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1.
Cochrane Database Syst Rev ; 10: CD011800, 2024 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-39351881

RESUMEN

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.


Asunto(s)
Cirugía Bariátrica , Ensayos Clínicos Controlados Aleatorios como Asunto , Deficiencia de Vitamina D , Vitamina D , Vitaminas , Humanos , Vitamina D/administración & dosificación , Vitamina D/sangre , Cirugía Bariátrica/efectos adversos , Deficiencia de Vitamina D/complicaciones , Deficiencia de Vitamina D/tratamiento farmacológico , Adulto , Vitaminas/administración & dosificación , Fracturas Óseas , Suplementos Dietéticos , Calidad de Vida , Administración Oral , Obesidad/complicaciones , Obesidad/cirugía , Densidad Ósea/efectos de los fármacos , Femenino , Complicaciones Posoperatorias/prevención & control , Causas de Muerte , Persona de Mediana Edad , Masculino
2.
Public Health Nutr ; 21(1): 160-171, 2018 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-28965534

RESUMEN

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.


Asunto(s)
Pueblo Asiatico , Dieta Saludable , Hiperglucemia/epidemiología , Síndrome Metabólico/epidemiología , Adulto , Antropometría , Colesterol/sangre , Estudios Transversales , Encuestas sobre Dietas , Comida Rápida , Femenino , Humanos , Hiperglucemia/sangre , Hiperglucemia/diagnóstico , Líbano/epidemiología , Estilo de Vida , Masculino , Síndrome Metabólico/sangre , Síndrome Metabólico/diagnóstico , Persona de Mediana Edad , Evaluación Nutricional , Factores de Riesgo , Factores Socioeconómicos , Encuestas y Cuestionarios
3.
Endocr Pract ; 23(9): 1091-1100, 2017 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-28683240

RESUMEN

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.


Asunto(s)
Diabetes Mellitus Tipo 2/epidemiología , Adolescente , Adulto , Anciano , Glucemia/análisis , Estudios Transversales , Diabetes Mellitus Tipo 2/sangre , Femenino , Hemoglobina Glucada/análisis , Humanos , Líbano/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Adulto Joven
4.
Environ Monit Assess ; 189(10): 517, 2017 Sep 23.
Artículo en Inglés | MEDLINE | ID: mdl-28942470

RESUMEN

Bisphenol A (BPA) is an endocrine disruptor with multiple purported metabolic effects. This study aimed to measure BPA among Lebanese population, to identify its predictors, and to explore any link to metabolic disorders. A representative sample of 501 adults from Lebanon was recruited in a cross-sectional study. Urinary BPA was measured, and data were collected for anthropometric measurements, medical history, food intake, and laboratory markers of metabolic conditions. BPA data was divided into tertiles. A total of 89% of the subjects had detectable urinary BPA levels, with an overall mean of 3.67 ± 4.75 µg/L and a mean creatinine-adjusted BPA of 2.90 ± 4.79 µg/g. There was a significant positive association with female gender and older age for being in the highest BPA tertile. BPA level was linked to metabolic syndrome (MetS), obesity, type-2 diabetes (T2D), hypertension, and dyslipidemia. After adjustment, the trend remained for BPA in association with MetS and T2D. Though urinary BPA in the Lebanese population was higher in older women, the levels were similar to world-reported figures. Our results suggest a link with metabolic disorders but not at a significant level. These findings call for longitudinal and broader sample measurements.


Asunto(s)
Compuestos de Bencidrilo/orina , Exposición a Riesgos Ambientales/análisis , Contaminantes Ambientales/orina , Fenoles/orina , Adulto , Biomarcadores/orina , Estudios Transversales , Disruptores Endocrinos/orina , Exposición a Riesgos Ambientales/estadística & datos numéricos , Monitoreo del Ambiente , Femenino , Humanos , Líbano , Masculino , Persona de Mediana Edad , Obesidad , Riesgo
5.
Prog Transplant ; 26(4): 389-391, 2016 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-27555069

RESUMEN

Liver transplantation provides an important, often life-saving treatment for end-stage liver disease. Osteoporosis post-liver transplantation has been described in adults; however, this has not been described in the pediatric population to date. We present a case of a 13-year-old female patient who underwent an orthotopic liver transplant for cryptogenic liver cirrhosis. Her immunosuppressants were tacrolimus and prednisone. Four months posttransplant, she started complaining of bilateral lower limb pain and limping while walking, progressing to a point where she was almost immobile. Magnetic resonance imagining of the pelvis showed bilateral avascular necrosis involving the weight-bearing surfaces of both femoral heads, in addition to the extensive edema involving both hip joints. Bone mineral densitometry was below normal for her age at the hip and forearm. She was started on high-dose calcium and vitamin D supplement, as well as zoledronic acid with a remarkable symptomatic and functional improvement.


