Developmental Stage Modulates Mineral-Hormonal Adaptation After Roux-en-Y Gastric Bypass: A Translational Life-Course...

Area of Science:

• Endocrinology
• Bariatric Surgery
• Mineral Metabolism

Background:

• Vitamin D deficiency is common in severe obesity and can worsen after malabsorptive bariatric surgery.
• Adolescence is a critical period for skeletal and metabolic development, potentially impacting adaptation post-Roux-en-Y gastric bypass (RYGB).

Purpose of the Study:

• To compare longitudinal mineral-hormonal adaptation after RYGB in adolescents and adults with severe obesity.
• To determine if developmental stage influences postoperative adaptation following RYGB.

Main Methods:

• Prospective observational cohort study of 120 participants (60 adolescents, 60 adults) undergoing RYGB.
• Serum 25-hydroxyvitamin D, ionized calcium, phosphorus, and parathyroid hormone (PTH) measured preoperatively and at 6 and 12 months postoperatively.
• Non-parametric tests used for group comparisons within a life-course framework.

Main Results:

• High prevalence of Vitamin D inadequacy (<30 ng/mL) at baseline in both adolescents (78.3%) and adults (85.0%).
• Adolescents showed higher rates of hypocalcemia and hypophosphatemia, progressive PTH elevation, and secondary hyperparathyroidism at 12 months post-RYGB.
• Adults had a less pronounced endocrine-mineral response but also persistent PTH increases; Vitamin D inadequacy remained prevalent despite supplementation.

Conclusions:

• Postoperative mineral-hormonal adaptation after RYGB varies by developmental stage.
• Adolescents exhibit greater endocrine-mineral vulnerability during skeletal maturation, influencing adaptation beyond weight loss.
• Findings support stage-specific monitoring and individualized management post-metabolic surgery.