Armstrong T, Walters E, Varshney S, Johnson C D
University Department of Surgery, Southampton General Hospital, UK.
Pancreatology. 2002;2(6):528-34. doi: 10.1159/000066095.
BACKGROUND/AIM: A previous study in our unit showed an inadequate dietary intake of fat-soluble vitamins and energy after pancreaticoduodenectomy (PD). This study was designed to determine whether deficiencies in dietary intake of micronutrients lead to nutritional deficiencies and to examine the impact of dietary advice on nutrition, bowel function, and quality of life.
Ten patients who had undergone PD for malignant disease more than 6 months previously were studied at baseline and follow-up 8 weeks apart. Dietary intakes of energy, fat, and micronutrients were assessed by analysis of weighed food diaries, and serum vitamins and trace elements were measured at each visit. Quality of life questionnaires (EORTC QLQ30 and PAN 26) were answered, and a clinical assessment of the bowel function was made. Targeted dietary intervention was given, where indicated, and its impact on the study parameters was assessed at the second clinic visit.
The patients were generally well nourished. Dietary deficiencies of fat-soluble vitamins were detected (vitamin A, n = 2; vitamin D, n = 10; vitamin E, n = 2), but these correlated with serum deficiency only for vitamin A. The selenium intake was borderline or insufficient in 6 patients' diet, with serum deficiencies in 4. Despite normal intakes of iron and zinc, half the patients showed serum deficiency. The bowel function was an important factor in quality of life, and symptoms improved in 3 patients with enzyme supplements and antidiarrhoeal medication.
PD patients appear to be prone to a predictable set of micronutrient deficiencies that may be compounded by insufficient dietary intake. The bowel function is important to these patients, and it should be optimized with aggressive enzyme replacement. Dietary intervention appears to make little short-term impact in the areas studied.
背景/目的：我们科室之前的一项研究表明，胰十二指肠切除术（PD）后患者脂溶性维生素和能量的膳食摄入量不足。本研究旨在确定微量营养素膳食摄入不足是否会导致营养缺乏，并探讨饮食建议对营养状况、肠道功能和生活质量的影响。
对10例6个月前因恶性疾病接受PD手术的患者进行研究，分别在基线和8周后的随访时进行评估。通过分析称重食物日记评估能量、脂肪和微量营养素的膳食摄入量，每次就诊时测定血清维生素和微量元素。患者回答生活质量问卷（EORTC QLQ30和PAN 26），并对肠道功能进行临床评估。在必要时给予针对性的饮食干预，并在第二次门诊就诊时评估其对研究参数的影响。
患者总体营养状况良好。检测到脂溶性维生素存在膳食缺乏（维生素A，n = 2；维生素D，n = 10；维生素E，n = 2），但仅维生素A的膳食缺乏与血清缺乏相关。6例患者饮食中硒摄入量处于临界水平或不足，4例血清硒缺乏。尽管铁和锌摄入量正常，但仍有一半患者血清缺乏。肠道功能是生活质量的一个重要因素，3例患者使用酶补充剂和止泻药物后症状改善。
PD患者似乎易于出现一组可预测的微量营养素缺乏，膳食摄入不足可能会使情况更加复杂。肠道功能对这些患者很重要，应积极进行酶替代治疗以优化肠道功能。饮食干预在本研究的领域似乎短期内影响不大。
