The content of calcium and vitamin D3 in patients with morbid obesity before and after surgical treatment depending on the type of surgery

Ya.S. Bereznitsky, R.V. Duka


Background. Obesity is the global problem of mankind. Overweight and obesity are among the five major risk factors for death. In the modern world, the problem of obesity is also discussed in the context of noncommunicable diseases, leading to significant difficulties for society. All obese patients are at risk of vitamin D deficiency and the development of secondary hyperparathyroidism, especially patients with morbid obesity. The purpose was to analyze the dynamics of changes in the levels of vitamin 25(OH)D and calcium in patients with morbid obesity before and after biliopancreatic diversion (BPD) in the modification of Hess-Marceau and sleeve gastrectomy. Materials and methods. Prospectively, 57 patients with morbid obesity and concomitant metabolic syndrome aged 21 to 62 years (mean age 40.00 ± 1.38 years) were examined, they underwent surgery and were monitored at the surgical department 1 of the Dnepropetrovsk Medical Academy of Ministry of Health of Ukraine for 3 or more years after the operation. The distribution of patients in groups was carried out taking into account the applied method of surgical treatment. Clinical group 1 included 29 (50.9 %) patients with BPD; group II — 28 (49.1 %) patients with sleeve gastrectomy. In all patients, the levels of calcium and vitamin 25(OH)D in the blood serum were determined. Evaluation of the study results was carried out in the dynamics of observation — at the first visit and within 3 years after surgery. Results. Analysis of the dynamics of morbid obesity after surgical treatment showed general trends to a significant (from p < 0.01 to p < 0.001) decrease in body mass index and body mass index (BMI) in patients of all clinical groups within 3 months after the start of treatment. In group 1, a significant decrease in indicators occurred within 18 months, and in group 2 — within 6–12 months. There was a decrease in the content of vitamin 25(OH)D and calcium at the beginning of the study, which required drug correction. In the course of the study, there was a tendency to decrease in the vitamin 25(OH)D content in patients of both groups within 12 months after bariatric intervention, with significant changes in the BPD group. In subsequent observation periods (after 1.5 and 2 years), such discrepancies from baseline in patients of both groups disappeared (p < 0.05 for all comparisons). A direct correlation was established between the levels of vitamin D and calcium and the length of a common loop during BPD: rs = +0.382 (p < 0.05) and rs = +0.378 (p < 0.05), respectively. At the same time, the length of the loop did not significantly affect the rate of weight loss after BPD (p > 0.05). Conclusions. The established direct correlation between the levels of vitamin D and calcium in the blood serum of patients who underwent BPD with the length of the common loop testified to the effectiveness of the BPD technique developed during the study (increasing the length of the common loop up to 1 m), the application of which led to a decrease in disturbances of the vitamin-calcium metabolism while maintaining the general tendency to a weight loss.


morbid obesity; surgical treatment; biliopancreatic diversion; sleeve gastrectomy; calcium metabolism; vitamin D3 metabolism


Belenkov IuN, Dzherieva IS, Rappoport SI, Volkova NI. Metabolicheskii sindrom kak rezul'tat obraza zhizni [Metabolic syndrome as a result of lifestile] Moscow: Meditsinskoe informatsionnoe agentstvo; 2015. 240 p. (in Russian).

Freedman D, Ron E, Ballard-Barbash R, Doody MM, Linet MS. Body mass index and all-cause mortality in a nationwide US cohort. Int J Obes (Lond). 2006 May;30(5):822-9. doi: 10.1038/sj.ijo.0803193.

Dedov II, Mel'nichenko GA. Ozhirenie. Etiologiia, patogenez, klinicheskie aspekty [Obesity. Etiology, pathogenesis, clinical aspects]. Moscow: Meditsinskoe informatsionnoe agentstvo; 2004. 456 p. (in Russian).

Lenz M., Richter T., Muhlhauser I. The morbidity and mortality associated with overweight and obesity in adulthood: a systematic review. Dtsch Arztebl Int. 2009 Oct;106(40):641-8. doi: 10.3238/arztebl.2009.0641.

Dedov II. Morbidnoe ozhirenie [Morbid obesity]. Moscow: Meditsinskoe informatsionnoe agentstvo; 2014. 08 p. (in Russian).

