Oral vitamin D supplementation for adults with obesity undergoing bariatric surgery.

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.

A minimally processed dietary pattern is associated with lower odds of metabolic syndrome among Lebanese adults.

OBJECTIVE: To (i) estimate the consumption of minimally processed, processed and ultra-processed foods in a sample of Lebanese adults; (ii) explore patterns of intakes of these food groups; and (iii) investigate the association of the derived patterns with cardiometabolic risk. DESIGN: Cross-sectional survey. Data collection included dietary assessment using an FFQ and biochemical, anthropometric and blood pressure measurements. Food items were categorized into twenty-five groups based on the NOVA food classification. The contribution of each food group to total energy intake (TEI) was estimated. Patterns of intakes of these food groups were examined using exploratory factor analysis. Multivariate logistic regression analysis was used to evaluate the associations of derived patterns with cardiometabolic risk factors. SETTING: Greater Beirut area, Lebanon. SUBJECTS: Adults ≥18 years (n 302) with no prior history of chronic diseases. RESULTS: Of TEI, 36·53 and 27·10 % were contributed by ultra-processed and minimally processed foods, respectively. Two dietary patterns were identified: the 'ultra-processed' and the 'minimally processed/processed'. The 'ultra-processed' consisted mainly of fast foods, snacks, meat, nuts, sweets and liquor, while the 'minimally processed/processed' consisted mostly of fruits, vegetables, legumes, breads, cheeses, sugar and fats. Participants in the highest quartile of the 'minimally processed/processed' pattern had significantly lower odds for metabolic syndrome (OR=0·18, 95 % CI 0·04, 0·77), hyperglycaemia (OR=0·25, 95 % CI 0·07, 0·98) and low HDL cholesterol (OR=0·17, 95 % CI 0·05, 0·60). CONCLUSIONS: The study findings may be used for the development of evidence-based interventions aimed at encouraging the consumption of minimally processed foods.

PREVALENCE OF DIABETES IN GREATER BEIRUT AREA: WORSENING OVER TIME.

OBJECTIVE: The Middle East North Africa region has one of the highest rates of diabetes, both in prevalence and in rate of increase. The aim of this study was to examine the prevalence and associated risk factors of type 2 diabetes mellitus (T2D) in the adult population of Beirut. METHODS: A random sample of 501 men and women aged 18 to 79 years was examined in a cross-sectional manner. The sample was then divided into 3 groups based on T2D self-report, glycosylated hemoglobin (HbA1c), and fasting glucose (no diabetes [ND], at risk for diabetes [RD], and probable diabetes [PD]). These were compared to determine the various associated risks. RESULTS: The sample consisted of 64.3% women, with an average age of 45.4 ± 15 years, and a mean body mass index (BMI) of 29.4 ± 5.9 kg/m2. The subjects were predominantly from a low socio-economic status, and more than half smoked either cigarettes or a waterpipe. The percentages of the 3 groups were as follows: 41.7%, 40.3%, and 18.0% for ND, RD, and PD, respectively. Out of 90 subjects diagnosed with PD, 26 did not know they had diabetes. Independent, positively associated risk factors were age, BMI, heart rate, hypertension, triglyceride, and high-density lipoprotein cholesterol. CONCLUSION: The prevalence of T2D was high in this study and seems to be increasing compared to prior diabetes reports. Overall, the whole sample had a high prevalence of cardiovascular risk factors such as smoking, obesity, and physical inactivity. However, subjects with diabetes had significantly more components of the metabolic syndrome. ABBREVIATIONS: ADA = American Diabetes Association CRP = C-reactive protein DD = definite diabetes FPG = fasting plasma glucose HbA1c = glycosylated hemoglobin MENA = Middle-East North Africa ND = no diabetes PD = probable diabetes RD = at risk of diabetes T2D = type 2 diabetes mellitus TSH = thyroid-stimulating hormone.