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Abnormal vitamin D levels are common in bariatric surgery patients. The incidence of deficiencies and the response to therapy is not accurately delineated. The purpose of this study was to define the vitamin D status of patients who undergo either a malabsorptive (gastric bypass) or restrictive (adjustable gastric band) bariatric surgery both prior to and after surgery.A retrospective analysis was performed on patients to undergo bariatric surgery from July 2002 to February 2007. Serum levels of vitamin D (Vit D), parathyroid hormone (PTH), and calcium were analyzed.Mean patient age was 45 y; 82% of patients were women. Of 127 total patients, 84% were Vit D deficient preoperatively. These patients had a higher preoperative body mass index (BMI) than those with normal Vit D levels on initial assessment (BMI 44 versus 50 kg/m(2), P0.01). A correlation was found between preoperative BMI and Vit D (r(2) = 0.12, P0.01) and PTH levels (r(2) = 0.07, P0.01). One year following gastric bypass surgery, 20% of patients with elevated PTH levels had normal Vit D levels. The incidence of observed deficiencies for adjustable gastric band versus gastric bypass did not differ statistically at any interval.Morbidly obese patients seeking bariatric surgery are often deficient in Vit D, a fact that should be accounted for when evaluating the impact of bariatric surgery on Vit D levels. Elevated BMI and increasing degrees of obesity may be risk factors for both Vit D deficiency and secondary hyperparathyroidism. Despite normal Vit D levels, some gastric bypass patients continue to show elevated levels of PTH.

Before bariatric surgery, some patients with type 2 diabetes mellitus (T2DM) experience improvement in blood glucose control and reduced insulin requirements while on a preoperative low-calorie diet (LCD). We hypothesized that patients who exhibit a significant glycemic response to this diet are more likely to experience remission of their diabetes in the postoperative period.Insulin-dependent T2DM patients undergoing bariatric surgery between August 2006 and February 2011 were eligible for inclusion. Insulin requirements at day 0 and 10 of the LCD were compared. Patients with a ≥ 50% reduction in total insulin dosage to maintain appropriate blood glucose control were considered rapid responders to the preoperative LCD. All others were non-rapid responders. We analyzed T2DM remission rates up to 1 y postoperatively.A total of 51 patients met inclusion criteria and 29 were categorized as rapid responders (57%). The remaining 22 were considered non-rapid responders (43%). The two groups did not differ demographically. Rapid responders had greater T2DM remission rates at 6 (44% versus 13.6%; P = 0.02) and 12 mo (72.7% versus 5.9%; P0.01). In patients undergoing laparoscopic gastric bypass, rapid responders showed greater excess weight loss at 3 mo (40.1% versus 28.2%; P0.01), 6 mo (55.2% versus 40.2%; P0.01), and 12 mo (67.7% versus 47.3%; P0.01).Insulin-dependent T2DM bariatric surgery patients who display a rapid glycemic response to the preoperative LCD are more likely to experience early remission of T2DM postoperatively and greater weight loss.

Objectives To examine changes in health and lifestyle indicators over 6 months in persons with type 2 diabetes mellitus receiving nutrition counseling from a registered dietitian, and to promote dietetics professionals' participation in outcomes monitoring and research. Design Prospective, noncontrolled descriptive study. Subjects Two hundred forty-four physician-referred adults with type 2 diabetes mellitus from 31 sites who received usual and customary nutrition counseling, and 83 registered dietitians. Main outcome measures Glycemic control, coronary heart disease risk, self-management behaviors, and quality of life were measured at baseline, 3 months, and 6 months. Dietitians' perceptions of the study were also measured. Statistical analysis Repeated-measures analysis of variance, paired t test, Wilcoxon signed rank test, sign test, Spearman correlation, and χ 2 analysis were conducted. Results Weight and glycemic control, coronary heart disease risk, and self-management behaviors improved significantly between baseline and 3 months and baseline and 6 months. Weight, body mass index, and glycosylated hemoglobin value also improved significantly between 3 months and 6 months. Increased time and/or number of sessions with the registered dietitian were associated with weight loss and reduced glycosylated hemoglobin, fasting plasma glucose, total cholesterol, and triglyceride levels. Self-perceived health status and missed workdays were significantly improved at 6 months. Difficulty obtaining current laboratory values, lack of time, and inability to reach subjects for follow-up presented the greatest obstacles for the dietitians. Conclusions Positive outcomes were observed in adults receiving nutrition intervention for type 2 diabetes. Clinical improvements were greatest between baseline and 3 months, with stabilization between 3 months and 6 months, suggesting ongoing intervention is needed to support continued clinical progress. Dietitians found participation in this state affiliate-coordinated research project rewarding.

ROSALIEAMOS,3 NANCY BETTS,4 CONSTANCE GEORGIOU,S SHARON HOERR,6 RAO IVATURI,7 AND JANE VOICHICK 2 lDepartment of Nutritional Sciences, Shantz 309, The University of Arizona, Tucson, Arizona 85721; 2Department of Nutritional Sciences, University of Wisconsin-Madison, 1415 Linden Drive, Madison, Wisconsin 53706; 3Department of Family and Consumer Sciences Ed., 220C Mackay Hall, Iowa State University, Ames, Iowa 50011; 4202 Ruth Leverton Hall, University of Nebraska, Lincoln, Nebraska 68583-0806; SNutrition and Food Management, Milam Hall 108, Oregon State University, Corvalis, Oregon 97331-5103; 6Department of Food Science and Human Nutrition, Michigan State University, East Lansing, Michigan 48824-1224; 7Department of Home Economics, Indiana State University, Terre Haute, Indiana 47809