Department of Dietetics, St Mary's Hospital, Imperial College Healthcare Trust, London W2 1NY, UK.
Proc Nutr Soc. 2010 Nov;69(4):536-42. doi: 10.1017/S0029665110001965. Epub 2010 Aug 10.
This review details the practicalities of providing nutrition support to obese patients who experience complications following bariatric surgery and highlights some of the nutritional challenges encountered by this group of patients. Bariatric surgery to treat morbid obesity has significantly increased internationally over the past decade with hospital admissions rising annually. The gastric bypass is currently the most commonly performed procedure. The complication rate can be up to 16%, with a considerable proportion having nutritional implications. The treatment can involve avoidance of oral diet and nutrition support, i.e. enteral or parenteral nutrition. Opposition to nutrition support can be encountered. It is useful to clarify the aims of nutrition support, these being: the avoidance of overfeeding and its consequences, preservation of lean body mass and promotion of healing. Evidence suggests that hypoenergic nutrition is not harmful and may actually be beneficial. There is a lack of consensus regarding the optimum method to predict the nutritional requirements in the obese acutely unwell patient. The literature suggests that the predicted equations are fairly accurate compared to measured energy expenditure in free living obese patients before and after bariatric surgery. However, these findings cannot be directly applied to those obese patients experiencing complications of bariatric surgery, who will be acutely unwell exhibiting inflammatory response. It is therefore necessary to refer to the literature on energy expenditure in hospitalized obese patients, to help guide practice. More research examining the energy and protein requirements of obese patients needing nutrition support following bariatric surgery is urgently required.
这篇综述详细介绍了为接受减重手术后出现并发症的肥胖患者提供营养支持的实际情况，并强调了这群患者所面临的一些营养挑战。在过去十年中，国际上治疗病态肥胖的减重手术显著增加，医院收治人数逐年上升。胃旁路术目前是最常施行的手术。其并发症发生率可达 16%，相当一部分有营养方面的影响。治疗可能需要避免口服饮食和营养支持，即肠内或肠外营养。可能会遇到对营养支持的反对意见。阐明营养支持的目的很有用，这些目的是：避免过度喂养及其后果，保持瘦体重并促进愈合。有证据表明，低能量营养并无害，实际上可能有益。对于肥胖急性病患者的营养需求最佳预测方法，尚未达成共识。文献表明，与肥胖患者在减重手术前后的自由生活中的能量消耗相比，预测公式相当准确。然而，这些发现不能直接应用于那些出现减重手术并发症的肥胖患者，这些患者会出现急性不适和炎症反应。因此，有必要参考有关住院肥胖患者能量消耗的文献，以帮助指导实践。迫切需要更多研究来检查接受减重手术后需要营养支持的肥胖患者的能量和蛋白质需求。
