Vitamin D Status 10 Years After Primary Gastric Bypass: Gravely High Prevalence of Hypovitaminosis D and Raised PTH Levels

Background

The primary aim of this study was to evaluate the prevalence of vitamin D deficiency and secondary hyperparathyroidism after Roux-en-Y gastric bypass. Secondly, we have tried to assess predictors for vitamin D deficiency.

Methods

Five hundred thirty-seven patients who underwent primary Roux-en-Y gastric bypass surgery between 1993 and 2003 at the Örebro University Hospital and Uppsala University Hospital were eligible for the study. Patients were asked to provide a blood sample between November 2009 and June 2010 and to complete a questionnaire about their postoperative health status. Serum values of 25-OH vitamin D, parathyroid hormone (PTH), alkaline phosphatase (ALP) and calcium were determined.

Results

Follow-up was completed in 293 patients, of which 83 % were female, with an age of 49?±?9.9 years after a median time of 11?±?2.8 years. Vitamin D, PTH and albumin-corrected calcium values were 42?±?20.4 nmol/L, 89.1?±?52.7 ng/L and 2.3?±?0.1 mmol/L, respectively. Of all patients, 65 % were vitamin D deficient, i.e. 25-OH vitamin D <50 nmol/L, and 69 % had PTH above the upper normal reference range, i.e. >73 ng/L. Vitamin D was inversely correlated with PTH levels (p?<?0.001) and positively correlated with calcium (p?=?0.016). Vitamin D did not correlate with ALP. The only factor found to predict vitamin D deficiency was high preoperative body mass index (BMI) (p?=?0.008), whereas gender, age, time after surgery and BMI at follow-up did not.

Conclusions

Vitamin D deficiency and secondary hyperparathyroidism after Roux-en-Y gastric bypass (RYGB) were confirmed in our study because 65 % of patients had vitamin D deficiency, and 69 % had increased PTH levels more than 10 years after surgery. These data are alarming and highlight the need for improved long-term follow-up. Vitamin D deficiency does not seem to progress with time after surgery, possibly due to weight loss. Only preoperative BMI, cutoff point 43 kg/m², was a predictor of vitamin D deficiency at follow-up. Improved long-term follow-up of patients that undergo RYGB is needed.     

Potential of on-line micro-LC immunochemical detection in the bioanalysis of cytokines

An on-line liquid chromatography-immunochemical detection (LC-ICD) system for the quantification of cytokines in cell extracts has been developed using a post-column continuous-flow reaction detection system using fluorescence labelled antibodies. Cytokines eluting from the micro-HPLC column react with antibodies to form fluorescent complexes. In a second step the excess of free antibody is trapped on a cytokine bound support prior to fluorescence detection. The concentration detection limit of the flow injection-ICD system was 50 pM (20 μl injection volume) for interleukine 4 (IL-4). An absolute detection limit of 1 fmol was obtained for IL-4. Similar to ICD systems for small non-protein analytes developed earlier, reaction times were in the order of 1 minute. The immobilised cytokine affinity columns can easily be regenerated and used for months. The present ICD system for interleukine 4, 6, 8 and 10 was coupled to ion exchange-, size exclusion- and reversed phase chromatography. Important parameters (reaction times, reaction conditions) were investigated to get a better understanding of post-column ICD systems for macromolecules.     

Personality traits in subtypes of alcoholics

Earlier studies have identified at least two distinct subgroups of alcoholics: Type II with early onset and high genetic loading and Type I with late onset in which genetic factors seem to be of minor importance. In the present study, type I and type II alcoholics are compared on stable personality traits determined by the Karolinska Scales of Personality. Both groups were found to have high scores on scales that measured somatic anxiety, psychic anxiety, muscular tension, impulsiveness, detachment, psychastenia, suspicion, guilt and inhibition of aggression. Both groups had low scores on the scale that measured socialization. Type II alcoholics had significantly higher scores than type I alcoholics on Somatic Anxiety and Verbal Aggression scales and significantly lower scores on Socialization and Inhibition of Aggression scales. On the Impulsive Sensation-Seeking Psychopathy factor (Impulsiveness + Monotony Avoidance - Socialization), type II alcoholics were significantly differentiated from both type I alcoholics and healthy volunteers. Results of this study were consistent with those of other studies indicating that alcoholism accompanied by antisocial behavior should be kept separate from alcoholism that is unrelated to antisocial behavior.