponectin levels. Obesity Surgery 2014;24(6):877-84. - PubMed
Clements 2010 {published data only}
    1. Clements RH, Saraf N, Kakade M, White M, J Hackett J. Body composition: early changes after weight loss induced by laparoscopic gastric bypass. Surgical Endoscopy 2010;24(S):S314-S701.
Compston 1980 {published data only}
    1. Compston JE, Horton LW, Laker MF, Merrett AL, Woodhead JS, Gazet JC, et al. Treatment of bone disease after jejunoileal bypass for obesity with oral 1 alpha-hydroxyvitamin D3. Gut 1980;21(8):669-74. - PMC - PubMed
Copaescu 2012 {published data only}
    1. Copaescu C, Turcu F. Serum calcium and parathyroid hormone levels after laparoscopic gastric sleeve resections. Obesity Surgery 2012;22:1144-205.
Dalcanale 2010 {published data only}
    1. Dalcanale L, Oliveira CP, Faintuch J, Nogueira MA, Rondó P, Lima VM, et al. Long-term nutritional outcome after gastric bypass. Obesity Surgery 2010;20(2):181-7. - PubMed
DiSilvestro 2019 {published data only}
    1. DiSilvestro R, Choban P, Aguila F, Miller M, Joseph E. A pilot, randomized study in women of nutrition-related clinical chemistry at 6 weeks after roux en y gastric bypass: comparison of two nutrition support plans. Obesity Surgery 2019;29:2781-9. - PubMed
Disse 2008 {published data only}
    1. Disse E, Simon C, Laville M. Monitoring before and after bariatric surgery. Medicine des Maladies Metaboliques 2008;2(5):473-8.
Dogan 2014 {published data only}
    1. Dogan K, Aarts E, Koehestanie P, Betzel B, Ploeger N, Boer H, et al. Optimization of vitamin supplementation after roux-en-Y gastric bypass surgery can lower postoperative deficiencies: a randomized controlled trial. Medicine 2014;93(25):1-9. - PMC - PubMed
Dralle 2017 {published data only}
    1. Dralle H. Secondary hyperparathyroidism after gastric bypass. Der Chirurg; Zeitschrift fur Alle Gebiete der Operativen Medizen 2017;88(6):537. - PubMed
Einarsdóttir 2010 {published data only}
    1. Einarsdóttir K, Preen DB, Clay TD, Kiely L, Holman CD, Cohen LD. Effect of a single 'megadose' intramuscular vitamin D (600,000 IU) injection on vitamin D concentrations and bone mineral density following biliopancreatic diversion surgery. Obesity Surgery 2010;20(6):732-7. - PubMed
EUCTR2011‐006163 {published data only}
    1. EUCTR2011-006163. Study to evaluate the pharmacokinetic of vitamin D in patients with obesity after bariatric surgery [Study to evaluate the pharmacokinetic of vitamin D (cholecalciferol) in patients with obesity after bariatric surgery in vitamin D deficiency and after normalization]. www.clinicaltrialsregister.eu/ctr-search/search?query=eudract_number:201... (first received 6 March 2012).
EUCTR2012‐002217‐19‐SE {published data only}
    1. EUCTR2012-002217-19-SE. Postoperative treatment with Vitamin D for patients with a history of Bariatric Surgery in C and U County. trialsearch.who.int/Trial2.aspx?TrialID=EUCTR2012-002217-19-SE (first received 27 September 2012).
EUCTR2019‐003907‐37‐IT {published data only}EUCTR
    1. EUCTR2019-003907-37-IT. The effects of vitamin D on bone, muscle and adipose tissue: a phase IV randomized double-blind study. trialsearch.who.int/Trial2.aspx?TrialID=EUCTR2019-003907-37-IT (first received 21 October 2020).
Flores 2015 {published data only}
    1. Flores L, Moizé V, Ortega E, Rodríguez L, Andreu A, Filella X, et al. Prospective study of individualized or high fixed doses of vitamin D supplementation after bariatric surgery. Obesity Surgery 2015;25(3):470-6. - PubMed
Furtado 2020 {published data only}
    1. Furtado M. Severe obesity and vitamin D deficiency treatment options before the bariatric surgery: a randomized clinical trial. Surgery for Obesity and Related Diseases 2020;16:e45-6. - PubMed
Gagner 2015 {published data only}
    1. Gagner M. Bariatric surgery: to bypass or switch? That is the question in obesity surgery. Nature Reviews Gastroenterology and Hepatology 2015;12(5):255-6. - PubMed
Galyean 2019 {published data only}
    1. Galyean S, Shankar P, Shah G. Effectiveness of monthly mega-dose of vitamin D supplementation in bariatric surgery patients. Journal of the Academy of Nutrition and Dietetics 2019;119(9):28.
Giusti 2016 {published data only}
    1. Giusti V, Theytaz F, Di Vetta V, Clarisse M, Suter M, Tappy L. Energy and macronutrient intake after gastric bypass for morbid obesity: a 3-y observational study focused on protein consumption. American Journal of Clinical Nutrition 2016;103(1):18-24. - PubMed
Goode 2004 {published data only}
    1. Goode L, Brolin R, Chowdhury H, Shapses S. Bone and gastric bypass surgery: effects of dietary calcium and vitamin D. Obesity Research 2004;12(1):40-7. - PubMed
Guthrie 2007 {published data only}
    1. Guthrie E. Bariatric surgery. US Pharmacist 2007;32(9):27-37.
Hedberg 2019 {published data only}
    1. Hedberg S, Olbersb T, Peltonenc M, Österberg J, Wirénb M, Ottossone J, et al, on behalf of the BEST study group. BEST: Bypass Equipoise Sleeve Trial; rationale and design of a randomized, registry-based, multicenter trial comparing Roux-en-Y gastric bypass with sleeve gastrectomy. Contemporary Clinical Trials 2019;84:105809. - PubMed
Heusschen 2020 {published data only}
    1. Heusschen L, Schijns W, Ploeger N, Deden L, Hazebroek E, Berends F, et al. The true story on deficiencies after sleeve gastrectomy: results of a double-blind RCT. Obesity Surgery 2020;30:1280-90. - PubMed
Heusschen 2022 {published data only}
    1. Heusschen L, Berendsen A, Deden L, Hazebroek E, Aarts E. Nutritional deficiencies 3 years after sleeve gastrectomy can be limited by a specialized multivitamin supplement. Obesity Surgery 2022;32(11):3561-70. - PMC - PubMed
Homan 2015 {published data only}
    1. Homan J, Schijns W, Aarts E, Betzel B, Ploeger N, Laarhoven K, et al. A double-blind prospective randomized controlled trial comparing multivitamin supplements after sleeve gastrectomy in morbidly obese patients: VITAAL study. Obesity Surgery 2015;25(Suppl 1):1-364.
