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de Luis D, Izaola O, Primo D, López Gómez JJ, Pacheco D. Role of rs2282679 in 25-hydroxyvitamin D levels and insulin resistance after a sleeve gastrectomy. Nutr Diabetes 2024; 14:12. [PMID: 38570479 PMCID: PMC10991311 DOI: 10.1038/s41387-024-00272-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND & AIMS Some studies have reported links between 25-hydroxyvitamin D levels and the presence of obesity and some genetic variants. The aim of our design was to evaluate the effects of rs2282679 genetic variant of CG gene on 25-hydroxyvitamin D levels, weight loss and metabolic parameters after a robotic sleeve gastrectomy in premenopausal females with obesity. METHODS 76 participants were enrolled. 25-hydroxyvitamin D levels, biochemical evaluation and anthropometric parameters were registered before surgery and after 3, 6 and 12 months follow up. Genotype of rs2282679 CG gene was evaluated. RESULTS The improvements in anthropometric parameters, blood pressure and lipid profile were similar in both genotypes (TT vs TG + GG). Basal insulin levels and HOMA-IR were greater in G allele carriers than non-carriers (Delta: 6.7 ± 1.2 mUI/L; p = 0.01) and (Delta: 1.3 ± 0.1 units; p = 0.02). 25-hydroxyvitamin D levels were lower in G allele carriers than non-carriers (Delta: 8.1 ± 1.1 ng/dl; p = 0.03). The levels of insulin and HOMA-IR remained greater in G allele carriers than non-carriers throughout all the visits. The levels of 25-hydroxyvitamin D remained lower in G allele carriers than non-G allele. The average level of 25-hydroxyvitamin D at 12 months in non-G allele carriers were above 30 ng/dl (36.0 ± 3.1 ng/dl) and the level in G allele carriers were below (24.9 ± 4.9 ng/dl). CONCLUSIONS rs 2282679 (GC) was related with low 25 hydroxyvitamin D levels and insulin resistance. In addition, the presence of G allele produced a decrease in the improvement of 25-hydroxyvitamin D levels and insulin resistance after weight loss during 12 months.
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Affiliation(s)
- Daniel de Luis
- Endocrinology and Nutrition Research Center, School of Medicine, Valladolid, Spain.
- Department of Endocrinology and Nutrition, Hospital Clinico Universitario, University of Valladolid, Valladolid, Spain.
| | - Olatz Izaola
- Endocrinology and Nutrition Research Center, School of Medicine, Valladolid, Spain
- Department of Endocrinology and Nutrition, Hospital Clinico Universitario, University of Valladolid, Valladolid, Spain
| | - David Primo
- Endocrinology and Nutrition Research Center, School of Medicine, Valladolid, Spain
- Department of Endocrinology and Nutrition, Hospital Clinico Universitario, University of Valladolid, Valladolid, Spain
| | - Juan José López Gómez
- Endocrinology and Nutrition Research Center, School of Medicine, Valladolid, Spain
- Department of Endocrinology and Nutrition, Hospital Clinico Universitario, University of Valladolid, Valladolid, Spain
| | - David Pacheco
- Endocrinology and Nutrition Research Center, School of Medicine, Valladolid, Spain
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van der Meer R, Mohamed SA, Monpellier VM, Liem RSL, Hazebroek EJ, Franks PW, Frayling TM, Janssen IMC, Serlie MJ. Genetic variants associated with weight loss and metabolic outcomes after bariatric surgery: A systematic review. Obes Rev 2023; 24:e13626. [PMID: 37632325 DOI: 10.1111/obr.13626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/15/2023] [Accepted: 07/17/2023] [Indexed: 08/27/2023]
Abstract
The extent to which genetic variations contribute to interindividual differences in weight loss and metabolic outcomes after bariatric surgery is unknown. Identifying genetic variants that impact surgery outcomes may contribute to clinical decision making. This review evaluates current evidence addressing the association of genetic variants with weight loss and changes in metabolic parameters after bariatric surgery. A search was conducted using Medline, Embase, Scopus, Web of Science, and Cochrane Library. Fifty-two eligible studies were identified. Single nucleotide polymorphisms (SNPs) at ADIPOQ (rs226729, rs1501299, rs3774261, and rs17300539) showed a positive association with postoperative change in measures of glucose homeostasis and lipid profiles (n = 4), but not with weight loss after surgery (n = 6). SNPs at FTO (rs11075986, rs16952482, rs8050136, rs9939609, rs9930506, and rs16945088) (n = 10) and MC4R (rs11152213, rs476828, rs2229616, rs9947255, rs17773430, rs5282087, and rs17782313) (n = 9) were inconsistently associated with weight loss and metabolic improvement. Four studies examining the UCP2 SNP rs660339 reported associations with postsurgical weight loss. In summary, there is limited evidence supporting a role for specific genetic variants in surgical outcomes after bariatric surgery. Most studies have adopted a candidate gene approach, limiting the scope for discovery, suggesting that the absence of compelling evidence is not evidence of absence.