Makolkin VI. Metabolicheskii sindrom [Metabolic syndrome]. Moscow: Meditsinskoe informatsionnoe agentstvo; 2010. 142 p. (in Russian).

Homan J, Betzel B, Aarts EO, et al. Vitamin and Mineral Deficiencies After Biliopancreatic Diversion and Biliopancreatic Diversion with Duodenal Switch – the Rule Rather than the Exception. Obes Surg. 2015 Sep;25(9):1626-32. doi: 10.1007/s11695-015-1570-5.

Marceau P, Biron S, Marceau S, et al. Long-term metabolic outcomes 5 to 20 years after biliopancreatic diversion. Obes Surg. 2015 Sep;25(9):1584-93. doi: 10.1007/s11695-015-1599-5.

Sedletskii IuI. Sovremennye metody lecheniia ozhireniia. Rukovodstvo dlia vrachei [Modern methods of treating obesity. A guide for doctors]. Saint-Petersburg: «Elbi-SPb»; 2007. 416 p. (in Russian).

Wolf AM, Beisiegel U. The effect of loss of excess weight on the metabolic risk factors after bariatric surgery in morbidly and super-obese patients. Obes Surg. 2007 Jul;17(7):910-9. PMID: 17894151.

Ershova EV, Troshina EA. Use of bariatric surgery in patients with type 2 diabetes: help to the practitioner. Obesity and metabolism. 2016;13(1):50-56. doi: 10.14341/OMET2016150-56 (in Russian).

Khat'kov IE, Gurchenkova EIu. Endoskopicheskie vmeshatel'stva pri lechenii alimentarno-konstitutsional'nogo ozhireniia [Endoscopic interventions in the treatment of alimentary-constitutional obesity]. Moscow:Vita-Press; 2013. 141 p. (in Russian).

Iashkov IuI. O khirurgicheskikh metodakh lecheniia ozhireniia [About surgical methods of treatment of obesity]. Moscow: AirArt; 2010. 47 p. (in Russian).

Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and metaanalysis. JAMA. 2004 Oct 13;292(14):1724-37. doi: 10.1001/jama.292.14.1724.

Sjostrom L, Narbo K, Sjostrom D, et al. Effects of bariatric surgery on mortality in Swedish Obese Subjects. N Engl J Med. 2007 Aug 23;357(8):741-52. doi: 10.1056/NEJMoa066254.

Tucker ON, Szomstein S, Rosenthal RJ. Indications for sleeve gastrectomy as a primary procedure for weight loss in the morbidly obese. J Gastrointest Surg. 2008 Apr;12(4):662-7. doi: 10.1007/s11605-008-0480-4.

Mahawar KK, Jennings N, Brown J, Gupta A, Balupuri S, Small PK. “Mini” Gastric Bypass: Systematic Review of a Controversial Procedure. Obes Surg. 2013 Nov;23(11):1890-8. doi: 10.1007/s11695-013-1026-8.

Gagner M, Matteotti R. Laparoscopic biliopancreatic diversion with duodenal switch. Surg Clin North Am. 2005 Feb;85(1):141-9, x-xi. doi: 10.1016/j.suc.2004.10.003.

Rebrova OIu. Statisticheskii analiz meditsinskikh dannykh. Primenenie paketa prikladnykh programm STATISTICA [Statistical analysis of medical data. Application of application of STATISTICA package]. Moscow: Media Sfera; 2002. 312 p. (in Russian).

Hess DS, Hess DW, Oakley RS. The biliopancreatic diversion with the duodenal switch: results beyond 10 years. Obes Surg. 2005 Mar;15(3):408-16. doi: 10.1381/0960892053576695.

Biron S, Hould FS, Lebel S, et al. Twenty years of biliopancreatic diversion: what is the goal of the surgery? Obes Surg. 2004 Feb;14(2):160-4. doi: 10.1381/096089204322857492.

Dolan K, Hatzifotis M, Newbury L, Fielding G. A comparison of laparoscopic adjustable gastric banding and biliopancreatic diversion in superobesity. Obes Surg. 2004 Feb;14(2):165-9. doi: 10.1381/096089204322857500.



  • There are currently no refbacks.

Copyright (c) 2017 GASTROENTEROLOGY

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.


© Publishing House Zaslavsky, 1997-2017


 Яндекс.МетрикаSeo анализ сайта Рейтинг