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The mediating role of bariatric surgery in the metabolic relationship between parathyroid hormone and 25-hydroxyvitamin D

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Abstract

Summary

Vitamin D metabolism is altered in obese individuals. Our findings indicated that in patients with severe obesity, a relatively low 25(OH)D concentration was required to suppress PTH. The PTH inflection point increased following surgery-induced weight loss, highlighting 25(OH)D different regulation mechanisms in patients with obesity.

Introduction

An optimal and sufficient concentration of 25-hydroxyvitamin D (25(OH)D) has been suggested as the level required to maximally suppress intact parathyroid hormone (iPTH). We evaluated the role of surgery-induced weight loss in determining the threshold(s) of 25(OH)D required to suppress iPTH.

Methods

This study was conducted in the framework of the Tehran Obesity Treatment Study (TOTS). We prospectively analyzed 687 patients with severe obesity who participated in the TOTS and underwent bariatric surgery from March 2013 to March 2019. The patients were followed for 1 year after surgery. Anthropometric parameters and serum levels of iPTH, 25OHD, phosphorous, and calcium were measured. Nonlinear and piecewise linear regression was used to evaluate the relationship between 25(OH)D and iPTH and to determine the 25(OH)D-suppression point at which iPTH was maximally suppressed.

Results

Body mass index was 44.6 kg/m2 at the baseline and decreased to 29.7 kg/m2 1 year after surgery (P < 0.05). Before the surgery, iPTH and 25(OH)D showed an exponential relationship; iPTH began to decrease rapidly at 25(OH)D concentration of 12 ng/mL, reaching maximal suppression at 30 ng/mL. However, the relationship between 25(OH)D and iPTH was non-exponential 1 year after surgery. The piecewise linear regression model revealed the 25(OH)D concentration of 21 ng/mL as the inflection point following surgery-induced weight loss.

Conclusion

In patients with severe obesity, PTH was suppressed at a relatively lower concentration of 25(OH)D; this threshold increased following surgery-induced weight loss. These findings suggest a role for bariatric surgery in regulating 25(OH)D metabolism in patients with obesity.

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Data availability

The datasets used and analyzed in the current study are available from the corresponding author on reasonable request.

References

  1. DeLuca HF (2004) Overview of general physiologic features and functions of vitamin D. Am J Clin Nutr 80(6 Suppl):1689s-s1696

    Article  CAS  PubMed  Google Scholar 

  2. Holick MF (2007) Vitamin D deficiency. N Engl J Med 357(3):266–281

    Article  CAS  PubMed  Google Scholar 

  3. Fuleihan GE-H, Rahme M, Bassil D (2013) Do desirable vitamin D levels vary globally? Nutritional influences on bone health Springer 273–99

  4. Brannon PM, Yetley EA, Bailey RL, Picciano MF (2008) Summary of roundtable discussion on vitamin D research needs. Am J Clin Nutr 88(2):587s-s592

    Article  CAS  PubMed  Google Scholar 

  5. Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R (2005) Estimates of optimal vitamin D status. Osteoporosis Int : a Journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 16(7):713–716

    Article  CAS  Google Scholar 

  6. SSE,S (2010) Lips Worldwide status of vitamin D nutrition. The Journal of steroid biochemistry and molecular biology 121(1–2) 297–300

  7. Arabi A, El Rassi R, El-Hajj FG (2010) Hypovitaminosis D in developing countries-prevalence, risk factors and outcomes. Nat Rev Endocrinol 6(10):550–561

    Article  CAS  PubMed  Google Scholar 

  8. Shapses SA, Lee EJ, Sukumar D, Durazo-Arvizu R, Schneider SH (2013) The effect of obesity on the relationship between serum parathyroid hormone and 25-hydroxyvitamin D in women. J Clin Endocrinol Metab 98(5):E886–E890