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Affiliation(s)
- Rieneke van der Meer
- Nederlandse Obesitas Kliniek, Huis ter Heide, The Netherlands
- Department of Endocrinology & Metabolism, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Siham A Mohamed
- Genetic and Molecular Epidemiology Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
| | | | - Ronald S L Liem
- Department of Surgery, Groene Hart Hospital, Gouda, The Netherlands
- Nederlandse Obesitas Kliniek, The Hague and Gouda, The Netherlands
| | - Eric J Hazebroek
- Department of Surgery, Rijnstate Hospital/Vitalys Clinics, Arnhem, The Netherlands
| | - Paul W Franks
- Genetic and Molecular Epidemiology Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Timothy M Frayling
- Genetics of Complex Traits, University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | - Mireille J Serlie
- Department of Endocrinology & Metabolism, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Endocrinology & Metabolism, Yale University, New Haven, CT, USA
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Giustina A, di Filippo L, Facciorusso A, Adler RA, Binkley N, Bollerslev J, Bouillon R, Casanueva FF, Cavestro GM, Chakhtoura M, Conte C, Donini LM, Ebeling PR, Fassio A, Frara S, Gagnon C, Latella G, Marcocci C, Mechanick JI, Minisola S, Rizzoli R, Santini F, Shaker JL, Sempos C, Ulivieri FM, Virtanen JK, Napoli N, Schafer AL, Bilezikian JP. Vitamin D status and supplementation before and after Bariatric Surgery: Recommendations based on a systematic review and meta-analysis. Rev Endocr Metab Disord 2023; 24:1011-1029. [PMID: 37665480 PMCID: PMC10698146 DOI: 10.1007/s11154-023-09831-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 09/05/2023]
Abstract
Bariatric surgery is associated with a postoperative reduction of 25(OH) vitamin D levels (25(OH)D) and with skeletal complications. Currently, guidelines for 25(OH)D assessment and vitamin D supplementation in bariatric patients, pre- and post-surgery, are still lacking. The aim of this work is to analyse systematically the published experience on 25(OH)D status and vitamin D supplementation, pre- and post-surgery, and to propose, on this basis, recommendations for management. Preoperatively, 18 studies including 2,869 patients were evaluated. Prevalence of vitamin D insufficiency as defined by 25(OH)D < 30 ng/mL (75 nmol/L) was 85%, whereas when defined by 25(OH)D < 20 ng/mL (50 nmol/L) was 57%. The median preoperative 25(OH)D level was 19.75 ng/mL. After surgery, 39 studies including 5,296 patients were analysed and among those undergoing either malabsorptive or restrictive procedures, a lower rate of vitamin D insufficiency and higher 25(OH)D levels postoperatively were observed in patients treated with high-dose oral vitamin D supplementation, defined as ≥ 2,000 IU/daily (mostly D3-formulation), compared with low-doses (< 2,000 IU/daily). Our recommendations based on this systematic review and meta-analysis should help clinical practice in the assessment and management of vitamin D status before and after bariatric surgery. Assessment of vitamin D should be performed pre- and postoperatively in all patients undergoing bariatric surgery. Regardless of the type of procedure, high-dose supplementation is recommended in patients after bariatric surgery.
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Affiliation(s)
- Andrea Giustina
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy.
| | - Luigi di Filippo
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Antonio Facciorusso
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Robert A Adler
- Richmond Veterans Affairs Medical Center and Virginia Commonwealth University, Richmond, VA, USA
| | | | | | - Roger Bouillon
- Laboratory of Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Ageing, 3000 KU, Leuven, Belgium
| | - Felipe F Casanueva
- Molecular Endocrinology Group, Instituto de Investigacion Sanitaria (IDIS), Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS). CIBER de Fisiopatologia de La Obesidad y Nutricion (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Giulia Martina Cavestro
- Gastroenterology and Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marlene Chakhtoura
- Calcium Metabolism and Osteoporosis Program, American University of Beirut-Medical Center, Beirut, Lebanon
| | - Caterina Conte
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Via Di Val Cannuta 247, 00166, Rome, Italy
| | - Lorenzo M Donini
- Experimental Medicine Department, Sapienza University, Rome, Italy
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Australia
| | - Angelo Fassio
- Rheumatology Unit, University of Verona, Verona, Italy
| | - Stefano Frara
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Claudia Gagnon
- Department of Medicine, Université Laval, Quebec City, Canada
| | - Giovanni Latella
- Gastroenterology, Hepatology and Nutrition Division, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Claudio Marcocci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Jeffrey I Mechanick
- Kravis Center for Clinical Cardiovascular Health at Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | | | - René Rizzoli
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Ferruccio Santini
- Obesity and Lipodystrophy Center, University Hospital of Pisa, Pisa, Italy
| | - Joseph L Shaker
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Fabio Massimo Ulivieri
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Jyrki K Virtanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Nicola Napoli
- Department of Medicine and Surgery, Research Unit of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy
| | - Anne L Schafer
- University of California, San Francisco and the San Francisco Veterans Affairs Health Care System, San Francisco, USA
| | - John P Bilezikian
- Department of Medicine, Endocrinology Division, Vagelos College of Physicians and Surgeons Columbia University, New York, NY, USA
