True fractional calcium absorption is decreased after Roux-en-Y gastric bypass surgery.
OBJECTIVE
Roux-en-Y gastric bypass (RYGB) is considered to be the gold standard alternative treatment for severe obesity. Weight loss after RYGB results primarily from decreased food intake. Inadequate calcium (Ca) intake and metabolic bone disease can occur after gastric bypass. To our knowledge, whether malabsorption of Ca contributes to an altered Ca metabolism in the RYGB patient has not been addressed previously.


METHODS
We recruited 25 extremely obese women in order to study true fractional Ca absorption (TFCA) before and 6 months after RYGB surgery, using a dual stable isotope method ((42)Ca and (43)Ca) and test load of Ca (200 mg). Hormones regulating Ca absorption and markers of bone turnover were also measured.


RESULTS
In 21 women (BMI 52.7 +/- 8.3 kg/m(2), age 43.9 +/- 10.4 years) who successfully completed the study, TFCA decreased from 0.36 +/- 0.08 to 0.24 +/- 0.09 (p < 0.001) after RYGB. Bone turnover markers increased significantly (p < 0.01). TFCA correlated with estradiol levels (r = 0.512, p < 0.02) and tended to correlate with 1,25 (OH)(2)D (r = 0.427, p < 0.06) at final measurement. Stepwise linear regression indicated that estradiol explained 62% of the variance for TFCA at 6 months post-surgery (p < 0.01).


CONCLUSIONS
TFCA decreases (0.12 +/- 0.08) after RYGB surgery but remains within normal range. Although only some patients were estimated to have low Ca absorption after surgery, all of the patients showed a dramatic increase in markers of bone resorption. The alteration in Ca metabolism after RYGB-induced weight loss appears to be regulated primarily by estradiol levels and might ultimately affect bone mass.
Riedt
Claudia S
CS
Department of Nutritional Sciences, Rutgers University, 96 Lipman Drive, New Brunswick, NJ 08901, USA.
Brolin
Robert E
RE
Sherrell
Robert M
RM
Field
M Paul
MP
Shapses
Sue A
SA
D000328:Adult; D001862:Bone Resorption / Q000097:blood; D001842:Bone and Bones / Q000378:metabolism*; D002127:Calcium Isotopes; D002136:Calcium, Dietary / Q000493:pharmacokinetics*; D004958:Estradiol / Q000097:blood; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D007408:Intestinal Absorption / Q000187:drug effects / Q000502:physiology*; D016014:Linear Models; D009767:Obesity, Morbid / Q000378:metabolism / Q000601:surgery*; D013997:Time Factors; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood; D015431:Weight Loss / Q000502:physiology
D002127:Calcium Isotopes; D002136:Calcium, Dietary; D014807:Vitamin D; D004958:Estradiol; C104450:25-hydroxyvitamin D