Nutritional management and weight regain after bariatric surgery: current situation and thoughts

doi:10.3877/cma.j.issn.2095-9605.2023.03.004

Abstract

Abstract:

Obesity has become a global public health problem, and bariatric surgery is currently the most enduring treatment for obesity. Postoperative nutritional management is crucial, with postoperative protein malnutrition being the most common micronutrient deficiency, and preoperative micronutrient deficiencies persisting and potentially worsening postoperatively. Among various bariatric surgeries, Roux-en-Y gastric bypass (RYGB) is associated with the most severe postoperative micronutrient deficiencies. Long-term weight regain presents a significant challenge postoperatively, with non-adherence to dietary recommendations and behavior contributing as important factors. This article reviews the current status of postoperative nutritional deficiencies, the state of weight regain, and associated risk factors, offering postoperative nutritional management recommendations, as well as long-term follow-up strategies. Future research is needed to establish consensus in clinical practice to improve postoperative nutritional management and prevent weight regain, ultimately enhancing the long-term effectiveness of weight loss surgery and the quality of life for patients.

Key words: Obesity, Bariatric Surgery, Nutritional Deficiency, Nutritional Management, Weight Regain, Postoperative Management

Junrong Ma, Yanbin Ye. Nutritional management and weight regain after bariatric surgery: current situation and thoughts[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2023, 09(03): 165-172.

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References 57

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营养素	RYGB	SG	LAGB	BPD-DS
宏量营养素
蛋白质	严重缺乏	缺乏	缺乏	严重缺乏
微量营养素
铁	明显缺乏	缺乏	明显缺乏	缺乏
钙	明显缺乏	普遍缺乏	普遍缺乏	明显缺乏
叶酸	缺乏	待研究	缺乏	缺乏
维生素D	明显缺乏	普遍缺乏	普遍缺乏	明显缺乏
维生素B₁₂	明显缺乏	缺乏	明显缺乏	缺乏
脂溶性维生素（A、K、E）	缺乏	缺乏	缺乏	缺乏
其他B族维生素（如B1、B2、B6）	常见于RYGB术后患者，其余手术方式此类营养素缺乏有待确定
其他矿物质（镁、锌、铜、硒）	矿物质缺乏症在BPD和RYGB术后患者中更常见，BPD-DS术后硒缺乏明显

营养素	RYGB	SG	LAGB	BPD-DS
宏量营养素
蛋白质	严重缺乏	缺乏	缺乏	严重缺乏
微量营养素
铁	明显缺乏	缺乏	明显缺乏	缺乏
钙	明显缺乏	普遍缺乏	普遍缺乏	明显缺乏
叶酸	缺乏	待研究	缺乏	缺乏
维生素D	明显缺乏	普遍缺乏	普遍缺乏	明显缺乏
维生素B₁₂	明显缺乏	缺乏	明显缺乏	缺乏
脂溶性维生素（A、K、E）	缺乏	缺乏	缺乏	缺乏
其他B族维生素（如B1、B2、B6）	常见于RYGB术后患者，其余手术方式此类营养素缺乏有待确定
其他矿物质（镁、锌、铜、硒）	矿物质缺乏症在BPD和RYGB术后患者中更常见，BPD-DS术后硒缺乏明显

术后阶段	饮食目标和建议
术后24 h	少量低糖清流食
术后第1周	清流饮食，逐渐增加饮水量，最终保证每天饮水量≥2 000 mL
术后第2周	无渣全流质饮食，不含植物纤维成分
术后第3~4周	半流质饮食，主要以细软、清淡易消化的食物为主，彻底咀嚼
术后第1~2个月	以软食为主，即容易软烂、易消化的食物
术后第3个月起	低脂普食，逐渐增加高蛋白食物，同时谨慎摄入红肉、鸡肉和火鸡等食物，需处理成易消化的细块

术后阶段	饮食目标和建议
术后24 h	少量低糖清流食
术后第1周	清流饮食，逐渐增加饮水量，最终保证每天饮水量≥2 000 mL
术后第2周	无渣全流质饮食，不含植物纤维成分
术后第3~4周	半流质饮食，主要以细软、清淡易消化的食物为主，彻底咀嚼
术后第1~2个月	以软食为主，即容易软烂、易消化的食物
术后第3个月起	低脂普食，逐渐增加高蛋白食物，同时谨慎摄入红肉、鸡肉和火鸡等食物，需处理成易消化的细块

营养素	建议摄入量	膳食来源
钙	减重术后摄入1 200~1 500 mg/d； BPD-DS术后建议摄取1 800~2 400 mg/d	奶制品、豆制品
铁	复合维生素–矿物质方案补充18~60 mg/d的总铁量；若吸收不足口服维生素B₁₂；口服铁不耐受或难治性铁缺乏患者建议静脉输注铁剂	内脏、牛肉、羊肉、菠菜、油麦菜等蔬菜，香蕉、橙子等水果
B族维生素	维生素B₁₂口服补充350~1 000 μg/d，育龄妇女等特殊人群的剂量应为8 00~1 000 μg/d；维生素B复合物制剂或复合维生素–多矿物质补充剂12 mg，50~100 mg/d最佳；每天口服叶酸5 mg，持续至少4个月治疗叶酸缺乏症	海鲜（如蛤蜊、虾、沙丁鱼）、肉类（如牛肝）及蛋类
脂溶性维生素	既往有维生素A、E、K缺乏病史的患者，考虑在常规剂量外适当增加；每天补充2 000~4 000 IU维生素D₃以维持术后血清25-OHD水平	奶制品、豆制品

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