Asunto(s)
Trasplante de Hígado/efectos adversos , Osteoporosis/etiología , Adolescente , Densidad Ósea , Femenino , Humanos , Inmunosupresores/uso terapéutico , Prednisona , Tacrolimus
6.
Prog Transplant ; 26(4): 389-391, 2016 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-27872411

RESUMEN

Liver transplantation provides an important, often life-saving treatment for end-stage liver disease. Osteoporosis post-liver transplantation has been described in adults; however, this has not been described in the pediatric population to date. We present a case of a 13-year-old female patient who underwent an orthotopic liver transplant for cryptogenic liver cirrhosis. Her immunosuppressants were tacrolimus and prednisone. Four months posttransplant, she started complaining of bilateral lower limb pain and limping while walking, progressing to a point where she was almost immobile. Magnetic resonance imagining of the pelvis showed bilateral avascular necrosis involving the weight-bearing surfaces of both femoral heads, in addition to the extensive edema involving both hip joints. Bone mineral densitometry was below normal for her age at the hip and forearm. She was started on high-dose calcium and vitamin D supplement, as well as zoledronic acid with a remarkable symptomatic and functional improvement.

7.
BMC Res Notes ; 16(1): 176, 2023 Aug 18.
Artículo en Inglés | MEDLINE | ID: mdl-37596697

RESUMEN

BACKGROUND: The effects of COVID-19 on the organism are still being investigated, especially after the transformation of this virus from a respiratory disease in its first appearance to a multi-organ disease that can affect nearly all systems and organs including the endocrinological system. The objective of the study was to find an association between COVID-19 infection and new onset type 2 diabetes in Lebanese adults. METHODS: A retrospective case-control study (2019-2022) included 200 subjects, 100 cases with new onset diabetes and 100 controls recruited from endocrinology clinics in rural and suburban located regions of Lebanon. Univariate and multivariate logistic regression were performed. RESULTS: Older age (aOR = 1.07; 95% CI 1.03-1.12), higher BMI (aOR = 1.32; 95% CI 1.17-1.48), having been infected with COVID-19 (aOR = 2.38; 95% CI 1.001-5.68) and having a family history of diabetes (aOR = 11.80; 95% CI 4.23-32.87) were significantly associated with higher odds of having new onset type 2 diabetes after adjusting for multiple risk factors. CONCLUSION: In addition to the traditional risk factors for developing type 2 diabetes, a recent COVID-19 infection was associated with the new onset DM in our study. Subsequently screening for diabetes should be strongly recommended for patients post COVID-19 infection.


Asunto(s)
COVID-19 , Diabetes Mellitus Tipo 2 , Humanos , Adulto , Diabetes Mellitus Tipo 2/epidemiología , Estudios de Casos y Controles , Estudios Retrospectivos , COVID-19/epidemiología , Factores de Riesgo
8.
Aging Dis ; 9(1): 77-89, 2018 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-29392083