Hultin 2018 {published data only}
    1. Hultin H, Stevens K, Sundbom M. Cholecalciferol injections are effective in hypovitaminosis D after duodenal switch: a randomized controlled study. Obesity Surgery 2018;28(10):3007-11. - PMC - PubMed
Ichikawa 2002 {published data only}
    1. Ichikawa C, Takiguchi N, Koda K, Oda K, Suzuki H, Miyazaki M. Early phase metabolic bone disorders after gastrectomy: influence of active vitamin D treatment. Digestive Diseases and Sciences 2002;47(8):1886-90. - PubMed
IRCT20180312039067N1 {published data only}
    1. IRCT20180312039067N1. A survey to compare the alteration of vitamin D deficiency in patients candidate for bariatric surgery with vitamin D deficiency in various methods oral, injection and mix of two methods in Azahra hospital in Esfahan. trialsearch.who.int/Trial2.aspx?TrialID=IRCT20180312039067N1 (first received 29 June 2018).
Karbaschian 2018 {published data only}
    1. Karbaschian Z, Mokhtari Z, Pazouki A, Kabir A, Hedayat M, Moghadam S, et al. Probiotic supplementation in morbid obese patients undergoing one anastomosis gastric bypass-mini gastric bypass (OAGB-MGB) surgery: a randomized, double-blind, placebo-controlled, clinical trial. Obesity Surgery 2018;28:2874-85. - PubMed
King 2017 {published data only}
    1. King R, Chandrajay S, Abbas A, Orme SM, Barth J. High-dose oral colecalciferol loading in obesity: impact of body mass index and its utility prior to bariatric surgery to treat vitamin D deficiency. Clinical Obesity 2017;7(2):92-7. - PubMed
Kocijan 2015 {published data only}
    1. Kocijan R, Haschka J, Marteer C, Nia A, Muschitz G, Resch H, et al. Strategies for the reduction of loss of bone and body lean mass after bariatric surgery. Journal of Bone and Mineral Research 2015;30:111.
Kruchitz 2018 {published data only}
    1. Kruschitz R, Luger M, Schindler K, Krebs M, Ludvik B. Effect of omega-loop gastric bypass surgery on CVD risk factors in vitamin D deficient morbidly obese patients within a double blind placebo-controlled trial. Obesity Facts 2018;11:255-6.
Levinson 2013 {published data only}
    1. Levinson R, Silverman JB, Catella JG, Rybak I, Jolin H, Isom K. Pharmacotherapy prevention and management of nutritional deficiencies post Roux-en-Y gastric bypass. Obesity Surgery 2013;23(7):992-1000. - PubMed
Lins 2014 {published data only}
    1. Lins RD, Arruda SL, Maia FK, De Oliveira YA, Silva JR, Rodrigues LV, et al. Evaluation of the effectiveness of the replacement of vitamin D in high doses in patients after Roux-en-Y. Obesity Surgery 2014;24(8):1276.
López Moreno 1991 {published data only}
    1. López Moreno JM, González G, Caracci M. Effect of gastrectomy in bone density evaluated by densitometry double photon. Revista Chilena de Cirugia 1991;43(4):368-71.
Luger 2015 {published data only}
    1. Luger M, Kruschitz R, Langer F, Prager G, Walker M, Marculescu R. Effects of omega-loop gastric bypass on vitamin D and bone metabolism in morbidly obese bariatric patients. Obesity Surgery 2015;25:1056–1062. - PubMed
Luger 2016 {published data only}
    1. Luger M, R Kruschitz R, Kienbacher C, Langer F, Schindler K, Prager G. Vitamin D loading dose supplementation after metabolic surgery and impact of biopsy-proven liver fibrosis and impaired renal function in morbidly obese patients. Obesity Facts 2016;9:172.
Luger 2017 {published data only}
    1. Luger M, Kruschitz R, Kienbacher C, Traussnigg S, Langer FB, Prager G, et al. Vitamin D3 loading is superior to conventional supplementation after weight loss surgery in vitamin D-deficient morbidly obese patients: a double-blind randomized placebo-controlled trial. Obesity Surgery 2017;27:1196-207. [DOI: 10.1007/s11695-016-2437-0] - DOI - PMC - PubMed
Luger 2018 {published data only}
    1. Luger M, Kruschitz R, Winzer E, Grabovac I, Schindler K, Krebs M, et al. Changes in bone mineral density due to omega-loop gastric bypass induced weight loss in patients with vitamin D supplementation over 12 months. Obesity Facts 2018;11:46-7. - PubMed
Moore 2011 {published data only}
    1. Moore S, King A, Kiernan M, Gardner C. Outcome expectations and realizations as predictors of weight regain among dieters. Eating Behavior 2011;12(1):60-3. - PMC - PubMed
Moore 2014 {published data only}
    1. Moore CE, Sherman V. Vitamin D supplementation efficacy: sleeve gastrectomy versus gastric bypass surgery. Obesity Surgery 2014;24(12):2055-60. - PubMed
Morgan 1965 {published data only}
    1. Morgan D, Paterson C, Woods C, Pulvertaft C, Fourman P. Search for osteomalacia in 1228 patients after gastrectomy and other operations on the stomach. Lancet 1965;2(7422):1085-8. - PubMed
Muschitz 2015a {published data only}
    1. Muschitz C, Kocijan R, Haschka J, Zendeli A, Pirker T, Geiger C, et al. The impact of vitamin D, calcium, protein supplementation, and physical exercise on bone metabolism after bariatric surgery: the BABS study. Journal of Bone and Mineral Research 2015;31(3):672-82. - PubMed
Muschitz 2015b {published data only}
    1. Muschitz C, Kocijan R, Haschka J, Resch H, Pietschmann P. Strategies for the reduction of loss of bone and body lean mass after bariatric surgery. Wiener Klinische Wochenschrift 2015;127:722-2.
Muschitz 2016 {published data only}
    1. Muschitz C, Kocijan R, Haschka J, Zendeli A, Pirker T, Geiger C, et al. The impact of vitamin D, calcium, protein supplementation, and physical exercise on bone metabolism after bariatric surgery: the BABS study. Osteoporosis International 2016;27(Supp 1):S79–S548. - PubMed
NCT01138475 {published data only}
    1. NCT01138475. Trial of paricalcitol and cholecalciferol (vitamin D3) in the treatment of secondary hyperparathyroidism in patients after Roux-en-Y gastric bypass surgery [A prospective, randomized, double-blind, double-dummy, placebo-controlled, parallel-group, pilot trial of paricalcitol and cholecalciferol (vitamin D3) in the treatment of secondary hyperparathyroidism in patients after Roux-en-Y gastric bypass surgery]. clinicaltrials.gov/show/NCT01138475 (first received 4 June 2010).
NCT01385098 {published data only}
    1. NCT01385098. Efficacy of vitamin D supplementation in bariatric surgery patients [Preoperative vitamin D status and efficacy of therapeutic vitamin D supplementation postoperatively in bariatric surgery patients]. clinicaltrials.gov/ct2/show/NCT01385098 (first received 28 June 2011).
