Low bone mineral density following gastric bypass is not explained by lifestyle and lack of exercise.

BACKGROUND: Bariatric surgery, Roux-en-Y gastric bypass (RYGBP) in particular, is associated with weight loss as well as low bone mineral density. Bone mineral density relies upon multiple factors, some of which are lifestyle factors. The aim of this study was to compare lifestyle factors in order to eliminate them as culprits of the suspected difference in BMD in RYGBP operated and controls. MATERIALS AND METHODS: Study participants included 71 RYGBP-operated women (42.3 years, BMI 33.1 kg/m2) and 94 controls (32.4 years, BMI 23.9 kg/m2). Each completed a DEXA scan, as well as survey of lifestyle factors (e.g. physical activity in daily life, corticosteroid use, and calcium intake). All study participants were premenopausal Caucasian women living in the same area. Blood samples were taken in RYGBP-patients. RESULTS: BMD was significantly lower in RYGBP, femoral neck 0.98 vs. 1.04 g/cm2 compared to controls, despite higher BMI (present and at 20 years of age) and similar physical activity and calcium intake. In a multivariate analysis, increased time since surgery and age were negatively associated with BMD of the femoral neck and total hip in RYGBP patients. CONCLUSION: Despite similar lifestyle, RYGBP was followed by a lower BMD compared to controls. Thus, the reduced BMD in RYGBP cannot be explained, seemingly nor prevented, by lifestyle factors. As the reduction in BMD was associated with time since surgery, strict follow-up is a lifelong necessity after bariatric surgery, and especially important in younger bariatric patients.

Hypovitaminosis D and hyperparathyroidism: a 5-year postoperative follow-up of 30,458 gastric bypass and sleeve gastrectomy patients.

BACKGROUND: Bariatric procedures are associated with nutrient deficiencies. Studies show an association between gastric bypass (Roux-en-Y gastric bypass [RYGB]) and hypovitaminosis D as well as hyperparathyroidism, yet few compare RYGB to sleeve gastrectomy (SG), and large long-term analyses are scarce. OBJECTIVE: Evaluate trends of vitamin D and parathyroid hormone (PTH) levels in RYGB and SG. SETTING: National quality register. METHOD: The Scandinavian Obesity Surgery Registry records all bariatric surgeries in Sweden. Data from 2008 to 2021 on primary RYGB or SG with reported 25-hydroxy vitamin D (25-OH-D) and/or PTH levels were included. Individuals with an estimated glomerular filtration rate of <60 mL/min/1.73 m2 were excluded, leaving a study population of 25,385 RYGB and 5073 SG patients. RESULTS: A decrease in 25-OH-D, mirrored by an increase in PTH, was observed after the first year for both procedures, but more pronounced in RYGB. At 5 years, 25-OH-D levels were still higher than at baseline. Regular supplementation resulted in better 25-OH-D and PTH levels. Linear regression found that procedure type (RYGB versus SG), 25-OH-D levels, and time since surgery were significant factors in predicting PTH levels. The risk of pathologic PTH levels (>7 pmol/L) at 2 and 5 years postoperatively was roughly three times higher in RYGB (odds ratios = 3.41 and 2.84, respectively). CONCLUSIONS: Previous studies alongside these results suggest that RYGB, more so than SG, may cause hypovitaminosis D and thereby hyperparathyroidism, which could lead to osteopenia. The threshold for 25-OH-D should be >75 nmol/L, and despite higher levels, current vitamin D supplementation may not be sufficient. Follow-up should include screening for hyperparathyroidism and hypovitaminosis D.

PROTOCOL: Key characteristics of effective preschool-based interventions to promote self-regulation: A systematic review and meta-analysis.

