Pôle de Médecine Interne et des Maladies Métaboliques, Centre Hospitalier Universitaire, Angers, France.
Obes Surg. 2010 Dec;20(12):1660-70. doi: 10.1007/s11695-010-0237-5.
Although zinc deficiency is common after bariatric surgery, its incidence is underestimated. The objective was to monitor zinc and nutritional status before and 6, 12 and 24 months (M6, M12 and M24) after gastric bypass (Roux-en-Y gastric bypass), sleeve gastrectomy and biliopancreatic diversion with duodenal switch (DS) in patients receiving systematised nutritional care.
Data for 324 morbidly obese patients (mean body mass index 46.2 ± 7.3 kg/m(2)) were reviewed retrospectively. The follow-up period was 6 months for 272 patients, 12 months for 175, and 24 months for 70. Anthropometric, dietary and serum albumin, prealbumin, zinc, iron and transferrin saturation measures were determined at each timepoint.
Nine percent of patients had zinc deficiency pre-operatively. Zinc deficiency was present in 42.5% of the population at M12 and then remained stable. Zinc deficiency was significantly more frequent after DS, with a prevalence of 91.7% at M12. Between M0 and M6, variation in plasma prealbumin, surgery type and zinc supplementation explained 27.2% of the variance in plasma zinc concentration. Surgery type explained 22.1% of this variance between M0 and M24. Mean supplemental zinc intake was low (22 mg/day). The percentage of patients taking zinc supplementation at M6, M12 and M24 was 8.9%, 20.6% and 29%, respectively.
Reduced protein intake, impaired zinc absorption and worsening compensatory mechanisms contribute to zinc deficiency. The mechanisms involved differ according to the type of surgery and time since surgery. Zinc supplementation is necessary early after bariatric surgery, but this requirement is often underestimated or is inadequate.
尽管肥胖症手术后普遍存在锌缺乏，但这种情况往往被低估。本研究旨在监测接受系统营养护理的患者在接受胃旁路术（Roux-en-Y 胃旁路术）、袖状胃切除术和胆胰分流术加十二指肠转位术（DS）前后 6、12 和 24 个月（M6、M12 和 M24）时的锌和营养状况。
回顾性分析了 324 例病态肥胖患者（平均体重指数 46.2±7.3kg/m2）的数据。272 例患者的随访期为 6 个月，175 例为 12 个月，70 例为 24 个月。在每个时间点均测定了人体测量学、饮食和血清白蛋白、前白蛋白、锌、铁和转铁蛋白饱和度。
9%的患者术前存在锌缺乏。M12 时人群中锌缺乏发生率为 42.5%，此后保持稳定。DS 术后锌缺乏明显更常见，M12 时的患病率为 91.7%。在 M0 到 M6 之间，血浆前白蛋白、手术类型和锌补充剂的变化解释了血浆锌浓度变化的 27.2%。手术类型解释了 M0 到 M24 之间这种变化的 22.1%。锌的补充摄入量低（22mg/天）。M6、M12 和 M24 时服用锌补充剂的患者比例分别为 8.9%、20.6%和 29%。
蛋白质摄入减少、锌吸收受损和代偿机制恶化导致锌缺乏。所涉及的机制因手术类型和手术时间而异。肥胖症手术后早期需要补充锌，但这种需求往往被低估或不足。