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Haghighat N, Sohrabi Z, Bagheri R, Akbarzadeh M, Esmaeilnezhad Z, Ashtary-Larky D, Barati-Boldaji R, Zare M, Amini M, Hosseini SV, Wong A, Foroutan H. A Systematic Review and Meta-Analysis of Vitamin D Status of Patients with Severe Obesity in Various Regions Worldwide. Obes Facts 2023; 16:519-539. [PMID: 37640022 PMCID: PMC10697766 DOI: 10.1159/000533828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 08/14/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Managing nutritional deficiencies is an essential component in the treatment of severe obesity. Vitamin D deficiency is often reported in investigations in severely obese cohorts. However, no prior study has summarized findings on this topic. Consequently, the aim of this systematic review and meta-analysis was to investigate the 25-hydroxyvitamin D [25(OH)D] status in individuals with severe obesity in different regions worldwide. We also evaluated levels of calcium, parathyroid hormone (PTH), and magnesium as secondary outcome measures. METHODS We searched Medline, PubMed, Scopus, the Cochrane Library, and EMBASE for relevant observational studies published in English from 2009 to October 2021. The heterogeneity index among the studies was determined using the Cochran (Q) and I2 tests. Based on the heterogeneity results, the random-effect model was applied to estimate the prevalence of vitamin D deficiency. RESULTS We identified 109 eligible observational studies. Overall, 59.44% of patients had vitamin D deficiency [25(OH)D <20 ng/mL], whereas 26.95% had vitamin D insufficiency [25(OH)D 20-30 ng/mL]. Moreover, the mean 25(OH)D level was 18.65 ng/mL in 96 studies. The pooled mean estimate of the serum calcium, PTH, and magnesium was 9.26 mg/dL (95% confidence interval [CI]: 9.19-9.32, I2 = 99.7%, p < 0.001), 59.24 pg/mL (95% CI: 54.98, 63.51, I2 = 99.7%, p < 0.001), and 0.91 mg/dL (95% CI: 0.84, 0.98, I2 = 100.0%, p < 0.001), respectively. The results of the subgroup analysis indicated that the mean estimates of 25(OH)D were highest in North America (21.71 ng/mL [19.69, 23.74], [I2 = 97.2%, p < 0.001]) and lowest in Southeast Asia (14.93 ng/mL [14.54, 15.33], [I2 = 0.0%, p = 0.778]). CONCLUSION The results obtained showed a significant prevalence of vitamin D deficiency among severely obese individuals in various geographical regions, whereas the highest and lowest mean estimates were reported for North America and Southeast Asia, respectively.
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Affiliation(s)
- Neda Haghighat
- Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Sohrabi
- Department of Community Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Bagheri
- Department of Exercise Physiology, University of Isfahan, Isfahan, Iran
| | - Marzieh Akbarzadeh
- Department of Community Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Esmaeilnezhad
- Department of Community Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Damoon Ashtary-Larky
- Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Barati-Boldaji
- Department of Community Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Morteza Zare
- Department of Community Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoud Amini
- Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Alexei Wong
- Department of Health and Human Performance, Marymount University, Arlington, VA, USA
| | - Hamidreza Foroutan
- Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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de Luis DA, Izaola O, Primo D, López JJ, Pacheco D. A single FTO gene variant rs9939609 is associated with weight change and insulin resistance improvement in response to a robotic sleeve gastrectomy in individuals with severe obesity. Surg Obes Relat Dis 2022; 19:459-465. [PMID: 36509673 DOI: 10.1016/j.soard.2022.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 09/05/2022] [Accepted: 10/03/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Genetic mechanisms have been involved in the weight response secondary to bariatric surgery. OBJECTIVE The aim of our study was to evaluate the effects of the rs9939609 genetic variant on weight loss and metabolic parameters after sleeve gastrectomy. SETTING Tertiary hospital. METHODS A total of 95 participants were enrolled. Co-morbidities, biochemical evaluation, and anthropometric parameters were registered before and after 3-, 6-, and 12-month follow-up. Genotype of the rs9939609 fat mass and obesity-associated (FTO) gene was evaluated. RESULTS We grouped the participants into 2 groups: carriers of A allele (TA+AA, 69.5%) and noncarriers of A allele (TT, 30.5%). We detected a statistically significant reduction of blood pressure, biochemical, and anthropometric parameters at 3 times during follow-up. After 6 months, changes of some parameters were greater in non-A allele carriers: weight (-39.6 + 4.0 kg versus -24.6 + 2.8 kg; P = .02), waist circumference (-21.1 + 2.1 cm versus -16.2 + 1.8 cm; P = .04), insulin (-12.3 + .9 mUI/L versus -8.9.1 + .2 mUI/L; P = .02), and homeostasis model assessment of insulin resistance (-3.1 + .1 units versus -2.3 + .1 units; P = .02 ). After 12 months, changes of the aforementioned parameters remained greater in non-A allele carriers. The percentage of participants with diabetes diminished earlier in the non-A allele carriers than A allele carriers at 6-month follow-up. The percentage of participants with diabetes at the end of the study was lower in non-A allele carriers (3.4% versus 12.1%; P = .02). CONCLUSIONS Our data suggest that non-A allele carriers of the genetic variant (rs9939609) of the FTO gene showed a better improvement of anthropometric and insulin levels in non-A allele carriers after a robotic sleeve gastrectomy. Both improvements are associated with a lower percentage of participants with diabetes at 12 months.
