Calcium and vitamin D depletion and elevated parathyroid hormone following biliopancreatic diversion.
BACKGROUND
Biliopancreatic diversion (BPD) is associated with a 70% excess weight loss (EWL) at 10 years, but there are concerns regarding long-term nutritional sequelae. Metabolic bone disease has been documented following Roux-en-Y gastric bypass.


METHODS
Patients who underwent a BPD from 1998 to 2001 were studied. A questionnaire was designed to review BPD patients and collect information on weight loss, frequency of gastrointestinal disturbances and compliance with multivitamin recommendations. The review included a blood test for vitamin D, parathyroid hormone (PTH), alkaline phosphatase (ALP) and calcium.


RESULTS
Of the 82 patients who underwent BPD during this period, the median %EWL at 36 months was 73.0%. 75.6% suffered diarrhea. At median follow-up of 32 months (18-50), 25.9% of patients were hypocalcemic, 50% had low vitamin D, 23.8% had elevated ALP, and 63.1% had elevated PTH, despite 82.9% taking multivitamins.


CONCLUSIONS
BPD results in significant weight loss. However, 1 in 4 patients are hypocalcemic, and 1 in 2 have a low vitamin D, despite multivitamin supplementation. BPD patients require routine calcium and vitamin D supplementation for life. Long-term sequelae from these abnormal serum levels are not known.
Newbury
Leyanne
L
Department of Nutrition and Dietetics, Royal Brisbane Hospital, Herston, Brisbane, Australia. leyanne_newbury@health.qld.gov.au
Dolan
Kevin
K
Hatzifotis
Michael
M
Low
Nadeen
N
Fielding
George
G
D000469:Alkaline Phosphatase / Q000097:blood; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D015904:Biliopancreatic Diversion / Q000009:adverse effects*; D001851:Bone Diseases, Metabolic / Q000097:blood / Q000209:etiology*; D002118:Calcium / Q000097:blood; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D006996:Hypocalcemia / Q000097:blood / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D010281:Parathyroid Hormone / Q000097:blood; D014807:Vitamin D / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000209:etiology*
D010281:Parathyroid Hormone; D014807:Vitamin D; D000469:Alkaline Phosphatase; D002118:Calcium