NCT01637155 {published data only}
    1. NCT01637155. Study to evaluate the pharmacokinetics of vitamin D (cholecalciferol) in patients undergoing obesity surgery in a deficit situation and after standardization. clinicaltrials.gov/ct2/show/record/NCT01637155 (first received 10 July 2012).
NCT01891591 {published data only}
    1. NCT01891591. Assessment of nutritional status after gastric bypass surgery [Assessment of nutritional status and vitamin deficiencies in obese subjects after gastric bypass surgery]. clinicaltrials.gov/ct2/show/record/NCT01891591 (first received 17 June 2013).
NCT02212652 {published data only}
    1. NCT02212652. Vitamin D to improve nutrition prior to bariatric surgery and investigate the relationship with negative outcomes [The effect of VItamin D Supplementation on nutritional STatus and Adverse outcomes in bariatric surgery (VISTA)]. clinicaltrials.gov/ct2/show/record/NCT02212652 (first received 6 August 2014).
NCT02483026 {published data only}
    1. NCT02483026. Nutritional deficiencies preventive treatment prior to laparoscopic sleeve gastrectomy [Nutritional deficiencies preventive treatment prior to laparoscopic sleeve gastrectomy: controlled clinical study]. clinicaltrials.gov/show/NCT02483026 (first received 18 April 2015).
NCT02686905 {published data only}
    1. NCT02686905. Vitamin supplementation after bariatric surgery [Effects of vitamin supplementation on micronutrient blood values, body composition, waist-to-hip ratio and fasting blood glucose after bariatric surgery]. clinicaltrials.gov/show/NCT02686905 (first received 4 February 2016).
NCT02817256 {published data only}
    1. NCT02817256. Vitamin and mineral supplementation post bariatric surgery [A randomized controlled trial of vitamin and mineral supplementation post bariatric surgery: sleeve gastrectomy]. clinicaltrials.gov/show/NCT02817256 (first received 29 June 2016).
NCT03360435 {published data only}
    1. NCT03360435. Absorption of transdermal vitamins in post bariatric surgery patients. clinicaltrials.gov/show/NCT03360435 (first received 4 December 2017).
NCT03455868 {published data only}
    1. NCT03455868. Bone health after bariatric surgery in patients with type 2 diabetes. clinicaltrials.gov/ct2/show/NCT03455868 (first received 19 February 2018).
NCT03938571 {published data only}
    1. NCT03938571. Standard duodenal switch vs. single anastomosis duodeno-ileostomy duodenal switch [Torsby I trial: a prospectively randomized study on standard duodenal switch vs. single anastomosis duodeno-ileostomy duodenal switch]. clinicaltrials.gov/ct2/show/NCT03938571 (first received 6 May 2019).
NCT04003935 {published data only}
    1. NCT04003935. Juice plus inflammaging and cardiovascular disease prevention study [Effects of long-term consumption of two plant-based dietary supplements on low-grade inflammation, cardiovascular disease prevention and circulating micronutrients in a cohort of elderly volunteers]. ClinicalTrials.gov/show/NCT04003935 (first received 1 July 2019).
NCT04412421 {published data only}
    1. NCT04412421. Supplementation after bariatric surgery [Adherence to vitamin and mineral supplementation after bariatric surgery]. clinicaltrials.gov/show/NCT04412421 (first received 2020).
NCT05333315 {published data only}
    1. NCT05333315. Clinical trials of five different food supplements with restriction diet in adults [The effects of five different food supplements with restriction diet on the components of the metabolic syndrome in overweight and obese adults]. clinicaltrials.gov/ct2/show/record/NCT05333315 (first received 1 April 2022).
Nelson 2008 {published data only}
    1. Nelson HS, Clements RH, Stall R. Discussion. American Surgeon 2008;74(6):474-5. - PubMed
Patel 2012 {published data only}
    1. Patel V, Rink C, Gordillo GM, Khanna S, Gnyawali U, Roy S, et al. Oral tocotrienols are transported to human tissues and delay the progression of the model for end-stage liver disease score in patients. Journal of Nutrition 2012;142(3):513-9. [NCT: 00678834] - PMC - PubMed
Patterson 1997 {published data only}
    1. Patterson L, Pasini D. Results of vitamin supplementation and dietary protocol on patients following distal Roux-en-Y gastric bypass. Obesity Surgery 1997;7(4):307.
Perin 2018 {published data only}
    1. Perin J, Prokopowicz G, Furtado M, Papas K, Steele K. A randomized trial of a novel chewable multivitamin and mineral supplement following roux-en-Y gastric bypass. Obesity Surgery 2018;28:2406-20. - PubMed
Robert 2020 {published data only}
    1. Robert M, Poghosyan T, Delaunay D, Pelascini E, Iceta S, Sterkers A, et al. Prospective multicentre randomised trial comparing the efficacy and safety of single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) versus Roux-en-Y gastric bypass (RYGB): SADISLEEVE study protocol. BMJ Open 2020;10:e037576. - PMC - PubMed
Ruiz‐Tovar 2016 {published data only}
    1. Ruiz-Tovar J, Llavero C, Zubiaga L, Boix E, Obelche group. Maintenance of multivitamin supplements after sleeve gastrectomy. Obesity Surgery 2016;26:2324-30. - PubMed
Schafer 2015 {published data only}
    1. Schafer AL, Weaver CM, Black DM, Wheeler AL, Chang H, Szefc GV. Intestinal calcium absorption decreases dramatically after gastric bypass surgery despite optimization of vitamin D status. Journal of Mineral and Bone Research 2015;30(8):1377-85. - PMC - PubMed
