title: Fat-soluble vitamin deficiencies after bariatric surgery could be misleading if they are not appropriately adjusted.
abstract: OBJECTIVE
  To evaluate the differences in frequency of fat-soluble vitamin deficiencies if we adjust their levels by its main carriers in plasma in patients undergoing Biliopancreatic diversion (BPD) and Roux-en-Y gastric bypass (RYGB).
  
  
  METHODS
  We recruited 178 patients who underwent RYGB (n = 116 patients) and BPD (n = 62 patients) in a single centre. Basal data information and one-year after surgery included: anthropometric measurements, fat-soluble vitamins A, E and D, retinol binding protein (RBP) and total cholesterol as carriers of vitamin A and E respectively. Continuous data were compared using T-Student and proportions using chisquare test.
  
  
  RESULTS
  There was a vitamin D deficiency of 96% of all patients, 10% vitamin A deficiency and 1.2% vitamin E deficiency prior to surgery. One year after surgery, 33% of patients were vitamin A deficient but the frequency reduced to 19% when we adjusted by RBP. We found a vitamin E deficiency frequency of 0% in RYGB and 4.8% in DBP one year after surgery. However, when we adjusted the serum levels to total cholesterol, we found an increased frequency of 8.7% in RYGB group for vitamin E deficiency and 21.4% in DBP (p = 0.04).
  
  
  CONCLUSIONS
  We have found a different frequency of deficit for fat-soluble vitamin both in BPD and RYGB once we have adjusted for its main carriers. This is clinically relevant to prevent from overexposure and toxicity. We suggest that carrier molecules should be routinely requested when we assess fat-soluble vitamin status in patients who undergo malabsorptive procedures.
authors.affiliation: Department of Endocrinology and Nutrition. Hospital Clínico San Carlos. Instituto de Investigación Sanitaria San Carlos (IdISSC). Facultad de Medicina. Universidad Complutense. Madrid. Spain.. cuestamartintutor@gmail.com.
authors.forename: Martín
authors.initials: M
authors.lastname: Cuesta
authors.affiliation: Department of Endocrinology and Nutrition. Hospital Clínico San Carlos. Instituto de Investigación Sanitaria San Carlos (IdISSC). Facultad de Medicina. Universidad Complutense. Madrid. Spain.. laupelber@gmail.com.
authors.forename: Laura
authors.initials: L
authors.lastname: Pelaz
authors.affiliation: Department of Family Medicine. Hospital Clínico San Carlos. Instituto de Investigación Sanitaria San Carlos (IdISSC). Facultad de Medicina. Universidad Complutense. Madrid. Spain.. celiaperezpena@gmail.com.
authors.forename: Celia
authors.initials: C
authors.lastname: Pérez
authors.affiliation: Department of Clinical Analysis. Hospital Clínico San Carlos. Instituto de Investigación Sanitaria San Carlos (IdISSC). Facultad de Medicina. Universidad Complutense. Madrid. Spain.. mariajosefa.torrejon@salud.madrid.org.
authors.forename: M José
authors.initials: MJ
authors.lastname: Torrejón
authors.affiliation: Department of Endocrinology and Nutrition. Hospital Clínico San Carlos. Instituto de Investigación Sanitaria San Carlos (IdISSC). Facultad de Medicina. Universidad Complutense. Madrid. Spain.. lucio.cabrerizo@salud.madrid.org.
authors.forename: Lucio
authors.initials: L
authors.lastname: Cabrerizo
authors.affiliation: Department of Endocrinology and Nutrition. Hospital Clínico San Carlos. Instituto de Investigación Sanitaria San Carlos (IdISSC). Facultad de Medicina. Universidad Complutense. Madrid. Spain.. pilar.matia@gmail.com.
authors.forename: Pilar
authors.initials: P
authors.lastname: Matía
authors.affiliation: Department of Endocrinology and Nutrition. Hospital Clínico San Carlos. Instituto de Investigación Sanitaria San Carlos (IdISSC). Facultad de Medicina. Universidad Complutense. Madrid. Spain.. nataliaferre79@gmail.com.
authors.forename: Natalia
authors.initials: N
authors.lastname: Pérez-Ferre
authors.affiliation: Department of Surgery. Hospital Clínico San Carlos. Instituto de Investigación Sanitaria San Carlos (IdISSC). Facultad de Medicina. Universidad Complutense. Madrid. Spain.. pernaute@yahoo.com.
authors.forename: Andrés
authors.initials: A
authors.lastname: Sánchez-Pernaute
authors.affiliation: Department of Surgery. Hospital Clínico San Carlos. Instituto de Investigación Sanitaria San Carlos (IdISSC). Facultad de Medicina. Universidad Complutense. Madrid. Spain.. ajtorresgarcia@gmail.com.
authors.forename: Antonio
authors.initials: A
authors.lastname: Torres
authors.affiliation: Department of Endocrinology and Nutrition. Hospital Clínico San Carlos. Instituto de Investigación Sanitaria San Carlos (IdISSC). Facultad de Medicina. Universidad Complutense. Madrid. Spain.. marubioh@gmail.com.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Rubio
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001361:Avitaminosis / Q000097:blood* / Q000175:diagnosis / Q000209:etiology*; D015904:Biliopancreatic Diversion / Q000009:adverse effects*; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014802:Vitamin A Deficiency / Q000097:blood / Q000175:diagnosis / Q000209:etiology; D014811:Vitamin E Deficiency / Q000097:blood / Q000175:diagnosis / Q000209:etiology; D055815:Young Adult