切换至 "中华医学电子期刊资源库"

中华肥胖与代谢病电子杂志 ›› 2022, Vol. 08 ›› Issue (03) : 197 -203. doi: 10.3877/cma.j.issn.2095-9605.2022.03.009

综述

减重手术与营养缺乏:机制、预防与治疗
张玉1, 高丽莲2, 杨华2,(), 钱玉秀3,(), 中国肥胖代谢外科研究协作组   
  1. 1. 510632 广州,暨南大学护理学院
    2. 510630 广州,暨南大学附属第一医院减重中心
    3. 510630 广州,暨南大学附属第一医院手术室
  • 收稿日期:2022-05-20 出版日期:2022-08-30
  • 通信作者: 杨华, 钱玉秀

Bariatric Surgery and Nutritional Deficiencies: Mechanism, Prevention and Treatment

Yu Zhang1, Lilian Gao2, Wah Yang2,(), Yuxiu Qian3,()   

  1. 1. School of Nursing, Jinan University, Guangzhou 510632, China
    2. Department of Metabolic and Bariatric Surgery,
    3. Operating Room, The First Affiliated Hospital of Jinan University, Guangzhou 510630, China
  • Received:2022-05-20 Published:2022-08-30
  • Corresponding author: Wah Yang, Yuxiu Qian
引用本文:

张玉, 高丽莲, 杨华, 钱玉秀, 中国肥胖代谢外科研究协作组. 减重手术与营养缺乏:机制、预防与治疗[J/OL]. 中华肥胖与代谢病电子杂志, 2022, 08(03): 197-203.

Yu Zhang, Lilian Gao, Wah Yang, Yuxiu Qian. Bariatric Surgery and Nutritional Deficiencies: Mechanism, Prevention and Treatment[J/OL]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2022, 08(03): 197-203.

肥胖代谢外科手术(MBS)是目前国际上公认的、能有效并且持续治疗肥胖症的方法。越来越多的研究证实,肥胖症患者在术前已存在着一定程度的营养缺乏。由于手术对消化道解剖和功能的改变,使患者术后在稳定而持续地减轻体重的同时,术前的营养缺乏也会加重,并且出现一系列与营养相关的并发症。本文阐述了患者在MBS前后营养缺乏的发生机制以及营养并发症的防治,并结合临床经验,总结围手术期的营养管理,为临床医护人员改善减重手术患者的营养状况提供参考依据。

Metabolic and bariatric surgery (MBS) is an internationally recognized effective and sustained treatment for obesity. More and more studies have confirmed that patients with obesity already have a certain extent of nutritional deficiency before surgery. Due to the changes in the anatomy and function of digestive tract after surgery, patients can lose weight steadily and continuously, while the preoperative nutritional deficiency will also be aggravated, and a series of nutrition-related complications will occur. This article elaborates the mechanism of nutritional deficiency and the treatment of nutritional complications in patients before and after MBS. Combined with clinical experience, it summarizes perioperative nutritional management, so as to provide reference for clinical medical staff to improve the nutritional status of bariatric surgery patients.