Shah 2014 {published data only}
    1. Shah P. Editorial [Consultant]. The Journal of Arthoplasty 2014;54(11):821.
Shahraki 2019 {published data only}
    1. Shahraki M, Khalili N, Yousefvand S, Sheikhbahaeic E, Shahmiri S. Severe obesity and vitamin D deficiency treatment options before bariatric surgery: a randomized clinical trial. Surgery for Obesity and Related Disease 2019;15:1604-11. - PubMed
Sigstad 1973 {published data only}
    1. Sigstad H. Skeletal changes in stomach surgery patients. Treatment with calcium and vitamin D. Tidsskrift for Den Norske Laegeforening 1973;93(10):703. - PubMed
Stein 2009 {published data only}
    1. Stein E, Strain G, Sinha N, Ortiz D, Pomp A, Dakin G, et al. Vitamin D insufficiency prior to bariatric surgery: risk factors and a pilot treatment study. Clinical Endocrinology 2009;71(2):176-83. - PMC - PubMed
Sundbom 2016 {published data only}
    1. Sundbom M, Berne B, Hultin H. Short-term UVB treatment or intramuscular cholecalciferol to prevent hypovitaminosis D after gastric bypass – a randomized clinical trial. Obesity Surgery 2016;26:2198-203. - PubMed
Tsamis 2015 {published data only}
    1. Tsamis D. Efficacy of vitamin D supplementation after bariatric operation: letter to the editor. Obesity Surgery 2015;25(2):329. - PubMed
Tsiftsis 2009 {published data only}
    1. Tsiftsis D, Mylonas P, Mead, N, Kalfarentzos F, Alexandrides T. Bone mass decreases in morbidly obese women after long limb-biliopancreatic diversion and marked weight loss without secondary hyperparathyroidism. A physiological adaptation to weight loss? Obesity Surgery 2009;19(11):1497-503. - PubMed
Volonakis 2021 {published data only}
    1. Volonakis S, Koika V, Tzavelas G, Skopeliti M, Skroubis G, Kalfarentzos F, et al. Adequate vitamin D supplementation does not ameliorate bone loss following long limb-biliopancreatic diversion in morbidly obese women. Hormones 2021;20:315-21. - PubMed

Additional references

Al‐Shoha 2009
    1. Al-Shoha A, Qiu S, Palnitkar S, Rao DS. Osteomalacia with bone marrow fibrosis due to severe vitamin D deficiency after a gastrointestinal bypass operation for severe obesity. Endocrine Practice 2009;15(6):528-33. - PubMed
Alshahrani 2013
    1. Alshahrani F, Aljohani N. Vitamin D: deficiency, sufficiency and toxicity. Nutrients 2013;5(9):3605-16. - PMC - PubMed
Altman 2003
    1. Altman DG, Bland JM. Interaction revisited: the difference between two estimates. BMJ (Clinical Research Ed.) 2003;326(7382):219. [PMID: ] - PMC - PubMed
Autier 2012
    1. Autier P, Gandini S, Mullie P. A systematic review: influence of vitamin D supplementation on serum 25-hydroxyvitamin D concentration. Journal of Clinical Endocrinology and Metabolism 2012;97(8):2606-13. - PubMed
Axelsson 2018
    1. Axelsson K, Werling M, Eliasson B, Szabo E, Näslund I, Wedel H, et al. Fracture risk after gastric bypass surgery: a retrospective cohort study. Journal of Bone and Mineral Research 2018;33(12):2122-31. - PubMed
Baim 2008
    1. Baim S, Binkley N, Bilezikian JP, Kendler DL, Hans DB, Lewiecki EM, et al. Official positions of the international society for clinical densitometry and executive summary of the 2007 ISCD position development conference. Journal of Clinical Densitometry 2008;11(1):75-91. - PubMed
Bal 2012
    1. Bal BS, Finelli FC, Shope TR, Koch TR. Nutritional deficiencies after bariatric surgery. Nature Reviews Endocrinology 2012;8(9):544-56. - PubMed
Bhan 2010
    1. Bhan A, Rao AD, Rao DS. Osteomalacia as a result of vitamin D deficiency. Endocrinology and Metabolism Clinics of North America 2010;39(2):321-31. - PubMed
Bischoff‐Ferrari 2009
    1. Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, Orav JE, Stuck A, Theiler R, et al. Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ (Clinical Research Ed.) 2009;339:b3692. - PMC - PubMed
Bischoff‐Ferrari 2012
    1. Bischoff-Ferrari HA, Willett WC, Orav EJ, Lips P, Meunier PJ, Lyons RA, et al. A pooled analysis of vitamin D dose requirements for fracture prevention. New England Journal of Medicine 2012;367(1):40-9. - PubMed
Bjelakovic 2014a
    1. Bjelakovic G, Gluud LL, Nikolova D, Whitfield K, Krstic G, Wetterslev J, et al. Vitamin D supplementation for prevention of cancer in adults. Cochrane Database of Systematic Reviews 2014, Issue 6. Art. No: CD007469. [DOI: 10.1002/14651858.CD007469.pub2] - DOI - PMC - PubMed
Bjelakovic 2014b
    1. Bjelakovic G, Gluud LL, Nikolova D, Whitfield K, Wetterslev J, Simonetti RG, et al. Vitamin D supplementation for prevention of mortality in adults. Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No: CD007470. [DOI: 10.1002/14651858.CD007470.pub3] - DOI - PMC - PubMed
Borenstein 2017a
    1. Borenstein M, Higgins JP, Hedges LV, Rothstein HR. Basics of meta-analysis: I² is not an absolute measure of heterogeneity. Research Synthesis Methods 2017;8(1):5-18. - PubMed
Borenstein 2017b
    1. Borenstein M. Prediction intervals. https://meta-analysis.com/ (accessed 3 July 2017).
Bouillon 2013
    1. Bouillon R, Schoor NM, Gielen E, Boonen S, Mathieu C, Vanderschueren D, et al. Optimal vitamin D status: a critical analysis on the basis of evidence-based medicine. Journal of Clinical Endocrinology and Metabolism 2013;98(8):E1283-304. - PubMed
Cashman 2011
    1. Cashman KD, Fitzgerald AP, Kiely M, Seamans KM. A systematic review and meta-regression analysis of the vitamin D intake-serum 25-hydroxyvitamin D relationship to inform European recommendations. British Journal of Nutrition 2011;106(11):1638-48. - PubMed
Cashman 2021
    1. Cashman K, Kiely M, Andersen R, Grønborg I, Madsen K, Nissen J, et al. Individual participant data (IPD)-level meta-analysis of randomised controlled trials with vitamin D-fortified foods to estimate dietary reference values for vitamin D. European Journal of Nutrition 2021;60(2):939-59. - PubMed
Cawley 2021
    1. Cawley J, Biener A, Meyerhoefer C, Ding Y, Zvenyach T, Smolarz G, et al. Direct medical costs of obesity in the United States and the most populous states. Journal of Managed Care and Specialty Pharmacy 2021;27(3):354-66. - PMC - PubMed
Chakhtoura 2016a
    1. Chakhtoura M, Nakhoul N, Akl EA, Mantzoros C, El Hajj Fuleihan G. Guidelines on vitamin D replacement in bariatric surgery: identification and systematic appraisal. Metabolism: Clinical and Experimental 2016;65(4):586-97. - PMC - PubMed
Chakhtoura 2016b
    1. Chakhtoura MT, Nakhoul NN, Shawwa K, Mantzoros CM, El Hajj Fuleihan G. Hypovitaminosis D in bariatric surgery: a systematic review of observational studies. Metabolism: Clinical and Experimental 2016;65(4):574-85. - PMC - PubMed
Chakhtoura 2022a
    1. Saad RK, Ghezzawi M, Habli D, Alami RS, Chakhtoura M. Fracture risk following bariatric surgery: a systematic review and meta-analysis. Osteoporosis International 2022;33(3):511-26. - PubMed
Chakhtoura 2022b
    1. Chakhtoura M, Bacha DS, Gharios C, Ajjour S, Assaad M, Jabbour Y. Vitamin D supplementation and fractures in adults: a systematic umbrella review of meta-analyses of controlled trials. Journal of Clinical Endocrinology and Metabolism 2022;107(3):882-98. - PMC - PubMed
Chang 2014
    1. Chang S-H, Stoll CR, Song J, Varela JE, Eagon CJ, Colditz GA. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012. JAMA Surgery 2014;149(3):275-87. - PMC - PubMed
Chapuy 1992
    1. Chapuy MC, Arlot ME, Duboeuf F, Brun J, Crouzet B, Arnaud S, et al. Vitamin D3 and calcium to prevent hip fractures in elderly women. New England Journal of Medicine 1992;327(23):1637-42. - PubMed
Chong 2023
    1. Chong B, Jayabaskaran J, Kong G, Chan YH, Chin YH, Goh R, et al. Trends and predictions of malnutrition and obesity in 204 countries and territories: an analysis of the Global Burden of Disease Study 2019. EClinicalMedicine 2023;57:101850. - PMC - PubMed
Coe 1977
    1. Coe FL, Keck J, Norton ER. The natural history of calcium urolithiasis. JAMA 1977;238(14):1519-23. - PubMed
Collazo‐Clavell 2004
    1. Collazo-Clavell ML, Jimenez A, Hodgson SF, Sarr MG. Osteomalacia after Roux-en-Y gastric bypass. Endocrine Practice 2004;10(3):195-8. - PubMed
Colquitt 2014
    1. Colquitt JL, Pickett K, Loveman E, Frampton GK. Surgery for weight loss in adults. Cochrane Database of Systematic Reviews 2014, Issue 8. Art. No: CD003641. [DOI: 10.1002/14651858.CD003641.pub4] - DOI - PMC - PubMed
CONSORT 2018
    1. Consolidated Standards of Reporting Trials (CONSORT). The CONSORT statement. https://www.consort-spirit.org (accessed 25 July 2018).