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Affiliation(s)
- Daniel Antonio de Luis
- Endocrinology and Nutrition Research Center, School of Medicine, Department of Endocrinology and Nutrition, Hospital Clinico Universitario, University of Valladolid, Valladolid, Spain.
| | - Olatz Izaola
- Endocrinology and Nutrition Research Center, School of Medicine, Department of Endocrinology and Nutrition, Hospital Clinico Universitario, University of Valladolid, Valladolid, Spain
| | - David Primo
- Endocrinology and Nutrition Research Center, School of Medicine, Department of Endocrinology and Nutrition, Hospital Clinico Universitario, University of Valladolid, Valladolid, Spain
| | - Juan José López
- Endocrinology and Nutrition Research Center, School of Medicine, Department of Endocrinology and Nutrition, Hospital Clinico Universitario, University of Valladolid, Valladolid, Spain
| | - David Pacheco
- Endocrinology and Nutrition Research Center, School of Medicine, Department of Endocrinology and Nutrition, Hospital Clinico Universitario, University of Valladolid, Valladolid, Spain
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Vitamin D and Calcium Status Among Adolescents with Morbid Obesity Undergoing Bariatric Surgery. Obes Surg 2021; 32:738-741. [PMID: 34799812 DOI: 10.1007/s11695-021-05809-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 11/11/2021] [Accepted: 11/14/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Obesity is very prevalent among children and adolescents these days. Obese children are at increased risk of vitamin D and other micronutrient deficiencies. This risk is even higher in children and adolescents with morbid obesity who are candidates for bariatric surgery. Although multiple studies have studied the prevalence of vitamin D deficiency in adults undergoing bariatric surgery, studies are limited concerning adolescents in this regard. We aimed to study the prevalence of vitamin D deficiency and insufficiency and calcium status among morbidly obese children and adolescents. MATERIALS AND METHODS A number of 96 adolescents (20 years old and younger) with morbid obesity (BMI ≥ 99% percentile), who were candidates for bariatric surgery, were enrolled in this study (from 2016 to 2018), and their serum vitamin D and calcium levels were measured. RESULTS Sixty-four percent of the patients were vitamin D-deficient and 15.7% of them had insufficient levels of serum vitamin D. Only 20.2% of the children had sufficient serum vitamin D levels. Serum calcium levels were within the normal range among all of the patients. There was no significant relationship between age and sex with vitamin D levels. CONCLUSION Vitamin D deficiency is of very high prevalence among adolescents with morbid obesity.
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Gholamalizadeh M, Mokhtari Z, Doaei S, Jalili V, Davoodi SH, Jonoush M, Akbari ME, Hajipour A, Bahar B, Tabesh GA, Omidi S, Mosavi Jarrahi SA. The association between fat mass and obesity-associated (FTO) genotype and serum vitamin D level in breast cancer patients. J Cell Mol Med 2021; 25:9627-9633. [PMID: 34490746 PMCID: PMC8505832 DOI: 10.1111/jcmm.16908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/04/2021] [Accepted: 08/23/2021] [Indexed: 12/13/2022] Open
Abstract
The preventive effect of vitamin D against breast cancer can be influenced by gene polymorphisms. This study aimed to investigate the association between serum level of 25(OH) vitamin D and FTO genotype in breast cancer patients. A cross‐sectional study was carried out on 180 newly diagnosed patients with breast cancer in Tehran, Iran. The blood samples were collected from the participants in order to assess the FTO gene rs9939609 polymorphism by the tetra‐primer amplification refractory mutation system (Tetra‐ARMS) PCR method. The serum level of 25(OH) vitamin D was measured using the direct competitive enzyme‐linked immunosorbent assay (ELISA) method. The association between vitamin D and the FTO genotype in patients with breast cancer was assessed after adjustment for cofounders. The frequency of TT, AT and AA genotypes in the breast cancer patients were 43% (n = 77), 49% (n = 89) and 8% (n = 14), respectively. All patients with higher than 40 ng/dl of serum 25(OH) vitamin D had one or two copies of FTO rs9939609 risk allele (p = 0.019). No linear association was found between the number of FTO risk allele and the level of serum vitamin D. All patients with high serum level of 25(OH) vitamin D had one or two copies of FTO rs9939609 risk allele. FTO gene polymorphisms may counteract the beneficial effects of vitamin D in breast cancer prevention. Further studies can help to better understand the genetic factors predisposing to breast cancer and their effect on the association between vitamin D and breast cancer.
