VITAMIN D LEVELS AND LIPID PROFILE IN PATIENTS UNDERGOING BARIATRIC SURGERY

Vitamin, mineral, and metabolic deficiencies occur in the postoperative period of bariatric surgery, in the short and long term, and are worrisome intercurrences.

AIMS:

To evaluate the association of serum vitamin D levels with the lipid profile in obese patients undergoing bariatric surgery.

METHODS:

Case series of patients assisted from 2010 to 2018, in a private hospital of medium and high complexity, who underwent bariatric surgery using sleeve gastrectomy or Roux-en-Y gastric bypass techniques, monitored by the same surgeon. Sociodemographic, clinical, laboratory, and anthropometric data were collected preoperatively and at 6, 12, and 24 months after surgery.

RESULTS:

A total of 156 individuals, mostly female (75.6%) were monitored. The most frequent comorbidities were hepatic steatosis (76.3%) and hypertension (48.27). Regarding preoperative vitamin D levels, only 18.9% of the population had a satisfactory level (≥30 ng/mL). There was a reduction in weight and an improvement in the lipid profile after surgery. Significant correlations were observed between the lipid profile and vitamin D concentration only in the sample submitted to the Roux-en-Y gastric bypass technique: negative correlation between total cholesterol and vitamin D two years after surgery; positive correlation between triglycerides and vitamin D one year after surgery; and negative correlation between high-density lipoprotein and vitamin D two years post-surgery.

CONCLUSIONS:

It is essential to routinely monitor vitamin D levels and lipid profile pre- and postoperatively in order to avoid damage associated with this vitamin deficiency.

HEADINGS:
Bariatric Surgery; Obesity; Vitamin D

		Follow-up			Losses			p^* * Pearson's χ² test.
		n	%	95%CI	n	%	95%CI	p^* * Pearson's χ² test.
Gender
	Male	38	24.4	17.3–31.8	7	13.5	6.0–24.4	0.10
	Female	118	75.6	68.2–82.7	45	86.5	75.6–94.0	0.10
Age
	<45 years	96	61.5	53.8–68.9	39	75.0	62.2–85.4	0.08
	≥45 years	60	38.5	31.1–46.2	13	25.0	14.6–37.8	0.08
Hypertension
	Yes	76	48.7	41.2–56.6	20	38.5	26.0–52.0	0.20
	No	80	51.3	43.4–58.8	32	61.5	48.0–74.0	0.20
Diabetes
	Yes	48	30.8	23.7–38.0	9	17.3	8.7–29.0	0.06
	No	108	69.2	62.0–76.3	43	82.7	71.0–91.3	0.06
Dyslipidemia
	Yes	49	31.4	23.9–38.9	16	30.8	19.4–44.0	0.93
	No	107	68.6	61.1–76.1	36	69.2	56.0–80.6	0.93
Hepatic steatosis
	Yes	119	76.3	68.7–82.8	40	76.9	64.3–86.9	0.92
	No	37	23.7	17.2–31.3	12	23.1	13.1–35.7	0.92
Total cholesterol
	Undesirable	85	54.8	47.0–62.5	32	61.5	48.0–74.0	0.40
	Desirable	70	45.2	37.5–53.0	20	38.5	26.0–52.0	0.40
HDL
	Undesirable	46	29.9	23.0–37.4	15	28.8	17.8–42.0	0.89
	Desirable	108	70.1	62.6–77.0	37	71.2	58.0–82.2	0.89
LDL
	Undesirable	49	31.6	24.6–39.2	18	34.6	22.6–48.1	0.69
	Desirable	106	68.4	60.8–75.4	34	65.4	51.9–77.4	0.69
Triglycerides
	Undesirable	62	40.0	32.5–47.8	21	40.4	27.7–53.9	0.96
	Desirable	93	60.0	52.2–67.5	31	59.6	46.1–72.3	0.96
Vitamin D
	Deficient	57	38.5	30.9–46.5	13	26.0	15.2–39.2	0.28
	Insufficient	63	42.6	34.8–50.6	26	52.0	38.3–65.5
	Sufficient	28	18.9	13.2–25.7	11	22.0	12.1–34.7