RESUMEN

In Lebanon, data stemming from national cross-sectional surveys indicated significant increasing trends in the prevalence of cardiovascular diseases and associated behavioral and age-related risk factors. To our knowledge, no data are available on relative telomere length (RTL) as a potential biomarker for age-related diseases in a Lebanese population. The aim of this study was to evaluate whether there is an association between RTL and demographic characteristics, lifestyle habits and diseases in the Lebanese. This was a cross-sectional study of 497 Lebanese subjects. Peripheral blood RTL was measured by amplifying telomere and single copy gene using real-time PCR. Mean ± SD RTL was 1.42 ± 0.83, and it was categorized into 3 tertiles. Older age (P=0.002) and wider waist circumference (WC) (P=0.001) were statistically significantly associated with shorter RTL. Multinomial logistic regression showed that subjects who had some level of sleeping difficulty had a statistically significantly shorter RTL when compared to those with no sleeping difficulties at all [OR (95% CI): 2.01 (1.11-3.62) in the first RTL tertile]. Importantly, statistically significantly shorter RTL was found with every additional 10 cm of WC [OR (95% CI): 1.30 (1.11-1.52) for first RTL tertile]. In addition, and after performing the multivariate logistic regression and adjusting for "predictors" of RTL, the odds of having hypertension or being treated for hypertension were higher in patients who had shorter RTL: OR (95% CI): 2.45 (1.36-4.44) and 2.28 (1.22-4.26) in the first RTL tertiles respectively with a similar trend, though not statistically significant, in the second RTL tertiles. This is the first study in Lebanon to show an association between age, central obesity, poor sleep and hypertension and RTL. It is hoped that telomere length measurement be potentially used as a biomarker for biological age and age-related diseases and progression in the Lebanese.

9.
Endocrine ; 59(1): 39-49, 2018 01.
Artículo en Inglés | MEDLINE | ID: mdl-29030774

RESUMEN

PURPOSE: In adults, growth hormone deficiency (GHD) has been associated with low bone mineral density (BMD), an effect counteracted by growth hormone (GH) replacement. Whether GH is beneficial in adults with age-related bone loss and without hypopituitarism is unclear. METHODS: We conducted a systematic literature search using Medline, Embase and the Cochrane Register of Controlled Trials. We extracted and analyzed data according to the bone outcome included [bone mineral content (BMC), BMD, and bone biomarker, fracture risk]. We performed a meta-analysis when possible. RESULTS: We included eight studies. Seven randomized 272 post-menopausal women, 61-69 years, to GH or control, for 6-24 months, and the eighth was an extension trial. Except for one study, all women received concurrent osteoporosis therapies. There was no significant effect of GH, as compared to control, on BMD at the lumbar spine (Weighted mean difference WMD = -0.01 [-0.04, 0.02]), total hip (WMD = 0 [-0.05, 0.06]) or femoral neck (WMD = 0 [-0.03, 0.04]). Similarly, no effect was seen on BMC. GH significantly increased the bone formation marker procollagen type-I carboxy-terminal propeptide (PICP) (WMD = 14.03 [2.68, 25.38]). GH resulted in a trend for increase in osteocalcin and in bone resorption markers. Patients who received GH had a significant decrease in fracture risk as compared to control (RR = 0.63 [0.46, 0.87]). Reported adverse events were not major, mostly related to fluid retention. CONCLUSION: GH may not improve bone density in women with age-related bone loss but may decrease fracture risk. Larger studies of longer duration are needed to further explore these findings in both genders, and to investigate the effect of GH on bone quality.


Asunto(s)
Densidad Ósea/efectos de los fármacos , Hormona de Crecimiento Humana/deficiencia , Hormona de Crecimiento Humana/farmacología , Hipopituitarismo/tratamiento farmacológico , Osteoporosis/tratamiento farmacológico , Fracturas Osteoporóticas/prevención & control , Anciano , Femenino , Fracturas Óseas/epidemiología , Fracturas Óseas/prevención & control , Terapia de Reemplazo de Hormonas , Humanos , Hipopituitarismo/complicaciones , Persona de Mediana Edad , Osteoporosis/complicaciones , Osteoporosis/epidemiología , Fracturas Osteoporóticas/epidemiología , Fracturas Osteoporóticas/etiología , Ensayos Clínicos Controlados Aleatorios como Asunto/estadística & datos numéricos , Factores de Riesgo
10.
Glob Heart ; 13(4): 275-283, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-29716848