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Affiliation(s)
- Maryam Gholamalizadeh
- Student Research Committee, Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zohreh Mokhtari
- Department of Clinical Biochemistry, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeid Doaei
- Research Center of Health and Environment, Guilan University of Medical Sciences, Rasht, Iran
| | - Vahideh Jalili
- Faculty of Medicine, Urmia University of Medical sciences, Urmia, Iran
| | - Sayed Hossein Davoodi
- Departments of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mona Jonoush
- Department of Nutrition, School of Medicine, Mashahd University of Medical Sciences, Mashahad, Iran
| | | | - Azadeh Hajipour
- School of Health, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Bojlul Bahar
- Nutrition Sciences and Applied Food Safety Studies, Research Centre for Global Development, School of Sport & Health Sciences, University of Central Lancashire, Preston, UK
| | - Ghasem Azizi Tabesh
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Omidi
- Department of Health Education and Promotion, Research Center of Health and Environment, School of Health, Guilan University of Medical Sciences, Rasht, Iran
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Gholamalizadeh M, Doaei S, Mokhtari Z, Jalili V, Bourbour F, Omidi S, Ebrahimi K, Kalantari N, Abdi S, Azizi Tabesh G, Naimi Joubani M, Roohbakhsh E, Mosavi Jarrahi SA. Association of serum 25-OH-vitamin D level with FTO and IRX3 genes expression in obese and overweight boys with different FTO rs9930506 genotypes. J Transl Med 2021; 19:350. [PMID: 34399781 PMCID: PMC8365950 DOI: 10.1186/s12967-021-03029-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 08/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background The roles of FTO gene and the level of serum 25-OH-vitamin D in obesity are frequently reported. This study aimed to investigate the interactions of serum 25-OH-vitamin D level, FTO and IRX3 genes expression, and FTO genotype in obese and overweight boys. Methods This study was carried out on the 120 male adolescents with overweight in Tehran, Iran. Blood samples were collected from the participants in order to evaluate the serum level of 25-OH-vitamin D, the expression level of FTO and IRX3 genes, and FTO genotype for rs9930506 at baseline and after 18 weeks of the study. Results In general, no significant association was found between serum 25-OH-vitamin D level and IRX3 and FTO genes expression. The results of linear regression on the relationship between 25-OH-vitamin D serum level and FTO and IRX3 genes expression based on FTO genotypes for rs9930506 indicated that in AA/AG genotype carriers, serum 25-OH-vitamin D level was positively associated with FTO gene expression (B = 0.07, p = 0.02) and inversely associated with IRX3 gene expression (B = − 0.07, p = 0.03). In GG carriers, serum 25-OH-vitamin D level was not associated with expression of IRX3 and FTO genes. Conclusion There are significant interactions between 25-OH-vitamin D and the expression of FTO and IRX3 genes in the subset of obese patients with specific genotypes for FTO rs9930506. There was no association between serum 25-OH-vitamin D levels and the expression of FTO and IRX genes in individuals with a homozygous genotype for the risk allele of the FTO gene polymorphism.
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Affiliation(s)
- Maryam Gholamalizadeh
- Student Research Committee, Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeid Doaei
- Research center of Health and Enviroment, School of Health, Guilan university of Medical Sciences, rasht, Iran
| | - Zohreh Mokhtari
- Department of Clinical Biochemistry, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Vahideh Jalili
- Faculty of Medicine, Urmia University of Medical sciences, Urmia, Iran
| | - Fatemeh Bourbour
- Department of Clinical Nutrition and Dietetics, Research Institute Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Saeed Omidi
- Research center of Health and Enviroment, School of Health, Guilan university of Medical Sciences, rasht, Iran
| | - Kamal Ebrahimi
- Msc Student of Psychiatric Nursing, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Naser Kalantari
- Department of community Nutrition and Dietetics, Research Institute Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Sheyda Abdi
- Department of Biochemistry and Dietetics, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ghasem Azizi Tabesh
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Naimi Joubani
- Research center of Health and Enviroment, School of Health, Guilan university of Medical Sciences, rasht, Iran
| | - Esmaeil Roohbakhsh
- Research center of Health and Enviroment, School of Health, Guilan university of Medical Sciences, rasht, Iran
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Gupta SR, Zhou Y, Wadden TA, Berkowitz RI, Chao AM. A Systematic Review of Genetic Correlates of Weight Loss After Bariatric Surgery. Obes Surg 2021; 31:4612-4623. [PMID: 34370160 DOI: 10.1007/s11695-021-05585-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 11/29/2022]
Abstract
This systematic review synthesized research evaluating the relationship between genetic predictors and weight loss after bariatric surgery. Fifty-seven studies were identified that examined single genes or genetic risk scores. Uncoupling protein (UCP) rs660339 was associated with excess weight loss after surgery in 4 of 6 studies. The most commonly assessed genes were fat mass and obesity-associated (FTO) gene (n = 10) and melanocortin-4 receptor (MC4R) (n = 14). Both were inconsistently related to weight loss. Genetic risk scores predicted weight loss in 6 of 7 studies. This evidence suggests the potential of using genetic variants and genetic risk scores to predict the amount of weight loss anticipated after bariatric surgery and identify patients who may be at risk for suboptimal weight reduction.