De Luis 2013
    1. De Luis DA, Pacheco D, Izaola O, Terroba MC, Cuellar L, Cabezas G. Micronutrient status in morbidly obese women before bariatric surgery. Surgery Obesity Related Diseases 2013;9(2):323-7. - PubMed
Deeks 2022
    1. Deeks JJ, Higgins JP, Altman DG. Chapter 10: Analysing data and undertaking meta-analyses. In: Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 6.3 (updated February 2022). Cochrane, 2022. Available from training.cochrane.org/handbook/archive/v6.3.
Drincic 2012
    1. Drincic AT, Armas LA, Diest EE, Heaney RP. Volumetric dilution, rather than sequestration best explains the low vitamin D status of obesity. Obesity (Silver Spring, Md.) 2012;20(7):1444-8. - PubMed
Ebrahim 2013
    1. Ebrahim S, Akl EA, Mustafa RA, Sun X, Walter SD, Heels-Ansdell D, et al. Addressing continuous data for participants excluded from trial analysis: a guide for systematic reviewers. Journal of Clinical Epidemiology 2013;66(9):1014-21. - PubMed
Ebrahim 2014
    1. Ebrahim S, Johnston BC, Akl EA, Mustafa RA, Sun X, Walter SD, et al. Addressing continuous data measured with different instruments for participants excluded from trial analysis: a guide for systematic reviewers. Journal of Clinical Epidemiology 2014;67(5):560-70. - PubMed
Eisenberg 2022
    1. Eisenberg D, Shikora S, Aarts E, Aminian A, Angrisani L, Cohen R, et al. 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): indications for metabolic and bariatric surgery. Surgery for Obesity and Related Diseases 2022;18:1345-56. - PubMed
El Hajj Fuleihan 2015
    1. El Hajj Fuleihan G, Bouillon R, Clarke B, Chakhtoura M, Cooper C, McClung M, et al. Serum 25-hydroxyvitamin D levels: variability, knowledge gaps, and the concept of a desirable range. Journal of Bone and Mineral Research 2015;30(7):1119-33. - PubMed
Fan 2022
    1. Fan K, Lv F, Li H, Meng F, Wang T, Zhou Y. Trends in obesity and severe obesity prevalence in the United States from 1999 to 2018. American Journal of Human Biology 2022;35(5):e23855. [DOI: 10.1002/ajhb.23855] - DOI - PubMed
Flores 2015
    1. Flores L, Moizé V, Ortega E, Rodríguez L, Andreu A, Filella X, et al. Prospective study of individualized or high fixed doses of vitamin D supplementation after bariatric surgery. Obesity Surgery 2015;25(3):470-6. - PubMed
Fried 2014
    1. Fried M, Yumuk V, Oppert JM, Scopinaro N, Torres A, Weiner R, et al, International Federation for Surgery of Obesity and Metabolic Disorders-European Chapter (IFSO-EC), European Association for the Study of Obesity (EASO), European Association for the Study of Obesity Obesity Management Task Force (EASO OMTF). Interdisciplinary European guidelines on metabolic and bariatric surgery. Obesity Surgery 2014;24(1):42-55. - PubMed
Gallagher 2013
    1. Gallagher JC, Yalamanchili V, Smith LM. The effect of vitamin D supplementation on serum 25OHD in thin and obese women. Journal of Steroid Biochemistry and Molecular Biology 2013;136:195-200. - PMC - PubMed
Garvey 2016
    1. Garvey T, Mechanick J, Brett E, Garber A, Hurley D, Jastreboff A, et al. American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. Endocrine Practice 2016;22(Suppl 3):1-203. - PubMed
Ghanta 2017
    1. Ghanta R, LaPar D, Zhang Q, Devarkonda V, Isbell J, Yarboro L, et al. Obesity increases risk-adjusted morbidity, mortality, and cost following cardiac surgery. Journal of American Heart Association 2017;6(3):e003831. - PMC - PubMed
Giustina 2020
    1. Giustina A, Bouillon R, Binkley N, Sempos C, Adler RA, Bollerslev J. Controversies in vitamin D: a statement from the third international conference. JBMR Plus 2020;4(12):e10417. - PMC - PubMed
GRADEpro GDT [Computer program]
    1. GRADEpro GDT. Version accessed June 2023. Hamilton (ON): McMaster University (developed by Evidence Prime), 2023. Available at https://www.gradepro.org.
