ometendoОжирение и метаболизмObesity and metabolism2071-87132306-5524Endocrinology Research Centre10.14341/omet12702ometendo-12702Research ArticleОБЗОРЫREVIEWSВлияние бариатрической хирургии на костный метаболизм: в фокусе витамин DEffects of bariatric surgery on bone metabolism: focusing on vitamin Dhttps://orcid.org/0000-0001-9253-8075СуплотоваЛ. А.AvdeevaV. A.

Суплотова Людмила Александровна, доктор медицинских наук, профессор

Тюмень

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Valeria A. Avdeeva, MD, PhD

54 Odesskaya street, 625023 Tyumen

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suplotovala@mail.ruhttps://orcid.org/0000-0002-8642-9435АвдееваВ. А.SuplotovaL. A.

Авдеева Валерия Александровна, кандидат медицинских наук

625023, г. Тюмень, ул. Одесская, д. 54

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Liudmila A. Suplotova, MD, PhD, Professor

Tyumen

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dr.avdeeva@yahoo.comhttps://orcid.org/0000-0001-7041-0732РожинскаяЛ. Я.RozhinskayaL. Y.

Рожинская Людмила Яковлевна, доктор медицинских наук, профессор

117036, г. Москва, ул. Дмитрия Ульянова, д. 11

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Liudmila Y. Rozhinskaya, MD, PhD, Professor

Tyumen

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lrozhinskaya@gmail.comТюменский государственный медицинский университеРоссияTyumen State Medical UniversityRussian FederationТюменский государственный медицинский университетРоссияTyumen State Medical UniversityRussian FederationНациональный медицинский исследовательский центр эндокринологииРоссияEndocrinology Research CentreRussian Federation202210022022191116122Copyright © Суплотова Л.А., Авдеева В.А., Рожинская Л.Я., 20222022Суплотова Л.А., Авдеева В.А., Рожинская Л.Я.Avdeeva V.A., Suplotova L.A., Rozhinskaya L.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.omet-endojournals.ru/jour/article/view/12702

Основной целью бариатрической хирургии является снижение веса за счет кардинальных дифференциальных изменений анатомо-физиологических особенностей желудочно-кишечного тракта. При этом одним из наиболее частых осложнений хирургии ожирения, особенно операций, связанных с нарушением всасывания, является дефицит витамина D. Пациенты с ожирением изначально имеют широкий спектр предрасполагающих факторов к метаболическим заболеваниям скелета из-за проблем, связанных с образом жизни. Дефицит питательных веществ при высококалорийном питании и малоподвижный образ жизни с тенденцией носить одежду, закрывающую большую часть кожных покровов, снижают уровень 25(OH)D в сыворотке крови. К тому же ситуация усугубляется уменьшением биодоступности 25(ОН)D из-за его секвестрации в жировой ткани и полной недоступностью его для центрального кровотока. Последствия бариатрической операции — уменьшение количества кожи и нарушение всасывания могут усугубить имеющийся дефицит. В результате снижение уровня 25(ОН)D и последующие за ним гипокальциемия и вторичный гиперпаратиреоз отрицательно влияют на состояние здоровья костной ткани. Представленный литературный обзор посвящен проблемам хирургии ожирения и дефициту витамина D. Основное внимание уделяется метаболизму костной ткани, связанному с бариатрическими операциями, обсуждаются причины до- и послеоперационного дефицита витамина D, а также приводятся рекомендации по его лечению после хирургии ожирения.

 

The main goal of bariatric surgery is weight loss due to fundamental differential changes in the anatomical and physiological characteristics of the gastrointestinal tract. At the same time, one of the most frequent complications of obesity surgery, especially operations associated with malabsorption, is vitamin D deficiency. Patients with obesity initially have a wide range of predisposing factors for metabolic diseases of the skeleton due to lifestyle problems. Nutrient deficiencies with high-calorie diets and a sedentary lifestyle with a tendency to wear clothing that covers most of the skin — reduces serum 25 (OH) D levels. In addition, the situation is aggravated by a decrease in the bioavailability of 25 (OH) D due to its sequestration in adipose tissue and its complete inaccessibility to the central blood flow. The consequences of bariatric surgery — a decrease in the amount of skin and malabsorption can aggravate the existing deficiency. As a result of a decrease in the level of 25 (OH) D and subsequent hypocalcemia and secondary hyperparathyroidism, negatively affect the state of bone health. The presented literature review is devoted to the problems of obesity surgery and vitamin D deficiency. The main focus is on bone metabolism associated with bariatric surgery, the causes of pre and postoperative vitamin D deficiency are discussed, and recommendations for its treatment after obesity surgery are given.

 

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The authors declare that there are no conflicts of interest present.