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Affiliation(s)
- Sapana R Gupta
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Yingjie Zhou
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA, 19104, USA
| | - Thomas A Wadden
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Robert I Berkowitz
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ariana M Chao
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA, 19104, USA. .,Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
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10
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Mehrdad M, Eftekhari MH, Jafari F, Nikbakht HA, Gholamalizadeh M. Associations between FTO rs9939609 polymorphism, serum vitamin D, mental health, and eating behaviors in overweight adults. Nutr Neurosci 2021; 25:1889-1897. [PMID: 33939949 DOI: 10.1080/1028415x.2021.1913316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background: Despite the significant role of the Fat Mass and Obesity-Associated (FTO) gene in obesity, the underlying mechanisms are not fully elucidated. Besides, vitamin D deficiency and obesity are mostly seen together, and it can be hypothesized that this nutrient may have an impact in the role of FTO genotype in adiposity.Objective: Thus, this study aimed to investigate the association of FTO rs9939609 gene polymorphism with eating behaviors, eating disorders, and general mental health in overweight adults, considering their vitamin D intake as a mediate confounding factor.Methods: This cross-sectional study was carried out on 197 overweight adults in Shiraz, Iran. Genotyping was performed through amplification refractory mutation system polymerase chain reaction (ARMS PCR). Mental health, vitamin D intake, eating behaviors and disorders were assessed by the validated questionnaires.Results: The risk allele of the FTO rs9939609 polymorphism (A) was significantly associated with a higher risk of eating behavior and mental health disorders (all P < 0.05). After considering vitamin D intake, the AA genotype carriers had significantly higher risks for poorer eating behavior (P = 0.002), mental health (P = 0.007), and general mental health (P = 0.039) compared with the TT carriers if they had insufficient vitamin D intake.Conclusion: In conclusion, these results indicated that the A-allele of the FTO rs9939609 polymorphism may be associated with poorer eating behaviors, mental health, and higher risk of eating disorders. It was also identified that the effect of FTO rs9939609 A risk allele on eating behavior and mental health may be limited to people with insufficient vitamin D intake.
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Affiliation(s)
- Mahsa Mehrdad
- Department of Clinical Nutrition, School of Nutrition & Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hassan Eftekhari
- Department of Clinical Nutrition, School of Nutrition & Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Jafari
- Department of Clinical Nutrition, School of Nutrition & Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Clinical Nutrition, School of Nutrition & Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein-Ali Nikbakht
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Maryam Gholamalizadeh
- Student Research Committee, Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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11
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Kucher AN. The FTO Gene and Diseases: The Role of Genetic Polymorphism, Epigenetic Modifications, and Environmental Factors. RUSS J GENET+ 2020. [DOI: 10.1134/s1022795420090136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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12
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Personalized Nutrition for Management of Micronutrient Deficiency-Literature Review in Non-bariatric Populations and Possible Utility in Bariatric Cohort. Obes Surg 2020; 30:3570-3582. [PMID: 32564308 PMCID: PMC7378102 DOI: 10.1007/s11695-020-04762-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/01/2020] [Accepted: 06/04/2020] [Indexed: 02/07/2023]
Abstract
Background Bariatric surgery can effectively treat morbid obesity; however, micronutrient deficiencies are common despite recommendations for high-dose supplements. Genetic predisposition to deficiencies underscores necessary identification of high-risk candidates. Personalized nutrition (PN) can be a tool to manage these deficiencies. Methods Medline, PubMed, and Google Scholar were searched. Articles involving genetic testing, micronutrient metabolism, and bariatric surgery were included. Results Studies show associations between genetic variants and micronutrient metabolism. Research demonstrates genetic testing to be a predictor for outcomes among obesity and bariatric surgery populations. There is limited research in bariatric surgery and micronutrient genetic variants. Conclusion Genotype-based PN is becoming feasible to provide an effective treatment of micronutrient deficiencies associated with bariatric surgery. The role of genomic technology in micronutrient recommendations needs further investigation.