Guh 2009
    1. Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health 2009;9(88):1-20. [DOI: 10.1186/1471-2458-9-88] - DOI - PMC - PubMed
Hage 2012
    1. Hage MP, Safadi B, Salti I, Nasrallah M. Role of gut-related peptides and other hormones in the amelioration of type 2 diabetes after Roux-en-Y gastric bypass surgery. International Scholarly Research Notices 2012;2012:1-13. - PMC - PubMed
Hage 2014
    1. Hage M, El Hajj Fuleihan G. Bone and mineral metabolism in patients undergoing Roux-en-Y gastric bypass. Osteoporosis International 2014;25(2):423-39. - PubMed
Halpern 2020
    1. Halpern B, Da Costa Louzada ML, Aschner P, Gerchman F, Brajkovich I, Faria Neto JR, et al. Obesity and COVID-19 in Latin America: a tragedy of two pandemics – official document of the Latin American Federation of Obesity Societies. Obesity Reviews 2020;22(3):e13165. - PMC - PubMed
Heaney 2003
    1. Heaney RP, Davies KM, Chen TC, Holick MF, Barger-Lux MJ. Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. American Journal of Clinical Nutrition 2003;77(1):204-10. - PubMed
Heber 2010
    1. Heber D, Greenway FL, Kaplan LM, Livingston E, Salvador J, Still C. Endocrine and nutritional management of the post-bariatric surgery patient: an Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology and Metabolism 2010;95(11):4823-43. - PubMed
Hewitt 2013
    1. Hewitt S, Sovik TT, Aasheim ET, Kristinsson J, Jahnsen J, Birketvedt GS, et al. Secondary hyperparathyroidism, vitamin D sufficiency, and serum calcium 5 years after gastric bypass and duodenal switch. Obesity Surgery 2013;23(3):384-90. - PubMed
Higgins 2002
    1. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Statistics in Medicine 2002;21:1539-58. - PubMed
Higgins 2003
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analysis. BMJ (Clinical Research Ed.) 2003;327:557-60. - PMC - PubMed
Higgins 2009
    1. Higgins JP, Thompson SG, Spiegelhalter DJ. A re-evaluation of random-effects meta-analysis. Journal of the Royal Statistical Society: Series a (Statistics in Society) 2009;172(1):137-59. - PMC - PubMed
Higgins 2011
    1. Higgins JP, Altman DG, Sterne JA. Chapter 8: Assessing risk of bias in included studies. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1 (updated March 2011). Available from training.cochrane.org/handbook/archive/v5.1/.
Higgins 2019
    1. Higgins JP, Li T, Deeks JJ. Chapter 6: Choosing effect measures and computing estimates of effect. In: Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 6.0 (updated July 2019). Cochrane, 2019. Available from training.cochrane.org/handbook/archive/v6.
Higgins 2022
    1. Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 6.3 (updated February 2022). Cochrane, 2022. Available from training.cochrane.org/handbook/archive/v6.3.
Hodgkinson 1958
    1. Hodgkinson A, Pyrah LN. The urinary excretion of calcium and inorganic phosphate in 344 patients with calcium stone of renal origin. British Journal of Surgery 1958;46(195):10-8. - PubMed
Holick 2005
    1. Holick MF. The vitamin D epidemic and its health consequences. Journal of Nutrition 2005;135(11):2739S-48S. - PubMed
Holick 2008
    1. Holick MF, Biancuzzo RM, Chen TC, Klein EK, Young A, Bibuld D, et al. Vitamin D2 is as effective as vitamin D3 in maintaining circulating concentrations of 25-hydroxyvitamin D. Journal of Clinical Endocrinology and Metabolism 2008;93(3):677-81. - PMC - PubMed
Holick 2011
    1. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism 2011;96(7):1911-30. - PubMed
Holick 2015
    1. Holick MF. Vitamin D and brain health: the need for vitamin D supplementation and sensible sun exposure. Journal of Internal Medicine 2015;277(1):90-3. - PubMed
Hozo 2005
    1. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Medical Research Methodology 2005;5:13. [DOI: 10.1186/1471-2288-5-13] - DOI - PMC - PubMed
Hyppönen 2014
    1. Hyppönen E, Cavadino A, Williams D, Fraser A, Vereczkey A, Fraser WD, et al. Vitamin D and pre-eclampsia: original data, systematic review and meta-analysis. Annals of Nutrition & Metabolism 2014;63(4):331-40. - PubMed
Imes 2014
    1. Imes CC, Burke LE. The obesity epidemic: the United States as a cautionary tale for the rest of the world. Current Epidemiology Report 2014;1(2):82-8. - PMC - PubMed
IOM 2011
    1. Institute of Medicine. Dietary reference intakes for calcium and vitamin D. 2011. Available from http://www.ncbi.nlm.nih.gov/books/NBK56070/pdf/Bookshelf_NBK56070.pdf.
Ish‐Shalom 2008
    1. Ish-Shalom S, Segal E, Salganik T, Raz B, Bromberg IL, Vieth R. Comparison of daily, weekly, and monthly vitamin D3 in ethanol dosing protocols for two months in elderly hip fracture patients. Journal of Clinical Endocrinology and Metabolism 2008;93(9):3430-5. - PubMed
Javanainen 2018
    1. Javanainen M, Pekkarinen T, Mustonen H, Scheinin T, Leivonen M. Two-year nutrition data in terms of vitamin D, vitamin B12, and albumin after bariatric surgery and long-term fracture data compared with conservatively treated obese patients: a retrospective cohort study. Obesity Surgery 2018;28:2968-75. - PubMed
Jensen 2014
    1. Jensen M, Ryan D, Apovian C, Ard J, Comuzzie A, Donato K, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association task force on practice guidelines and the obesity society. Journal of the American College of Cardiology 2014;63(25):2985-3023. - PubMed
Kearns 2014
    1. Kearns MD, Alvarez JA, Tangpricha V. Large, single-dose, oral vitamin D supplementation in adult populations: a systematic review. Endocrine Practice 2014;20(4):341-51. - PMC - PubMed
Kim 2021
    1. Kim J, Nimeri A, Khorgami Z, El Chaar M, Galvez Lima A, Vosburg W. Metabolic bone changes after bariatric surgery: 2020 update, American Society for Metabolic and Bariatric Surgery Clinical Issues Committee position statement. Surgery for Obesity and Related Diseases 2021;17:1-8. - PubMed
Kivimaki 2022
    1. Kivimaki M, Strandberg T, Pentti J, Nyberg S, Frank P, Jokela M, et al. Body-mass index and risk of obesity-related complex multimorbidity: an observational multicohort study. Lancet Diabetes and Endocrinology 2022;10(4):253-63. - PMC - PubMed
Komaei 2019
    1. Komaei I, Sarra F, Lazzara C, Ammendola M, Memeo R, Sammarco G, et al. One anastomosis gastric bypass-mini gastric bypass with tailored biliopancreatic limb length formula relative to small bowel length: preliminary results. Obesity Surgery 2019;29(9):3062-70. - PubMed
Kwok 2014
    1. Kwok CS, Pradhan A, Khan MA, Anderson SG, Keavney BD, Myint PK, et al. Bariatric surgery and its impact on cardiovascular disease and mortality: a systematic review and meta-analysis. International Journal of Cardiology 2014;173(1):20-8. - PubMed
Lee 2011
    1. Lee WJ, Chen CY, Chong K, Lee YC, Chen SC, Lee SD. Changes in postprandial gut hormones after metabolic surgery: a comparison of gastric bypass and sleeve gastrectomy. Surgery for Obesity and Related Diseases 2011;7(6):683-90. - PubMed
Lefebvre 2022
    1. Lefebvre C, Glanville J, Briscoe S, Littlewood A, Marshall C, Metzendorf MI, et al. Chapter 4: Searching for and selecting studies. In: Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 6.3 (updated February 2022). Cochrane, 2022. Available from training.cochrane.org/handbook/archive/v6.3.
