Averting Secondary Hyperparathyroidism with a Novel Bariatric Supplement (Nuvista®)

Ravi Shah, DO, Fred Brody, MD MBA, Khashayar Vaziri, MD, Melissa Flood, NP, Cathy Garey, RN, Claire LeBrun, MPH RD. The George Washington University Medical Center

Introduction
Following gastric bypass surgery, vitamin D deficiency may occur in up to 44% of patients with alterations in PTH at 12 months. This study analyzes nutritional biomarkers in a cohort of gastric bypass patient utilizing a novel nutritional product post-operatively intended to avert these deficiencies.

Methods
Nineteen morbidly obese patients underwent a laparoscopic gastric bypass or adjustable band surgery. Post-operatively, this cohort ingested a 1200-1500 calorie diet with two packets of a novel nutritional product called Nuvista® daily. Per packet, this product contains 150 calories, 15 grams of protein, grams of fat, and grams of carbohydrate along with significant levels of calcium, vitamin D, and multiple other minerals and vitamins. Baseline biochemical markers were obtained and then rechecked at 3 and 6 months. Pre- and postoperative patient demographics and biochemical levels were compared and a p<0.05 was considered significant.

Results

There were 17 women and 2 men who underwent bariatric surgery. Mean preoperative levels for calcium, Vitamin D, and PTH were 9.3±0.4 mg/dL, 19.9±6.3 ng/mL, and 39.3±15.8 pg/mL, respectively. Overall, 47.1% of patients were Vitamin D deficient using 20 ng/mL as the lower limit of normal. Using a Vitamin D level of 30 ng/mL, 88% of the cohort was Vitamin D deficient. At 3 and 6 months post-operatively, calcium and PTH levels remained unchanged while supplementing with Nuvista® (p>0.05). The Vitamin D levels were significantly increased at 3 months compared to baseline (23.6±6.6 ng/mL vs 19.9±6.3 ng/mL; p=0.05). At 6 months, there was no significant difference in Vitamin D levels versus baseline (p=0.66).

Conclusion
Traditionally, PTH levels may increase in 25-44% of morbidly obese patients following RYGB. These changes in PTH levels may be seen as early as 18 weeks postoperatively. Ingesting a high protein low calorie supplement, Nuvista®, that is fortified with calcium and Vitamin D may avert an increase in PTH levels and the potential complications from secondary hyperparathyroidism. Despite an overwhelming percentage of Vitamin D deficient patients, postoperative PTH levels remain unchanged over 3 and 6 months. Fianlly, accrual continues for this study and the cohort will be followed for another 6 months to validate the interim data that shows that PTH levels remain unchanged utilizing Nuvista®.