Low Vitamin D Levels Increase Risk of Infection During Surgery
In this age of rising health care costs, researching simple and effective means to prevent prolonged hospital stays is a priority. The past decade has seen increasing interest in the role that vitamin D plays in the immune system. Quraishi and co-workers recently published some results of a retrospective analysis into vitamin D levels before bariatric surgery and the risk of infection after the operation.
The authors used hospital records of patients admitted to the Massachusetts General Hospital for Roux-en-Y gastric bypass surgery. As part of the routine nutrition assessment, levels of vitamin D are measured prior to surgery. Vitamin D deficiency in obese subjects is common (see recent reports from da Rosa, and Biagioni, for example). The authors of the current study do not report the proportion of patients with deficient vitamin D levels, however mean levels were less than 30 ng/ml which means that over half of subjects had sub-optimal levels. Infections that occurred at least 48 hours after surgery were noted: these were divided into Hospital-Acquired Infections (HAIs) and Surgery Site Infections (SSIs).
The authors found that the risk of HAIs and SSIs both increased when the group of subjects with adequate levels (>30 ng/ml) was compared to the group with sub-optimal and deficient levels (<30ng/ml). The authors also looked at the rate of HAIs and SSIs according to circulating vitamin D levels. With both types of infection, there was an almost linear inverse relationship between vitamin D and risk of infection. That is, as vitamin D levels increase, the risk of infection decreased. The lowest risk of infection was seen at vitamin D levels of 50 ng/ml and above.
This study is observational, and therefore it is possible that higher levels of vitamin D indicate a better diet and lifestyle before surgery and therefore reduced risk of infection. The authors did adjust the results for confounders such as age, sex, race, BMI, physical status, other illnesses, vitamin D supplementation and others to minimize this issue with observational research. Still, clinical studies are still warranted to see whether correcting low levels of vitamin D can prevent infection. It appears that this research group is undertaking a clinical trial to test this theory (see clinical trial number NCT01689779). It will be interesting to see whether this simple and inexpensive treatment can reduce prolongation of hospital stays, surely a boon for patients as well as reducing the costs of prolongation of hospital stays.
Quraishi SA, Bittner EA, Blum L, Hutter MM, Camargo CA, Jr. Association Between Preoperative 25-Hydroxyvitamin D Level and Hospital-Acquired Infections Following Roux-en-Y Gastric Bypass Surgery. JAMA Surg. 2013. doi:10.1001/jamasurg.2013.3176. http://dx.doi.org/10.1001/jamasurg.2013.3176
Biagioni MF, Mendes AL, Nogueira CR, Paiva SA, Leite CV, Mazeto GM. Weight-Reducing Gastroplasty with Roux-en-Y Gastric Bypass: Impact on Vitamin D Status and Bone Remodeling Markers. Metab Syndr Relat Disord. 2013 Sep 21. [Epub ahead of print] http://www.ncbi.nlm.nih.gov/pubmed/24053724
da Rosa CL, Dames Olivieri Saubermann AP, Jacqueline J, Pereira SE, Saboya C, Ramalho A. Routine supplementation does not warrant the nutritional status of vitamin d adequate after gastric bypass Roux-en-Y. Nutr Hosp. 2013 Jan-Feb;28(1):169-72. doi: 10.3305/nh.2013.28.1.6166. http://www.ncbi.nlm.nih.gov/pubmed/23808446
Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr April 2008 87: 4 1080S-1086S. http://ajcn.nutrition.org/content/87/4/1080S.full
Read more about malnutrition in hospital patients on TalkingNutrition
September 3, 2013: Malnutrition Jeopardizes Patient Health and Hospitalization Outcomes
August 15, 2013: What Are the Consequences of Malnutrition in Hospital Patients?
Augsut 14, 2013: Nutrition Advice and Hospitalization Outcomes