[1]
Parrott JM, Craggs-Dino L, Faria SL, et al. The optimal nutritional programme for bariatric and metabolic surgery [J]. Curr Obes Rep, 2020, 9(3): 326-338.
[2]
Arterburn DE, Telem DA, Kushner RF, et al. Benefits and risks of bariatric surgery in adults: a review [J]. JAMA, 2020, 324(9): 879-887.
[3]
Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes-5-year outcomes [J]. N Engl J Med, 2017, 376(7): 641-651.
[4]
Gloy VL, Briel M, Bhatt DL, et al. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials [J]. BMJ, 2013, 347: f5934.
[5]
中国医师协会外科医师分会肥胖和糖尿病外科医师委员会,中国肥胖代谢外科研究协作组. 中国肥胖代谢外科数据库: 2021年度报告 [J/CD]. 中华肥胖与代谢病电子杂志, 2022,8(1): 15-23.
[6]
杨华,陈缘,董志勇, 等. 中国肥胖代谢外科数据库:2020年度报告[J/CD]. 中华肥胖与代谢病电子杂志. 2021, 7(1): 1-7.
[7]
杨华,陈缘,王存川. 中国肥胖代谢外科数据库:2019年度报告 [J/CD].中华肥胖与代谢病电子杂志, 2020, 6(3): 143-149.
[8]
杨华,张鹏,董志勇, 等. 中国肥胖代谢外科手术方式推荐立场声明 [J/CD]. 中华肥胖与代谢病电子杂志, 2021, 7(1): 8-12.
[9]
邱晨,褚薛慧,孙喜太.接受代谢手术者术前及术后营养状况的研究进展 [J].东南大学学报(医学版), 2016, 35(4): 635-640.
[10]
陈伟,潘慧.减重手术的营养及内分泌代谢相关并发症管理 [J]. 中国医学科学院学报, 2011, 33(3): 228-231.
[11]
Mohapatra S, Gangadharan K, Pitchumoni CS. Malnutrition in obesity before and after bariatric surgery [J]. Dis Mon, 2020, 66(2): 100866.
[12]
李伟婧,石晓磊,孙振,等. 肥胖患者减重代谢手术前营养状况评价 [J]. 国际外科学杂志, 2021, 48(5): 323-326.
[13]
Lee PC, Ganguly S, Dixon JB, et al. Nutritional deficiencies in severe obesity: a multiethnic asian cohort [J]. Obes Surg, 2019, 29(1): 166-171.
[14]
Bordalo LA, Teixeira TF, Bressan J, et al. Bariatric surgery: how and why to supplement [J]. Rev Assoc Med Bras (1992), 2011, 57(1): 113-120.
[15]
Caron M, Hould FS, Lescelleur O, et al. Long-term nutritional impact of sleeve gastrectomy [J]. Surg Obes Relat Dis, 2017, 13(10): 1664-1673.
[16]
Parrott J, Frank L, Rabena R, et al. American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient 2016 Update: Micronutrients [J]. Surg Obes Relat Dis, 2017, 13(5): 727-741.
[17]
Asghari G, Khalaj A, Ghadimi M, et al. Prevalence of Micronutrient Deficiencies Prior to Bariatric Surgery: Tehran Obesity Treatment Study (TOTS) [J]. Obes Surg, 2018, 28(8): 2465-2472.
[18]
Pereira-Santos M, Costa PR, Assis AM, et al. Obesity and vitamin D deficiency: a systematic review and meta-analysis [J]. Obes Rev, 2015, 16(4): 341-349.
[19]
Targher G, Bertolini L, Scala L, et al. Associations between serum 25-hydroxyvitamin D3 concentrations and liver histology in patients with non-alcoholic fatty liver disease [J]. Nutr Metab Cardiovasc Dis, 2007, 17(7): 517-524.
[20]
Drincic AT, Armas LA, Van Diest EE, et al. Volumetric dilution, rather than sequestration best explains the low vitamin D status of obesity [J]. Obesity (Silver Spring), 2012, 20(7): 1444-1448.
[21]
Vix M, Liu KH, Diana M, et al. Impact of Roux-en-Y gastric bypass versus sleeve gastrectomy on vitamin D metabolism: short-term results from a prospective randomized clinical trial [J]. Surg Endosc, 2014, 28(3): 821-826.
[22]
Lanzarini E, Nogués X, Goday A, et al. High-dose vitamin d supplementation is necessary after bariatric surgery: a prospective 2-year follow-up study [J]. Obes Surg, 2015, 25(9): 1633-1638.
[23]
Guan BS, Yang JG, Chen YY, et al. Nutritional deficiencies in chinese patients undergoing gastric bypass and sleeve gastrectomy: prevalence and predictors [J]. Obes Surg, 2018, 28(9): 2727-2736.
[24]
Flancbaum L, Belsley S, Drake V, et al. Preoperative nutritional status of patients undergoing Roux-en-Y gastric bypass for morbid obesity [J]. J Gastrointest Surg, 2006, 10(7): 1033-1037.
[25]
Arias PM, Domeniconi EA, García M, et al. Micronutrient deficiencies after roux-en-y gastric bypass: long-term results [J]. Obes Surg, 2020, 30(1): 169-173.
[26]