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Wilms B, Ernst B, Thurnheer M, Schmid SM, Spengler CM, Schultes B. Resting energy expenditure after Roux-en Y gastric bypass surgery. Surg Obes Relat Dis 2018; 14:191-199. [DOI: 10.1016/j.soard.2017.10.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/07/2017] [Accepted: 10/24/2017] [Indexed: 02/07/2023]
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14
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Bandstein M, Voisin S, Nilsson EK, Schultes B, Ernst B, Thurnheer M, Benedict C, Mwinyi J, Schiöth HB. A Genetic Risk Score Is Associated with Weight Loss Following Roux-en Y Gastric Bypass Surgery. Obes Surg 2017; 26:2183-2189. [PMID: 26832135 PMCID: PMC4985537 DOI: 10.1007/s11695-016-2072-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background Currently, Roux-en Y gastric bypass (RYGB) is the most efficient therapy for severe obesity. Weight loss after surgery is, however, highly variable and genetically influenced. Genome-wide association studies have identified several single nucleotide polymorphisms (SNP) associated with body mass index (BMI) and waist-hip ratio (WHR). We aimed to identify two genetic risk scores (GRS) composed of weighted BMI and WHR-associated SNPs to estimate their impact on excess BMI loss (EBMIL) after RYGB surgery. Methods Two hundred and thirty-eight obese patients (BMI 45.1 ± 6.2 kg/m2, 74 % women), who underwent RYGB, were genotyped for 35 BMI and WHR-associated SNPs and were followed up after 2 years. SNPs with high impact on post-surgical weight loss were filtered out using a random forest model. The filtered SNPs were combined into a GRS and analyzed in a linear regression model. Results An up to 11 % lower EBMIL with higher risk score was estimated for two GRS models (P = 0.026 resp. P = 0.021) composed of seven BMI-associated SNPs (closest genes: MC4R, TMEM160, PTBP2, NUDT3, TFAP2B, ZNF608, MAP2K5, GNPDA2, and MTCH2) and of three WHR-associated SNPs (closest genes: HOXC13, LYPLAL1, and DNM3-PIGC). Patients within the lowest GRS quartile had higher EBMIL compared to patients within the other three quartiles in both models. Conclusions We identified two GRSs composed of BMI and WHR-associated SNPs with significant impact on weight loss after RYGB surgery using random forest analysis as a SNP selection tool. The GRS may be useful to pre-surgically evaluate the risks for patients undergoing RYGB surgery. Electronic supplementary material The online version of this article (doi:10.1007/s11695-016-2072-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marcus Bandstein
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Box 593, 751 24, Uppsala, Sweden.
| | - Sarah Voisin
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Box 593, 751 24, Uppsala, Sweden
| | - Emil K Nilsson
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Box 593, 751 24, Uppsala, Sweden
| | - Bernd Schultes
- Interdisciplinary Obesity Center, eSwiss Medical & Surgical Center, St. Gallen, Switzerland
| | - Barbara Ernst
- Interdisciplinary Obesity Center, eSwiss Medical & Surgical Center, St. Gallen, Switzerland
| | - Martin Thurnheer
- Interdisciplinary Obesity Center, eSwiss Medical & Surgical Center, St. Gallen, Switzerland
| | - Christian Benedict
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Box 593, 751 24, Uppsala, Sweden
| | - Jessica Mwinyi
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Box 593, 751 24, Uppsala, Sweden
| | - Helgi B Schiöth
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Box 593, 751 24, Uppsala, Sweden
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15
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The importance of gene-environment interactions in human obesity. Clin Sci (Lond) 2017; 130:1571-97. [PMID: 27503943 DOI: 10.1042/cs20160221] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 05/23/2016] [Indexed: 12/16/2022]
Abstract
The worldwide obesity epidemic has been mainly attributed to lifestyle changes. However, who becomes obese in an obesity-prone environment is largely determined by genetic factors. In the last 20 years, important progress has been made in the elucidation of the genetic architecture of obesity. In parallel with successful gene identifications, the number of gene-environment interaction (GEI) studies has grown rapidly. This paper reviews the growing body of evidence supporting gene-environment interactions in the field of obesity. Heritability, monogenic and polygenic obesity studies provide converging evidence that obesity-predisposing genes interact with a variety of environmental, lifestyle and treatment exposures. However, some skepticism remains regarding the validity of these studies based on several issues, which include statistical modelling, confounding, low replication rate, underpowered analyses, biological assumptions and measurement precision. What follows in this review includes (1) an introduction to the study of GEI, (2) the evidence of GEI in the field of obesity, (3) an outline of the biological mechanisms that may explain these interaction effects, (4) methodological challenges associated with GEI studies and potential solutions, and (5) future directions of GEI research. Thus far, this growing body of evidence has provided a deeper understanding of GEI influencing obesity and may have tremendous applications in the emerging field of personalized medicine and individualized lifestyle recommendations.
