Micronutrient Supplementation and Bone Health After Prophylactic Total Gastrectomy in Patients With CDH1 Variants.

Autor:	Gamble LA; Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA., Lopez R; Clinical Center Nutrition Department, National Institutes of Health, Bethesda, MD 20892, USA.; US Public Health Service, Washington, DC 20245, USA., Rajasimhan S; Pharmacy Department, National Institutes of Health Clinical Center, Bethesda, MD 20892, USA., Samaranayake SG; Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA., Bowden C; Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA., Famiglietti AL; Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA., Blakely AM; Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA., Jha S; National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health Clinical Center, Bethesda, MD 20892, USA., Ahlman MA; Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD 20892, USA., Davis JL; Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
Jazyk:	angličtina
Zdroj:	The Journal of clinical endocrinology and metabolism [J Clin Endocrinol Metab] 2023 Sep 18; Vol. 108 (10), pp. 2635-2642.
DOI:	10.1210/clinem/dgad137
Abstrakt:	Introduction: Patients with germline variants in CDH1 who undergo prophylactic total gastrectomy (TG) are at risk of altered nutrient and drug absorption due to modified gastrointestinal anatomy. Bone mineral density loss and micronutrient deficiencies have not been described previously in this patient population. Methods: In this study we included 94 patients with germline CDH1 variants who underwent prophylactic TG between October 2017 and February 2022. We examined pre- and post-gastrectomy bone mineral density (BMD); serum biomarkers including calcium, phosphorus, alkaline phosphatase, and 25 (OH)-vitamin D; and postoperative adherence to calcium and multivitamin supplementation. Results: Almost all patients (92/94, 98%) lost a substantial amount of weight post-TG, with an average weight loss of 26.5% at 12 months post-surgery. Serum biomarkers of mineral metabolism, namely calcium and phosphorus, did not change significantly after TG. However, average BMD was decreased in all patients at 12 months post-TG. Nonadherence to calcium supplementation was associated with a decrease in BMD. Nonadherence to multivitamin supplementation was associated with greater percent BMD loss in the femoral neck and total hip. Conclusions: Appropriate micronutrient supplementation and nutritional counseling pre- and postoperatively in patients undergoing prophylactic TG are important to mitigate the long-term effects of gastrectomy on bone health. (Published by Oxford University Press on behalf of the Endocrine Society 2023.)
Databáze:	MEDLINE
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