Lakhani SV, Shah HN, Alexander K, et al. Small intestinal bacterial overgrowth and thiamine deficiency after Roux-en-Y gastric bypass surgery in obese patients [J]. Nutr Res, 2008, 28(5): 293-298.
[27]
Ozer S, Sonmezgoz E, Demir O. Negative correlation among vitamin B12 levels, obesity severity and metabolic syndrome in obese children: A case control study [J]. J Pak Med Assoc, 2017, 67(11): 1648-1653.
[28]
Liu QL, Li SY, Quan H, et al. Vitamin B12 status in metformin treated patients: systematic review [J]. PLoS One, 2014, 9(6): e100379.
[29]
Heidelbaugh JJ. Proton pump inhibitors and risk of vitamin and mineral deficiency: evidence and clinical implications [J]. Ther Adv Drug Saf, 2013, 4(3): 125-33.
[30]
Antoniewicz A, Kalinowski P, Kotulecka KJ, et al. Nutritional deficiencies in patients after roux-en-y gastric bypass and sleeve gastrectomy during 12-month follow-up [J]. Obes Surg, 2019, 29(10): 3277-3284.
[31]
Van Rutte PW, Aarts EO, Smulders JF, et al. Nutrient deficiencies before and after sleeve gastrectomy [J]. Obes Surg, 2014, 24(10): 1639-46.
[32]
Ortega RM, López-Sobaler AM, Andrés P, et al. Folate status in young overweight and obese women: changes associated with weight reduction and increased folate intake [J]. J Nutr Sci Vitaminol (Tokyo), 2009, 55(2): 149-155.
[33]
Bradbury KE, Williams SM, Mann JI, et al. Estimation of serum and erythrocyte folate concentrations in the New Zealand adult population within a background of voluntary folic acid fortification [J]. J Nutr, 2014, 144(1):68-74.
[34]
范美龄. 肥胖患者腹腔镜胃袖状切除术后营养元素的变化研究 [D]. 广州: 暨南大学, 2020.
[35]
Ben-Porat T, Weiss R, Sherf-Dagan S, et al. Nutritional deficiencies in patients with severe obesity before bariatric surgery: what should be the focus during the preoperative assessment? [J]. J Acad Nutr Diet, 2020, 120(5): 874-884.
[36]
Gowanlock Z, Lezhanska A, Conroy M, et al. Iron deficiency following bariatric surgery: a retrospective cohort study [J]. Blood Adv, 2020, 4(15): 3639-3647.
[37]
Hershko C, Hoffbrand AV, Keret D, et al. Role of autoimmune gastritis, Helicobacter pylori and celiac disease in refractory or unexplained iron deficiency anemia[J]. Haematologica, 2005, 90(5): 585-595.
[38]
Mahawar KK, Bhasker AG, Bindal V, et al. Zinc deficiency after gastric bypass for morbid obesity: a systematic review [J]. Obes Surg, 2017, 27(2): 522-529.
[39]
Sallé A, Demarsy D, Poirier AL, et al. Zinc deficiency: a frequent and underestimated complication after bariatric surgery [J]. Obes Surg, 2010, 20(12): 1660-1670.
[40]
Cominetti C, Garrido AB Jr, Cozzolino SM. Zinc nutritional status of morbidly obese patients before and after Roux-en-Y gastric bypass: a preliminary report [J]. Obes Surg, 2006, 16(4): 448-53.
[41]
Mechanick JI, Apovian C, Brethauer S, et al. Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures-2019 Update:Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists [J]. Obesity (Silver Spring), 2020, 28(4): O1-O58.
[42]
Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery [J]. Endocr Pract, 2013, 19(2): 337-72.
[43]
O'Kane M, Parretti HM, Pinkney J, et al. British Obesity and Metabolic Surgery Society Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery-2020 update [J]. Obes Rev, 2020, 21(11): e13087.
[44]
Nuzzo A, Czernichow S, Hertig A,et al. Prevention and treatment of nutritional complications after bariatric surgery [J]. Lancet Gastroenterol Hepatol, 2021, 6(3): 238-251.
[45]
Aasheim ET. Wernicke encephalopathy after bariatric surgery: a systematic review [J]. Ann Surg, 2008, 248(5): 714-720.
[46]
Zhang W, Fan ML, Wang CC, et al. Hair Loss After Metabolic and Bariatric Surgery: a Systematic Review and Meta-analysis [J]. Obes Surg, 2021, 31(6): 2649-2659.