    Article  PubMed  PubMed Central  Google Scholar 

  9. Gannagé-Yared MH, Chemali R, Yaacoub N, Halaby G (2000) Hypovitaminosis D in a sunny country: relation to lifestyle and bone markers. JBMR : Off J Am Soc Bone Mineral Res 15(9):1856–1862

    Article  Google Scholar 

  10. Hill KM, McCabe GP, McCabe LD, Gordon CM, Abrams SA, Weaver CM (2010) An inflection point of serum 25-hydroxyvitamin D for maximal suppression of parathyroid hormone is not evident from multi-site pooled data in children and adolescents. J Nutr 140(11):1983–1988

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Durazo-Arvizu RA, Dawson-Hughes B, Sempos CT, Yetley EA, Looker AC, Cao G et al (2010) Three-phase model harmonizes estimates of the maximal suppression of parathyroid hormone by 25-hydroxyvitamin D in persons 65 years of age and older. J Nutr 140(3):595–599

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Sai AJ, Walters RW, Fang X, Gallagher JC (2011) Relationship between vitamin D, parathyroid hormone, and bone health. J Clin Endocrinol Metab 96(3):E436–E446

    Article  CAS  PubMed  Google Scholar 

  13. Asghari G, Yuzbashian E, Wagner CL, Mahdavi M, Shamsi R, Hosseinpanah F et al (2019) The relation between circulating levels of vitamin D and parathyroid hormone in children and adolescents with overweight or obesity: Quest for a threshold. PLoS One 14(11):e0225717

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Snijder MB, van Dam RM, Visser M, Deeg DJ, Dekker JM, Bouter LM et al (2005) Adiposity in relation to vitamin D status and parathyroid hormone levels: a population-based study in older men and women. J Clin Endocrinol Metab 90(7):4119–4123

    Article  CAS  PubMed  Google Scholar 

  15. Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF (2000) Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr 72(3):690–693

    Article  CAS  PubMed  Google Scholar 

  16. Grethen E, McClintock R, Gupta CE, Jones R, Cacucci BM, Diaz D et al (2011) Vitamin D and hyperparathyroidism in obesity. J Clin Endocrinol Metab 96(5):1320–1326

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Gloy VL, Briel M, Bhatt DL, Kashyap SR, Schauer PR, Mingrone G et al (2013) Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. BMJ (Clinical research ed) 347:f5934

    Google Scholar 

  18. Wei JH, Lee WJ (2018) High incidence of secondary hyperparathyroidism in bariatric patients: comparing different procedures. Obes Surg 28(3):798–804

    Article  PubMed  Google Scholar 

  19. Hultin H, Edfeldt K, Sundbom M (2010) Hellman Left-shifted relation between calcium and parathyroid hormone in obesity. J Clin Endocrinol Metab 95(8):3973–3981

    Article  CAS  PubMed  Google Scholar 

  20. Barzin M, Hosseinpanah F (2016) Bariatric surgery for morbid obesity: Tehran Obesity Treatment Study (TOTS) Rationale and Study Design. JMIR Res Protoc 5(1):e8

    Article  PubMed  PubMed Central  Google Scholar 

  21. Bouillon R, Van Schoor NM, Gielen E, Boonen S, Mathieu C, Vanderschueren D et al (2013) Optimal vitamin D status: a critical analysis on the basis of evidence-based medicine. J Clin Endocrinol Metab 98(8):E1283–E1304

    Article  CAS  PubMed  Google Scholar 

  22. Adams JS, Clemens TL, Parrish JA, Holick MF (1982) Vitamin-D synthesis and metabolism after ultraviolet irradiation of normal and vitamin-D-deficient subjects. N Engl J Med 306(12):722–725

    Article  CAS  PubMed  Google Scholar 

  23. Hewison M, Burke F, Evans KN, Lammas DA, Sansom DM, Liu P et al (2007) Extra-renal 25-hydroxyvitamin D3–1alpha-hydroxylase in human health and disease. J Steroid Biochem Mol Biol 103(3–5):316–321