Li 2018
    1. Li Z, Zhou X, Fu W. Vitamin D supplementation for the prevention of vitamin D deficiency after bariatric surgery: a systematic review and meta-analysis. European Journal of Clinical Nutrition 2018;72:1061-70. - PubMed
Liu 2021
    1. Liu B, Du Y, Wu X, Snetselaar L, Wallace R, Bao W. Trends in obesity and adiposity measures by race or ethnicity among adults in the United States 2011–18: population based study. BMJ 2021;372(n365):1-10. - PMC - PubMed
Manco 2005
    1. Manco M, Calvani M, Nanni G, Greco AV, Iaconelli A, Gasbarrini G, et al. Low 25-hydroxyvitamin D does not affect insulin sensitivity in obesity after bariatric surgery. Obesity Research 2005;13(10):1692-700. - PubMed
McTigue 2003
    1. McTigue KM, Harris R, Hemphill B, Lux L, Sutton S, Bunton AJ, et al. Screening and interventions for obesity in adults: summary of the evidence for the US Preventive Services Task Force. Annals of Internal Medicine 2003;139(11):933-49. - PubMed
Mechanick 2013
    1. Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient – 2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring, Md.) 2013;9(2):159-91. - PMC - PubMed
Mechanick 2020
    1. Mechanick J, Apovian C, Brethauer S, Garvey T, Joffe A, Kim J, et al. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures – 2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, the Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Obesity (Silver Spring, Md.) 2020;28(4):O1-O58. - PubMed
Mitri 2014
    1. Mitri J, Pittas AG. Vitamin D and diabetes. Endocrinology and Metabolism Clinics of North America 2014;43(1):205-32. - PMC - PubMed
Mokhtari 2022
    1. Mokhtari Z, Hosseini E, Zaroudi M, Gibson D, Hekmatdoost A, Mansourian M, et al. The effect of vitamin D supplementation on serum 25-hydroxy vitamin D in the patients undergoing bariatric surgery: a systematic review and meta-analysis of randomized clinical trials. Obesity Surgery 2022;32(32):3088-103. - PubMed
Nakamura 2014
    1. Nakamura K, Haglind EG, Clowes JA, Achenbach SA, Atkinson EA, Melton L, et al. Fracture risk following bariatric surgery: a population-based study. Osteoporosis International 2014;25(1):151-8. - PMC - PubMed
Norman 2010
    1. Norman AW, Bouillon R. Vitamin D nutritional policy needs a vision for the future. Experimental Biology and Medicine 2010;235(9):1034-45. - PubMed
Nuzzo 2021
    1. Nuzzo A, Czernichow S, Hertig A, Ledoux S, Poghosyan T, Quilliot D, et al. Prevention and treatment of nutritional complications after bariatric surgery. Lancet Gastroenterology & Hepatology 2021;6(3):238-51. - PubMed
Ogden 2014
    1. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA 2014;311(8):806-14. - PMC - PubMed
Page 2021
    1. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ (Clinical Research Ed.) 2021;372:n71. [PMID: ] - PMC - PubMed
Petersen 2016
    1. Petersen L, Zeng X, Caufield-Noll C, Schweitzer M, Magnuson T, Steele K. Vitamin D status and supplementation before and after bariatric surgery: a comprehensive literature review. Surgery for Obesity and Related Diseases 2016;12(3):693-702. - PubMed
Restrepo 2022
    1. Restrepo B. Obesity prevalence among U.S. Adults during the COVID-19 pandemic. American Journal of Preventive Medicine 2022;63(1):102-6. - PMC - PubMed
RevMan 2024 [Computer program]
    1. Review Manager (RevMan). Version 7.12.0. The Cochrane Collaboration, 2024. Available at https://revman.cochrane.org.
Riley 2011
    1. Riley RD, Higgins JP, Deeks JJ. Interpretation of random effects meta-analyses. BMJ (Clinical Research Ed.) 2011;342:d549. - PubMed
Ross 2011
    1. Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, et al. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. Journal of Clinical Endocrinology and Metabolism 2011;96(1):53-8. - PMC - PubMed
Saad 2020
    1. Saad R, Habli D, El Sabbagh R, Chakhtoura M. Bone health following bariatric surgery: an update. Journal of Clinical Densitometry 2020;23(2):165-81. - PubMed
Saltzman 2013
    1. Saltzman E, Karl JP. Nutrient deficiencies after gastric bypass surgery. Annual Review of Nutrition 2013;33:183-203. - PubMed
Santesso 2016
    1. Santesso N, Carrasco-Labra A, Langendam M, Brignardello-Petersen R, Mustafa RA, Heus P, et al. Improving GRADE evidence tables part 3: detailed guidance for explanatory footnotes supports creating and understanding GRADE certainty in the evidence judgments. Journal of Clinical Epidemiology 2016;74:28-39. [PMID: ] - PubMed
Santesso 2020
    1. Santesso N, Glenton C, Dahm P, Garner P, Akl EA, Alper B, et al. GRADE guidelines 26: informative statements to communicate the findings of systematic reviews of interventions. Journal of Clinical Epidemiology 2020;119:126-35. [DOI: 10.1016/j.jclinepi.2019.10.014] - DOI - PubMed
Sawaya 2012
    1. Sawaya RA, Jaffe J, Friedenberg L, Friedenberg FK. Vitamin, mineral, and drug absorption following bariatric surgery. Current Drug Metabolism 2012;13(9):1345-55. - PMC - PubMed
Schauer 2014
    1. Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Brethauer SA, Navaneethan SD, et al. Bariatric surgery versus intensive medical therapy for diabetes – 3-year outcomes. New England Journal of Medicine 2014;370(21):2002-13. - PMC - PubMed
Scherer 2018
    1. Scherer RW, Meerpohl JJ, Pfeifer N, Schmucker C, Schwarzer G, Elm E. Full publication of results initially presented in abstracts. Cochrane Database of Systematic Reviews 2018, Issue 11. Art. No: MR000005. [DOI: 10.1002/14651858.MR000005.pub4] - DOI - PMC - PubMed
Schünemann 2022
    1. Schünemann HJ, Higgins JP, Vist GE, Glasziou P, Akl EA, Skoetz N, et al. Chapter 14: Completing 'summary of findings' tables and grading the certainty of the evidence. In: Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editor(s), Cochrane Handbook for Systematic Reviews of Interventions Version 6.3 (updated February 2022). Cochrane, 2022. Available from training.cochrane.org/handbook/archive/v6.3.
