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Severe obesity and vitamin D deficiency treatment options before bariatric surgery: a randomized clinical trial

Highlights1)Vitamin D deficiency is a pandemic issue and has a lot of impacts on our health.2)People with morbid obesity are more susceptible to be Vitamin D deficient.3)Bariatric surgeries can worsen vitamin D deficiency postoperatively.4)There are many studies about the prevalence of vitamin D deficiency in people with obesity and the treatment options postoperatively.5)This research is registered RCT on 100 patients, which was presented orally in 23rd IFSO congress in Dubai 2018.6)6-week-oral treatment with 50000 IU Vitamin D3 capsule had a higher impacts on serum 25(OH) Vitamin D.7)We recommend non-injection method for people with morbid obesity.8)We recommend bariatric surgeons to check 25(OH) Vitamin D before the surgery and treat this condition preoperatively while the patient is on the waiting list for the surgery.AbstractBackgroundObesity, which has various complications and co-morbidities, is an epidemic issue worldwide. Vitamin D deficiency (VDD) is a well-known metabolic disorder among patients with severe obesity. While they are good candidates for bariatric surgery, this deficiency can affect the outcome of surgery negatively.ObjectivesThe aim of this study was to compare 3 different VDD treatment strategies for use before bariatric surgery and compare serum vitamin D levels after 7 weeks.SettingsUniversity hospital, Isfahan, Iran.MethodsThis was a single-blinded, randomized clinical trial on 100 patients who were referred for bariatric surgery from 2016 to 2018. Vitamin D (VitD) level was checked before surgery for the patients included in the study, if their VitD level was <30 ng/mL. We rechecked their serum VitD in the 8th week, after 7 weeks of treatment. The participants were randomly allocated into 3 groups: 33 patients were treated with 50,000 units VitD3 capsules every week for 7 weeks; 33 patients were treated with a single dose of 300,000 units VitD3 ampoule; and 34 patients were treated with a combination of a half of the injection dose, followed by the oral capsule for 4 weeks.ResultsNo case was lost during the follow-up time. No significant differences were found among the 3 groups in terms of their age (P = .654), body mass index (P = .434), sex (P = .799), initial 25(OH) VitD level (P = .273), and history of supplement use (P = .45). Mean serum VitD levels were 15.21, 13.16, and 13.37 ng/mL, respectively, before the surgery and reached 32.91, 24.74, and 29.49 ng/mL after 7 weeks of treatment in oral, injection, and combined groups, respectively. Finally, the 7-week oral treatment option had significantly higher levels of VitD (P value = .034).ConclusionVDD treatment with 50,000 units VitD3 capsule every week for 7 weeks before bariatric surgery yields a higher level of VitD. Based on our findings, injectable supplements are not recommended for VDD treatment.

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