    Article  CAS  PubMed  Google Scholar 

  24. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP et al (2011) Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 96(7):1911–1930

    Article  CAS  PubMed  Google Scholar 

  25. Himbert C, Ose J, Delphan M, Ulrich CM (2017) A systematic review of the interrelation between diet- and surgery-induced weight loss and vitamin D status. Nutri Res (New York, NY) 38:13–26

    Article  CAS  Google Scholar 

  26. Amini Z, Bryant S, Smith C, Singh R, Kumar S (2013) Is the serum vitamin D-parathyroid hormone relationship influenced by obesity in children? Hormone Res Paediatr 80(4):252–256

    Article  CAS  Google Scholar 

  27. Çelik N, Doğan HO, Zararsiz G (2021) Different threshold levels of circulating total and free 25-hydroxyvitamin D for the diagnosis of vitamin D deficiency in obese adolescents. Eur J Pediatr 180(8):2619–2627

    Article  PubMed  Google Scholar 

  28. Salazar DA, Ferreira MJS, Neves JS, Pedro JMP, Guerreiro VA, S ESV, et al (2020) Variable thresholds of vitamin D plasma levels to suppress PTH: the effect of weight and bariatric surgery. Obesity surgery 30(4):1551–9

    Article  PubMed  Google Scholar 

  29. Looker AC (2007) Do body fat and exercise modulate vitamin D status? Nutr Rev 65(8 Pt 2):S124–S126

    Article  PubMed  Google Scholar 

  30. Pourshahidi LK (2015) Vitamin D and obesity: current perspectives and future directions. Proc Nutr Soc 74(2):115–124

    Article  CAS  PubMed  Google Scholar 

  31. Walsh JS, Bowles S, Evans AL (2017) Vitamin D in obesity. Curr Opin Endocrinol Diabetes Obes 24(6):389–394

    Article  CAS  PubMed  Google Scholar 

  32. Malmberg P, Karlsson T, Svensson H, Lönn M, Carlsson NG, Sandberg AS et al (2014) A new approach to measuring vitamin D in human adipose tissue using time-of-flight secondary ion mass spectrometry: a pilot study. J Photochem Photobiol, B 138:295–301

    Article  CAS  Google Scholar 

  33. Tian Z, Fan XT, Li SZ, Zhai T, Dong J (2020) Changes in bone metabolism after sleeve gastrectomy versus gastric bypass: a meta-analysis. Obes Surg 30(1):77–86

    Article  PubMed  Google Scholar 

  34. Parikh SJ, Edelman M, Uwaifo GI, Freedman RJ, Semega-Janneh M, Reynolds J et al (2004) The relationship between obesity and serum 1,25-dihydroxy vitamin D concentrations in healthy adults. J Clin Endocrinol Metab 89(3):1196–1199

    Article  CAS  PubMed  Google Scholar 

  35. Lagunova Z, Porojnicu AC, Vieth R, Lindberg FA, Hexeberg S, Moan J (2011) Serum 25-hydroxyvitamin D is a predictor of serum 1,25-dihydroxyvitamin D in overweight and obese patients. J Nutr 141(1):112–117

    Article  CAS  PubMed  Google Scholar 

  36. Vimaleswaran KS, Berry DJ, Lu C, Tikkanen E, Pilz S, Hiraki LT et al (2013) Causal relationship between obesity and vitamin D status: bi-directional Mendelian randomization analysis of multiple cohorts. PLoS Med 10(2):e1001383

    Article  PubMed  PubMed Central  Google Scholar 

  37. Jiang X, Ge T, Chen CY (2021) The causal role of circulating vitamin D concentrations in human complex traits and diseases: a large-scale Mendelian randomization study. Sci Rep 11(1):184

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Ding C, Gao D, Wilding J, Trayhurn P, Bing C (2012) Vitamin D signalling in adipose tissue. Br J Nutr 108(11):1915–1923