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Chakhtoura MT, Nakhoul NN, Shawwa K, Mantzoros C, El Hajj Fuleihan GA. Hypovitaminosis D in bariatric surgery: A systematic review of observational studies. Metabolism 2016; 65:574-85. [PMID: 26805016 PMCID: PMC4792683 DOI: 10.1016/j.metabol.2015.12.004] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 11/08/2015] [Accepted: 12/12/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Obesity is a public health problem that carries global and substantial social and economic burden. Relative to non-surgical interventions, bariatric surgery has the most substantial and lasting impact on weight loss. However, it leads to a number of nutritional deficiencies requiring long term supplementation. OBJECTIVES The aims of this paper are to review 25-hydroxyvitamin D [25(OH)D] status pre and post bariatric surgery, describe the dose response of vitamin D supplementation, and assess the effect of the surgical procedure on 25(OH)D level following supplementation. METHODS We searched Medline, PubMed, the Cochrane Library and EMBASE, for relevant observational studies published in English, from 2000 to April 2015. The identified references were reviewed, in duplicate and independently, by two reviewers. RESULTS We identified 51 eligible observational studies assessing 25(OH)D status pre and/or post bariatric surgery. Mean pre-surgery 25(OH)D level was below 30ng/ml in 29 studies, and 17 of these studies showed mean 25(OH)D levels ≤20ng/ml. Mean 25(OH)D levels remained below 30ng/ml following bariatric surgery, despite various vitamin D replacement regimens, with only few exceptions. The increase in post-operative 25(OH)D levels tended to parallel increments in vitamin D supplementation dose but varied widely across studies. An increase in 25(OH)D level by 9-13ng/ml was achieved when vitamin D deficiency was corrected using vitamin D replacement doses of 1100-7100IU/day, in addition to the usual maintenance equivalent daily dose of 400-2000IU (total equivalent daily dose 1500-9100IU). There was no difference in mean 25(OH)D level following supplementation between malabsorptive/combination procedures and restrictive procedures. CONCLUSION Hypovitaminosisis D persists in obese patients undergoing bariatric surgery, despite various vitamin D supplementation regimens. Further research is needed to determine the optimal vitamin D dose to reach desirable 25(OH)D levels in this population, and to demonstrate whether this dose varies according to the surgical procedure.
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Affiliation(s)
- Marlene Toufic Chakhtoura
- Division of Endocrinology, Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, Beirut, Lebanon; Scholars in HeAlth Research Program (SHARP), American University of Beirut Medical Center, Beirut, Lebanon.
| | - Nancy N Nakhoul
- Scholars in HeAlth Research Program (SHARP), American University of Beirut Medical Center, Beirut, Lebanon; Division of Endocrinology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Khaled Shawwa
- Scholars in HeAlth Research Program (SHARP), American University of Beirut Medical Center, Beirut, Lebanon
| | - Christos Mantzoros
- Division of Endocrinology, Diabetes and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ghada A El Hajj Fuleihan
- Division of Endocrinology, Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, Beirut, Lebanon
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Peterson LA, Zeng X, Caufield-Noll CP, Schweitzer MA, Magnuson TH, Steele KE. Vitamin D status and supplementation before and after bariatric surgery: a comprehensive literature review. Surg Obes Relat Dis 2016; 12:693-702. [PMID: 27036669 DOI: 10.1016/j.soard.2016.01.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/11/2015] [Accepted: 01/01/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Bariatric surgery is the most effective long-term weight loss method. The most common procedures are Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG). Bariatric patients are at high risk of vitamin D deficiency (VDD) and insufficiency (VDI), which are associated with skeletal and nonskeletal ailments. There is no consensus regarding the optimal treatment for VDD/VDI in bariatric patients. OBJECTIVES To critically examine the literature on vitamin D status (serum 25[OH]D concentrations) pre- and postbariatric surgery as well as supplementation regimens currently used. METHODS We searched PubMed, Embase, and Cochrane from inception to May 2015 for articles relating to vitamin D, RYGB, and VSG. Of 208 citations retrieved, 30 were included. RESULTS Preoperative VDD (<20 ng/mL) ranged from 13% to 90%, while VDI (<30 ng/mL) was found in up to 98%. Prevalence remained similar postoperatively and was highest after RYGB. Most studies found dosages<800 IU daily insufficient postbariatric surgery. Other studies examined the effectiveness of dosages between 1000 and 5000 IU daily, reaching similar conclusions. Several studies suggested using 50,000 IU weekly plus a daily dose. No studies reported optimization. CONCLUSIONS It is widely accepted that serum 25(OH)D concentrations above 30 ng/mL are optimal; however, current postbariatric vitamin D supplementation fails to raise 25(OH)D above that level universally. This review highlights both the great need and the lack of consensus on the optimal supplementation regimen (dosage and frequency) for pre- and postbariatric patients. Future studies should investigate multiple regimens and attempt to identify methods for personalizing these regimens if found necessary.
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Affiliation(s)
| | - Xiange Zeng
- The Johns Hopkins Krieger School of Arts and Sciences, Baltimore, Maryland
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