[47]
Argyrakopoulou G, Konstantinidou SK, Dalamaga M, et al. Nutritional deficiencies before and after bariatric surgery: prevention and treatment [J]. Curr Nutr Rep, 2022.
[48]
Zhang W, Fan ML, Wang CC, et al. Importance of maintaining zinc and copper supplement dosage ratio after metabolic and bariatric surgery [J]. Obes Surg, 2021, 31(7): 3339-3340.
[49]
Paccou J, Martignène N, Lespessailles E,et al. Gastric bypass but not sleeve gastrectomy increases risk of major osteoporotic fracture: french population-based cohort study [J]. J Bone Miner Res, 2020, 35(8): 1415-1423.
[50]
Stein EM, Silverberg SJ. Bone loss after bariatric surgery: causes, consequences, and management [J]. Lancet Diabetes Endocrinol, 2014, 2(2): 165-174.
[51]
van der Beek ESJ, Monpellier VM, Eland I, et al. Nutritional deficiencies in gastric bypass patients; incidence, time of occurrence and implications for post-operative surveillance [J]. Obesity surgery, 2015, 25(5): 818-823.
[52]
Deledda A, Pintus S, Loviselli A, et al. Nutritional management in bariatric surgery patients [J]. Int J Environ Res Public Health, 2021, 18(22):12049.
[53]
Riva-Moscoso A, Martinez-Rivera RN, Cotrina-Susanibar G, et al. Factors associated with nutritional deficiency biomarkers in candidates for bariatric surgery: a cross-sectional study in a peruvian high-resolution clinic [J]. Nutrients, 2021,14(1):82.
[54]
Thibault R, Huber O, Azagury DE, et al. Twelve key nutritional issues in bariatric surgery [J]. Clin Nutr, 2016, 35(1):12-17.
[55]
中国研究型医院学会糖尿病与肥胖外科专业委员会.减重与代谢外科加速康复外科原则中国专家共识(2021版) [J].中华消化外科杂志, 2021, 20(8):841-845.
[56]
Yang W, Abbott S, Borg CM, et al. Global variations in preoperative practices concerning patients seeking primary bariatric and metabolic surgery (PACT Study): A survey of 634 bariatric healthcare professionals [J]. Int J Obes (Lond), 2022.
[57]
中国医师协会外科医师分会肥胖和糖尿病外科医师委员会,中国肥胖代谢外科研究协作组. 肥胖代谢外科个案管理中国专家共识(2022版) [J/CD]. 中华肥胖与代谢病电子杂志, 2022, 08(1): 1-8.
[1] 史学兵, 谢迎东, 谢霓, 徐超丽, 杨斌, 孙帼. 声辐射力弹性成像对不可切除肝细胞癌门静脉癌栓患者放射治疗效果的评价[J/OL]. 中华医学超声杂志(电子版), 2024, 21(08): 778-784.
[2] 宋玟焱, 杜美君, 陈佳丽, 石冰, 黄汉尧. 唇腭裂手术围手术期疼痛管理的研究进展及基于生物材料治疗新方法的展望[J/OL]. 中华口腔医学研究杂志(电子版), 2024, 18(06): 397-405.
[3] 李华志, 曹广, 刘殿刚, 张雅静. 不同入路下行肝切除术治疗原发性肝细胞癌的临床对比[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 52-55.
[4] 陈浩, 王萌. 胃印戒细胞癌的临床病理特征及治疗选择的研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 108-111.
[5] 梁孟杰, 朱欢欢, 王行舟, 江航, 艾世超, 孙锋, 宋鹏, 王萌, 刘颂, 夏雪峰, 杜峻峰, 傅双, 陆晓峰, 沈晓菲, 管文贤. 联合免疫治疗的胃癌转化治疗患者预后及术后并发症分析[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 619-623.
[6] 刘柏隆, 周祥福. 压力性尿失禁阶梯治疗的项目介绍[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(01): 125-125.
[7] 刘柏隆. 女性压力性尿失禁阶梯治疗之手术治疗方案选择[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(01): 126-126.
[8] 中华医学会器官移植学分会. 肝移植术后缺血性胆道病变诊断与治疗中国实践指南[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 739-748.
[9] 陈伟杰, 何小东. 胆囊癌免疫靶向治疗进展[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 763-768.
[10] 刘琦, 王守凯, 王帅, 苏雨晴, 马壮, 陈海军, 司丕蕾. 乳腺癌肿瘤内微生物组的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 841-845.
[11] 崔军威, 蔡华丽, 胡艺冰, 胡慧. 亚甲蓝联合金属定位夹及定位钩针标记在乳腺癌辅助化疗后评估腋窝转移淋巴结的临床应用价值探究[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 625-632.
[12] 王誉英, 刘世伟, 王睿, 曾娅玲, 涂禧慧, 张蒲蓉. 老年乳腺癌新辅助治疗病理完全缓解的预测因素分析[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 641-646.
[13] 张平骥, 徐钰, 李天水, 庞文翼, 符师宁, 张梦圆. 重症患者镇静治疗现状及期望的调查研究[J/OL]. 中华临床医师杂志(电子版), 2024, 18(06): 562-567.
[14] 王昌前, 林婷婷, 宁雨露, 王颖杰, 谭文勇. 光免疫治疗在肿瘤领域的临床应用新进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(06): 575-583.
[15] 徐靖亭, 孔璐. PARP抑制剂治疗卵巢癌的耐药机制及应对策略[J/OL]. 中华临床医师杂志(电子版), 2024, 18(06): 584-588.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?