    Article  CAS  PubMed  Google Scholar 

  39. Roizen JD, Long C, Casella A, O’Lear L, Caplan I, Lai M et al (2019) Obesity decreases hepatic 25-hydroxylase activity causing low serum 25-hydroxyvitamin D. JBMR : Off J Am Soc Bone Mineral Res 34(6):1068–1073

    Article  CAS  Google Scholar 

  40. Rayalam S, Della-Fera MA, Ambati S, Yang JY, Park HJ, Baile CA (2008) Enhanced effects of 1,25(OH)(2)D(3) plus genistein on adipogenesis and apoptosis in 3T3-L1 adipocytes. Obesity (Silver Spring, Md) 16(3):539–546

    Article  CAS  Google Scholar 

  41. Makris K, Bhattoa HP, Cavalier E, Phinney K, Sempos CT, Ulmer CZ et al (2021) Recommendations on the measurement and the clinical use of vitamin D metabolites and vitamin D binding protein - a position paper from the IFCC Committee on bone metabolism. Clin Chim acta; Int journal Clin Chem 517:171–97

    Article  CAS  Google Scholar 

  42. Corica D, Zusi C, Olivieri F, Marigliano M, Piona C, Fornari E et al (2019) Vitamin D affects insulin sensitivity and β-cell function in obese non-diabetic youths. Eur J Endocrinol 181(4):439–450

    Article  CAS  PubMed  Google Scholar 

  43. Hosseini-Esfahani F, Khalaj A, Valizadeh M, Azizi F, Barzin M (2021) Mirmiran Nutrient intake and deficiency of patients 1 year after bariatric surgery: Tehran Obesity Treatment Study (TOTS). J gastrointes Surg : Off J Soc Surg Alimentary Tract 25(4):911–918

    Article  Google Scholar 

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Acknowledgements

The authors would like to thank the hospital staff, assistants, and coordinators who took part in this research. Also, special thanks to Mohammadreza Golsibi for his assistance and support of the electronic data collection system. This article was derived from the disease registry entitled “Registration of patients in Tehran Obesity Treatment Center” and approved under the ethical code of “IR.SBMU.ENDOCRINE.REC1397.059” (date: 2018-05-08) by the local ethics committee. The study was supported by the deputy of research and technology of Shahid Beheshti University of Medical Sciences (http://dregistrysbmu.ac.ir).

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Authors and Affiliations

  1. Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Maryam Barzin, Amir Ebadinejad, Farnaz Vahidi, Maryam Mahdavi, Majid Valizadeh & Farhad Hosseinpanah

  2. Tehran Obesity Treatment Center, Department of Surgery, Faculty of Medicine, Shahed University, Tehran, Iran

    Alireza Khalaj

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Contributions

MB, study design, data collection, the coordination of patients’ issues and manuscript preparation, and the final approval of the manuscript. AE, data collection, literature review, and manuscript preparation. FV, data collection, literature review, and manuscript preparation. AK, study design, performing surgical operations, and the final approval of the manuscript. MM, data analysis, interpretation, and manuscript preparation. MV, final approval of the manuscript. FH, study design, revising, and the final approval of the manuscript. All authors reviewed and approved the final draft of the manuscript.

Corresponding author

Correspondence to Farhad Hosseinpanah.

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Ethics approval and consent to participate

All the procedures performed in the study were approved by the Research Ethics Committee of the Research Institute for Endocrine Sciences of Shahid Beheshti University of Medical Sciences and were in accordance with the ethical standards of the institutional Human Research Review Committee (No. 2ECRIES 93/03/13) and the 1964 Helsinki Declaration and its later amendments. Informed written consent was obtained from all participants.

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Barzin, M., Ebadinejad, A., Vahidi, F. et al. The mediating role of bariatric surgery in the metabolic relationship between parathyroid hormone and 25-hydroxyvitamin D. Osteoporos Int 33, 2585–2594 (2022). https://doi.org/10.1007/s00198-022-06533-5

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