RESUMEN

BACKGROUND: Lebanon has no established governmental noncommunicable diseases surveillance and monitoring system to permit reporting on noncommunicable diseases rates. The last World Health Organization-supported surveillance report showed worrying trends in cardiovascular disease (CVD) risk factors. OBJECTIVES: A cardiovascular cohort was established to permit CVD outcomes studies in an urban sample in the Lebanese capital and the study in hand presents the baseline CVD risk factors of this cohort. METHODS: A cross-sectional study was carried out including 501 Lebanese adults (64.3% women) from the Greater Beirut area using random multistage probability sampling. Interviews, physical exams, and blood withdrawal were conducted to collect information on demographic and lifestyle factors, body mass index, blood pressure, fasting blood glucose, blood lipids, as well as history of coronary artery diseases, hypertension, diabetes mellitus type 2, dyslipidemia, and stroke. Means with SD for continuous variables and frequencies and percentages for categorical variables are reported. RESULTS: The prevalence CVD risk factors including obesity, smoking, diabetes mellitus type 2, hypertension, and dyslipidemia prevalence in the Greater Beirut area was higher than that reported for the general population. Important sex and age differences were also observed, whereby older participants and women had higher rates of obesity, diabetes mellitus type 2, and dyslipidemia and younger participants and men were engaged more in cigarette smoking and alcohol consumption. Interestingly, water pipe smoking was similarly prevalent among genders. CONCLUSIONS: The overall prevalence of CVD risk factors in this urban population is higher than reported in the 2010 World Health Organization Stepwise Approach to Surveillance report on the Lebanese population, indicating that the urban population in the capital carries a higher burden of CVD risk. In addition, sex and age difference rates of CVD risk factors highlight the need for tailored public health measures to tackle the sex- and age-based CVD risk factors.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Países en Desarrollo , Medición de Riesgo , Población Urbana , Adulto , Estudios Transversales , Femenino , Humanos , Líbano/epidemiología , Masculino , Persona de Mediana Edad , Morbilidad/tendencias , Factores de Riesgo
11.
Metabolism ; 65(4): 586-97, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-26833101

RESUMEN

INTRODUCTION: Bariatric surgery is the most effective therapeutic option to reduce weight in morbidly obese individuals, but it results in a number of mineral and vitamin deficiencies. Clinical Practice Guidelines (CPGs) attempt to balance those benefits and harms to provide guidance to physicians and patients. OBJECTIVES: We compare and evaluate the quality of the evidence and of the development process of current CPGs that provide recommendations on vitamin D replacement in patients undergoing bariatric surgery, using a validated tool. METHODS: We searched 4 databases, with no time restriction, to identify relevant and current CPGs. Two reviewers assessed eligibility and abstracted data, in duplicate. They evaluated the quality of CPGs development process using the Appraisal of Guidelines, Research, and Evaluation II (AGREE II) tool that consists of 6 domains. A content expert verified those assessments. RESULTS: We identified 3 eligible CPGs: (1) the Endocrine Society (ES) guidelines (2010); (2) the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), and the American Society for Metabolic & Bariatric Surgery (ASMBS) guidelines (update 2013); and (3) the Interdisciplinary European (IE) guidelines on Metabolic and Bariatric Surgery (latest update 2014). The ES and the AACE/TOS/ASMBS guidelines recommended high doses of vitamin D, varying from 3000IU daily to 50,000IU 1-3 times weekly. Vitamin D doses were not mentioned in the IE guidelines. The recommendations were based on a low quality of evidence, if any, or limited to a single high quality trial, for some outcomes. In terms of quality, only the IE guidelines described their search methodology but none of the CPGs provided details on evidence selection and appraisal. None of the three CPGs rigorously assessed the preferences of the target population, resource implications, and the applicability of these guidelines. According to the AGREE II tool, we rated the ES guidelines as average in quality, and the other two as low in quality. CONCLUSION: Current CPGs recommendations on vitamin D supplementation in bariatric surgery differ between societies. They do not fulfill criteria for optimal guideline development, in part possibly due to limited resources, and are based on expert opinion. Thus, the pressing need for high quality randomized trials to inform CPGs, to be developed based on recommended standards.


