The following is a summary of “Micronutrient Supplementation and Bone Health After Prophylactic Total Gastrectomy in Patients With CDH1 Variants,” published in the October 2023 issue of Endocrinology by Gamble, et al.
Patients harboring germline variants in CDH1 undergoing prophylactic total gastrectomy (TG) face potential challenges related to altered nutrient and drug absorption due to modified gastrointestinal anatomy. For a study, researchers sought to investigate bone mineral density (BMD) loss and micronutrient deficiencies in the population, which have not been previously documented.
The study included 94 patients with germline CDH1 variants who underwent prophylactic TG between October 2017 and February 2022. The analysis encompassed pre- and post-gastrectomy BMD, serum biomarkers (calcium, phosphorus, alkaline phosphatase, 25 (OH)-vitamin D), and adherence to postoperative calcium and multivitamin supplementation.
Nearly all patients (98%) experienced substantial post-TG weight loss, averaging 26.5% at 12 months post-surgery. Serum biomarkers of mineral metabolism, calcium, and phosphorus showed no significant changes after TG. However, BMD was decreased in all patients at 12 months post-TG. Nonadherence to calcium supplementation correlated with decreased BMD. Nonadherence to multivitamin supplementation was associated with a greater percentage of BMD loss in the femoral neck and total hip.
The study emphasized the importance of appropriate micronutrient supplementation and nutritional counseling both pre-and postoperatively for individuals undergoing prophylactic TG to address the potential long-term effects of gastrectomy on bone health.