This is the protocol for a Cochrane Review. The objectives are as follows: The aim of this systematic review is to advance our understanding of the key characteristics of effective preschool-based interventions designed to foster self-regulation. To accomplish this, the review addresses the following questions: 1. What types of preschool-based interventions have been developed to promote self-regulation? 2. What is the average effect of these preschool-based interventions on self-regulation, focusing on four key constructs: integrative effortful control, integrative executive function, self-regulation, and self-regulated learning? 3. What characteristics-such as Resource Allocation, Activity Type, and Instruction Method-could potentially contribute to the effects of preschool-based interventions in promoting self-regulation?

Training parents to help their children read: a randomized control trial.

BACKGROUND: Low levels of literacy and high levels of behaviour problems in middle childhood often co-occur. These persistent difficulties pose a risk to academic and social development, leading to social exclusion in adulthood. Although parent-training programmes have been shown to be effective in enabling parents to support their children's development, very few parent interventions offer a combination of behavioural and literacy training. AIMS: This paper (1) reports on a prevention programme which aimed to tackle behaviour and literacy problems in children at the beginning of school, and (2) presents the effects of the intervention on children's literacy. SAMPLE: One hundred and four 5- and 6-year-old children selected from eight schools in an inner city disadvantaged community in London participated in the intervention. METHODS: This is a randomized control trial with pre- and post-measurements designed to evaluate the effectiveness of an intervention. The behavioural intervention consisted of the 'Incredible Years' group parenting programme combined with a new programme designed to train parents to support their children's reading at home. RESULTS: Analyses demonstrated a significant effect of the intervention on children's word reading and writing skills, as well as parents' use of reading strategies with their children. CONCLUSION: A structured multicomponent preventive package delivered with attention to fidelity can enable parents to support their children's reading at home and increase their literacy skills. Together with the improvement in child behaviour, these changes could improve the life chances of children in disadvantaged communities.

Cholecalciferol Injections Are Effective in Hypovitaminosis D After Duodenal Switch: a Randomized Controlled Study.

BACKGROUND: By treating obesity, one of the major epidemics of this past century, through bariatric surgery, we may cause complications due to malnourishment in a growing population. At present, vitamin D deficiency is of interest, especially in patients with inferior absorption of fat-soluble nutrients after biliopancreatic diversion with duodenal switch (BPD/DS). METHODS: Twenty BPD/DS patients, approximately 4 years postoperatively, were randomized to either intramuscular supplementation of vitamin D with a single dose of 600,000 IU cholecalciferol, or a control group. Patients were instructed to limit their supplementation to 1400 IU of vitamin D and to avoid the influence of UV-B radiation; the study was conducted when sunlight is limited (December to May). RESULTS: Despite oral supplementation, a pronounced deficiency in vitamin D was seen (injection 19.3; control 23.2 nmol/l) in both groups. The cholecalciferol injection resulted in elevated 25[OH]D levels at 1 month (65.4 nmol/l), which was maintained at 6 months (67.4 nmol/l). This resulted in normalization of intact parathyroid hormone (PTH) levels. No changes in vitamin D or PTH occurred in the control group. CONCLUSIONS: In BPD/DS patients, having hypovitaminosis D despite full oral supplementation, a single injection of 600,000 IU of cholecalciferol was effective in elevating vitamin D levels and normalizing levels of intact PTH. The treatment is simple and highly effective and thus recommended, especially in cases of reduced UV-B radiation.

Toddlers' transition to out-of-home day care: settling into a new care environment.

This study investigates toddlers' initial reaction to day care entry and their behaviour change over the first few months in care. One hundred and four toddlers (10-33 months of age) in Viennese childcare centres participated in the study. One-hour video observations were carried out at 3 time points during the first 4 months in the setting and coded into a total of 36 5-min observation segments. Multilevel models (observation segments nested within children) with an autoregressive error structure fitted data well. Two weeks after entry into care, toddlers' levels of affect and interaction were low. Overall, changes in all areas of observed behaviour were less than expected. There were considerable individual differences in change over time, mostly unrelated to child characteristics. Significant associations between children's positive affect, their dynamic interactions and their explorative and investigative interest were found.