		Sleeve gastrectomy					Roux-en-Y gastric bypass
		n	Mean	SD	95%CI	p^* * ANOVA.	n	Mean	SD	95%CI	p^* * ANOVA.
Weight		60					76
	Preoperative		104.13^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	13.71	100.59–107.67	<0.001		116.83^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	22.38	111.72–121.94	<0.001
	Postoperative 6 months		80.66^b a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	11.31	77.73–83.58			89.10^b a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	17.07	85.19–93.00
	Postoperative 12 months		70.27^c a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	11.50	67.29–73.24			76.60^c a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	15.16	73.13–80.06
	Postoperative 24 months		71.48^c a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	11.75	68.45–74.52			75.22^c a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	15.99	71.57–78.87
BMI		60					76
	Preoperative		39.09^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	3.50	38.19–40.00	< 0.001		42.28^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	5.11	41.11–43.44	<0.001
	Postoperative 6 months		30.31^b a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	3.39	29.44–31.19			32.39^b a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	4.79	31.30–33.49
	Postoperative 12 months		26.41^c a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	3.33	25.55–27.27			27.68^c a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	3.87	26.80–28.56
	Postoperative 24 months		26.83^c a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	3.45	25.94–27.72			27.11^c a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	3.99	26.20–28.02
Total Cholesterol		52					65
	Preoperative		201.87^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	39.12	190.98–212.76	0.011		194.90^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	39.81	185.04–204.77	<0.001
	Postoperative 6 months		185.69^b a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	32.67	176.60–194.79			161.34^b a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	33.21	153.11–169.57
	Postoperative 12 months		192.21^ab a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	33.18	182.97–201.45			157.08^b a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	30.39	149.54–164.61
	Postoperative 24 months		197.31^ab a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	39.16	186.41–208.21			161.94^b a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	31.43	154.15–169.73
HDL		37					61
	Preoperative		50.37^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	12.06	46.35–54.39	<0.001		44.88^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	11.09	42.04–47.72	<0.001
	Postoperative 6 months		50.48^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	13.21	46.08–54.88			42.04^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	9.74	39.54–44.53
	Postoperative 12 months		58.92^b a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	14.29	54.16–63.68			49.25^b a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	12.41	46.07–52.43
	Postoperative 24 months		64.37^c a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	14.85	59.42–69.33			55.27^c a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	12.84	51.98–58.56
LDL		37					61
	Preoperative		125.87^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	32.89	114.90–136.83	0.088		117.12^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	32.31	108.84–125.39	<0.001
	Postoperative 6 months		118.29^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	28.05	108.94–127.65			97.90^b a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	27.80	90.78–105.02
	Postoperative 12 months		114.54^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	26.25	105.79–123.30			90.16^b.c a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	25.06	83.74–96.58
	Postoperative 24 months		111.91^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	39.66	98.69–125.14			89.93^c a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	24.36	83.69–96.17
Triglycerides		52					64
	Preoperative		160.77^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	86.12	136.79–184.75	<0.001		167.07^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	80.19	147.04–187.10	<0.001
	Postoperative 6 months		100.31^b a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	34.15	90.80–109.82			104.16^b a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	51.89	91.19–117.12
	Postoperative 12 months		90.79^c a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	35.78	80.83–100.75			83.44^c a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	32.58	75.30–91.57
	Postoperative 24 months		99.58^b,c a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	62.74	82.11–117.04			87.05^c a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	35.88	78.08–96.01
Vitamin D		33					40
	Preoperative		21.82^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	6.70	19.44–24.19	<0.001		23.26^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	6.74	21.11–25.42	0.073
	Postoperative 6 months		27.67^b a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	8.96	24.49–30.85			25.26^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	8.08	22.68–27.85
	Postoperative 12 months		27.56^b a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	7.33	24.96–30.16			26.11^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	8.06	23.53–28.69
	Postoperative 24 months		26.81^b a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	8.49	23.80–29.82			26.35^a a,b,c indicate significant differences (p<0.05) between the means by Bonferroni's post hoc test.	8.68	23.58–29.13

Lipid profile	Time	Preoperative	Post-operative 6 months	Post-operative 12 months	Post-operative 24 months
Lipid profile	Time	Vitamin D
TC	SG	−0,15	−0,10	−0,12	−0,19
TC	RYGB	0,09	−0,20	0,03	-0,31 ^* * Spearman's Rho coefficients (p<0.05).
TG	SG	−0,12	−0,19	−0,06	−0,13
TG	RYGB	−0,19	0,01	0,24 ^* * Spearman's Rho coefficients (p<0.05).	0,01
HDL	SG	−0,09	0,09	−0,03	0,07
HDL	RYGB	−0,16	−0,11	−0,07	-0,32 ^* * Spearman's Rho coefficients (p<0.05).
LDL	SG	−0,10	−0,11	−0,14	0,03
LDL	RYGB	−0,04	−0,16	0,03	−0,24

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[1] Correspondence: Isabelle Maria Cabral do Nascimento. E-mail: isabellecabral1@hotmail.com