ABSTRACT
Objective:To investigate the postoperative changes in levels of 25-hydroxy vitamin D (25-[OH]D], parathyroid hormone (PTH) and other relevant biomarkers in obese patients receiving metabolic surgery and analyze the dynamic changes in relevant biomarkers in the short term (after 3-6 months) and the long term (after 12-24 months).Methods:A total of 96 obese patients who underwent metabolic surgery and received follow-up examinations from January 2018 to January 2020 were included. Baseline and postoperative data were collected, including anthropometric data (height, weight, neck circumference, waistline and hipline) and laboratory test results (fasting glucose, glycated hemoglobin, 25-[OH)D, PTH, serum calcium and serum phosphorus). Body mass index (BMI) and waist-hip ratio were calculated. The anthropometric data were analyzed by repeated measures analysis of variance and laboratory data were compared between groups using t test and Kruskal-Wallis test. Results:96 patients (33 males and 63 females) were included, of whom 49 were complicated with diabetes. Prior to surgery, 79 (79.17%) of the patients had 25-(OH)D deficiency (< 20 μg/L), 16 (16.67%) had 25-(OH)D insufficiency (≥ 20 μg/L and < 30 μg/L) and 23 (23.96%) had high PTH levels (> 70 ng/L). After the surgery, 25-(OH)D level was transiently increased in the short term ( P = 0.01) but declined thereafter in the long term ( P < 0.01) to levels lower than baseline ( P = 0.023). Long-term PTH level was higher than baseline ( P = 0.012), with 11 patients showing PTH levels higher than normal (> 70 ng/L). Serum phosphorus level was increased in both the short term and the long term ( P < 0.01). Conclusions:Obese patients have 25-(OH)D deficiency/insufficiency before metabolic surgery and experience further decrease in the long term after surgery, despite a transient increase. Secondary increase in PTH level occurs in some of the patients after surgery. Long-term nutritional supplements and comprehensive nutritional management play important roles in postoperative management of obese patient.
ABSTRACT
Objective:To explore the association of weight loss with diabetes remission after metabolic surgery in patients with type 2 diabetes mellitus(T2DM) for 10 years and more.Methods:Data of T2DM patients with obesity who underwent metabolic surgery in the General Surgery Department & Obesity and Metabolic Disease Center of China-Japan Friendship Hospital from November 2017 to June 2021 were retrospectively collected and analyzed. Remission of diabetes was defined as glycated hemoglobin (HbA1c) < 6.5% or fasting blood glucose < 7.0 mmol/L after discontinuing anti-diabetic medication for more than 3 months. The patients were followed up and divided into two groups according to whether the percentage total weight loss (%TWL) was ≥ 20% or not. The age, sex, body mass index (BMI), fasting C-peptide, and HBA1c were compared between the two groups.Results:Among 65 (28 males and 37 females) patients with T2DM for ≥ 10 years , 50 (76.9%) achieved diabetes remission after a median of 12-month follow-up. 6.2%, 41.5% , 38.5% and 13.8% of the patients achieved %TWL < 10%, 10~20%, 20~30% and ≥ 30% , respectively. The diabetes remission rates were 50%, 63.0%, 92.0% and 88.9%, respectively. Compared with the %TWL < 20% group, the preoperative weight [(95.5±18.8) kg vs (85.5±11.0) kg, P = 0.012] and BMI [(34.4±6.0) vs (30.9±3.3) , P = 0.006] were significantly higher in the %TWL ≥ 20% group, and diabetes remission rates was aslo significantly higher in the %TWL ≥ 20% group (91.2% vs 61.3%, P = 0.010) . After adjusting for age, preoperative BMI, fasting C-peptide and duration of T2DM, Cox multivariate regression analysis showed that %TWL ≥ 20% was independently associated with diabetic remission after metabolic surgery in patients with T2DM for ≥ 10 years (HR = 1.99, 95% CI: 1.03 to 3.83, P = 0.04). Conclusions:More than 70% of patients with T2DM for ≥ 10 years could achieve diabetes remission after metabolic surgery. %TWL ≥ 20% may be one independent factor of diabetes remission in patients with long-duration T2DM.