Asunto(s)
Cirugía Bariátrica/efectos adversos , Guías como Asunto , Complicaciones Posoperatorias/tratamiento farmacológico , Deficiencia de Vitamina D/tratamiento farmacológico , Deficiencia de Vitamina D/etiología , Vitamina D/uso terapéutico , Vitaminas/uso terapéutico , Suplementos Dietéticos , Humanos , Obesidad Mórbida/cirugía , Complicaciones Posoperatorias/metabolismo , Vitamina D/administración & dosificación , Vitaminas/administración & dosificación
12.
Metabolism ; 65(4): 574-85, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-26805016

RESUMEN

BACKGROUND: Obesity is a public health problem that carries global and substantial social and economic burden. Relative to non-surgical interventions, bariatric surgery has the most substantial and lasting impact on weight loss. However, it leads to a number of nutritional deficiencies requiring long term supplementation. OBJECTIVES: The aims of this paper are to review 25-hydroxyvitamin D [25(OH)D] status pre and post bariatric surgery, describe the dose response of vitamin D supplementation, and assess the effect of the surgical procedure on 25(OH)D level following supplementation. METHODS: We searched Medline, PubMed, the Cochrane Library and EMBASE, for relevant observational studies published in English, from 2000 to April 2015. The identified references were reviewed, in duplicate and independently, by two reviewers. RESULTS: We identified 51 eligible observational studies assessing 25(OH)D status pre and/or post bariatric surgery. Mean pre-surgery 25(OH)D level was below 30ng/ml in 29 studies, and 17 of these studies showed mean 25(OH)D levels ≤20ng/ml. Mean 25(OH)D levels remained below 30ng/ml following bariatric surgery, despite various vitamin D replacement regimens, with only few exceptions. The increase in post-operative 25(OH)D levels tended to parallel increments in vitamin D supplementation dose but varied widely across studies. An increase in 25(OH)D level by 9-13ng/ml was achieved when vitamin D deficiency was corrected using vitamin D replacement doses of 1100-7100IU/day, in addition to the usual maintenance equivalent daily dose of 400-2000IU (total equivalent daily dose 1500-9100IU). There was no difference in mean 25(OH)D level following supplementation between malabsorptive/combination procedures and restrictive procedures. CONCLUSION: Hypovitaminosisis D persists in obese patients undergoing bariatric surgery, despite various vitamin D supplementation regimens. Further research is needed to determine the optimal vitamin D dose to reach desirable 25(OH)D levels in this population, and to demonstrate whether this dose varies according to the surgical procedure.


Asunto(s)
Cirugía Bariátrica/efectos adversos , Complicaciones Posoperatorias/metabolismo , Deficiencia de Vitamina D/etiología , Suplementos Dietéticos , Humanos , Obesidad Mórbida/cirugía , Estudios Observacionales como Asunto , Vitamina D/uso terapéutico , Deficiencia de Vitamina D/tratamiento farmacológico , Deficiencia de Vitamina D/metabolismo , Vitaminas/uso terapéutico
13.
Ther Adv Endocrinol Metab ; 5(3): 43-52, 2014 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-25126407

RESUMEN

AIM: Lebanon is among the top 10 countries with the highest prevalence of diabetes in the Middle East region with estimates reaching as high as 16.6% in adults aged 20-79 years. The objective of this study was to assess the level of A1C control among a cohort of type 2 diabetic patients and factors associated with uncontrolled A1C. METHODS: We carried out a retrospective observational study among type 2 diabetes mellitus patients attending an outpatient endocrinologist's clinic between June 2008 and July 2012 in Beirut, Lebanon. Two groups were compared, based on their diabetic control (A1C < 7% and A1C ≥ 7%). RESULTS: A total of 551 patients were included in this study, where 31.8% attained A1C control. Crude analyses showed that some factors were significantly associated with uncontrolled A1C, and these were long-standing diabetes, diabetes-related complications, uncontrolled blood pressure, lipid profile, as well as the use of metformin, sulfonylurea, or insulin. When multivariate analysis was carried out, the chances of having uncontrolled A1C were significantly higher among patients who developed neuropathy (odds ratio [OR] 2.08, 95% confidence interval [CI] 1.11-3.90), had uncontrolled triglycerides (OR 1.98, 95% CI 1.33-2.94), used insulin (OR 4.52, 95% CI 2.32-8.83), and sulfonylureas (OR 2.88, 95% CI 1.88-4.40). CONCLUSION: Uncontrolled diabetes is more likely to exist in patients with neuropathy, uncontrolled triglycerides and those using insulin or sulfonylurea. Further research is needed to confirm the findings.

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