Scibora 2012
    1. Scibora LM, Ikramuddin S, Buchwald H, Petit MA. Examining the link between bariatric surgery, bone loss, and osteoporosis: a review of bone density studies. Obesity Surgery 2012;22(4):654-67. - PubMed
Sempos 2020
    1. Sempos CT, Binkley N. 25-Hydroxyvitamin D assay standardisation and vitamin D guidelines paralysis. Public Health Nutrition 2020;23(7):1153-64. - PMC - PubMed
Shab‐Bidar 2014
    1. Shab-Bidar S, Bours S, Geusens PP, Kessels AG, den Bergh JP. Serum 25 (OH) D response to vitamin D3 supplementation: a meta-regression analysis. Nutrition (Burbank, Los Angeles County, Calif.) 2014;30:275-85. - PubMed
Shikora 2007
    1. Shikora SA, Kim JJ, Tarnoff ME. Nutrition and gastrointestinal complications of bariatric surgery. Nutrition in Clinical Practice 2007;22(1):29-40. - PubMed
Slater 2004
    1. Slater GH, Ren CJ, Siegel N, Williams T, Barr D, Wolfe B, et al. Serum fat-soluble vitamin deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery. Journal of Gastrointestinal Surgery 2004;8(1):48-55. - PubMed
Souberbielle 2010
    1. Souberbielle JC, Body JJ, Lappe JM, Plebani M, Shoenfeld Y, Wang TJ, et al. Vitamin D and musculoskeletal health, cardiovascular disease, autoimmunity and cancer: recommendations for clinical practice. Autoimmunity Reviews 2010;9(11):709-15. - PubMed
SPSS Software [Computer program]
    1. SPSS software [Statistical Package for the Social Science]. Version 22. New York (NY): IBM corporation, 2013.
STATA Software [Computer program]
    1. STATA. Version 14. College Station, TX, USA: StataCorp, 2015.
Stefan 2021
    1. Stefan N, Birkenfeld A, Schulze M. Global pandemics interconnected – obesity, impaired metabolic health and COVID-19. Nature Reviews Endocrinology 2021;17:135-49. - PubMed
Stein 2014
    1. Stein EM, Silverberg SJ. Bone loss after bariatric surgery: causes, consequences, and management. Lancet Diabetes and Endocrinology 2014;2(2):165-74. - PMC - PubMed
Sterne 2011
    1. Sterne JA, Sutton AJ, Ioannidis JP, Terrin N, Jones DR, Lau J, et al. Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ (Clinical Research Ed.) 2011;343:d4002. - PubMed
Sterne 2017
    1. Sterne JA, Egger M, Moher D, Boutron I. Chapter 10: Addressing reporting biases. In: Higgins JP, Churchill R, Chandler J, Cumpston MS, editor(s), Cochrane Handbook for Systematic Reviews of Interventions Version 5.2.0 (updated June 2017), Cochrane, 2017. Available from training.cochrane.org/handbook/archive/v5.2.
Valverde 2005
    1. Valverde I, Puente J, Martín-Duce A, Molina L, Lozano, Sancho V, et al. Changes in glucagon-like peptide-1 (GLP-1) secretion after biliopancreatic diversion or vertical banded gastroplasty in obese subjects. Obesity Surgery 2005;15(3):387-97. - PubMed
Vanlint 2013
    1. Vanlint S. Vitamin D and obesity. Nutrients 2013;5(3):949-56. - PMC - PubMed
Vieth 2006
    1. Vieth R. Critique of the considerations for establishing the tolerable upper intake level for vitamin D: critical need for revision upwards. Journal of Nutrition 2006;136(4):1117-22. - PubMed
Vieth 2007
    1. Vieth R. Vitamin D toxicity, policy, and science. Journal of Bone and Mineral Research 2007;22(S2):V64-8. - PubMed
Wamberg 2012
    1. Wamberg L, Christiansen T, Paulsen S, Fisker S, Rask P, Rejnmark L, et al. Expression of vitamin D-metabolizing enzymes in human adipose tissue – the effect of obesity and diet-induced weight loss. International Journal of Obesity 2012;37(5):651-7. - PubMed
Wamberg 2013
    1. Wamberg L, Kampmann U, Stødkilde-Jørgensen H, Rejnmark L, Pedersen S, Richelsen B. Effects of vitamin D supplementation on body fat accumulation, inflammation, and metabolic risk factors in obese adults with low vitamin D levels – results from a randomized trial. European Journal of Internal Medicine 2013;24(7):644-9. - PubMed
Ward 2021
    1. Ward Z, Bleich N, Long M, Gortmaker S. Association of body mass index with health care expenditures in the United States by age and sex. PLOS One 2021;16(3):e0247307. [DOI: ] - PMC - PubMed
Weinert 2015
    1. Weinert LS, Silveiro SP. Maternal-fetal impact of vitamin D deficiency: a critical review. Maternal and Child Health Journal 2015;19(1):94-101. - PubMed
Wong 2006
    1. Wong SS, Wilczynski NL, Haynes RB. Developing optimal search strategies for detecting clinically sound treatment studies in EMBASE. Journal of the Medical Library Association 2006;94(1):41-7. - PMC - PubMed
Wood 2008
    1. Wood L, Egger M, Gluud LL, Schulz KF, Juni P, Altman DG, et al. Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes: meta-epidemiological study. BMJ (Clinical Research Ed.) 2008;336(7644):601-5. - PMC - PubMed
Wortsman 2000
    1. Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF. Decreased bioavailability of vitamin D in obesity. American Journal of Clinical Nutrition 2000;72(3):690-3. - PubMed
Xu 2018
    1. Xu H, Cupples A, Stokes A. Association of obesity with mortality over 24 years of weight history – findings from the Framingham Heart Study. JAMA Network Open 2018;1(7):e184587. - PMC - PubMed
Ybarra 2005
    1. Ybarra J, Sánchez-Hernández J, Gich I, De Leiva A, Rius X, Rodríguez-Espinosa J, et al. Unchanged hypovitaminosis D and secondary hyperparathyroidism in morbid obesity after bariatric surgery. Obesity Surgery 2005;15(3):330-5. - PubMed
Youssef 2007
    1. Youssef Y, Richards W, Sekhar N, Kaiser J, Spagnoli A, Abumrad N, et al. Risk of secondary hyperparathyroidism after laparoscopic gastric bypass surgery in obese women. Surgical Endoscopy 2007;21(8):1393-6. - PubMed
Yu 2014a
    1. Yu EW. Bone metabolism after bariatric surgery. Journal of Bone and Mineral Research 2014;29(7):1507-18. - PMC - PubMed
Yu 2014b
    1. Yu EW, Bouxsein ML, Roy AE, Baldwin C, Cange A, Neer RM, et al. Bone loss after bariatric surgery: discordant results between DXA and QCT bone density. Journal of Bone and Mineral Research 2014;29(3):542-50. - PMC - PubMed
Zittermann 2014a
    1. Zittermann A. Vitamin D and cardiovascular disease. Anticancer Research 2014;34(9):4641-8. - PubMed
Zittermann 2014b
    1. Zittermann A, Ernst JB, Gummert JF, Börgermann J. Vitamin D supplementation, body weight and human serum 25-hydroxyvitamin D response: a systematic review. European Journal of Nutrition 2014;53(2):367-74. - PubMed

References to other published versions of this review

Chakhtoura  2015
    1. Chakhtoura MT, Nakhoul NF, Akl EA, Safadi BY, Mantzoros CS, El-Hajj Fuleihan G. Vitamin D supplementation for obese adults undergoing bariatric surgery. Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No: CD011800. [DOI: 10.1002/14651858.CD011800] - DOI - PMC - PubMed

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