Santarpia Lidia, Grandone Ilenia, Alfonsi Lucia, Sodo Maurizio, Contaldo Franco, Pasanisi Fabrizio
Interuniversity Research Center for Obesity and Eating Disorder CISRO, Department of Clinical Medicine and Surgery, Naples, Italy.
Interuniversity Research Center for Obesity and Eating Disorder CISRO, Department of Clinical Medicine and Surgery, Naples, Italy.
Nutrition. 2014 Nov-Dec;30(11-12):1301-5. doi: 10.1016/j.nut.2014.03.011. Epub 2014 Mar 30.
The growing prevalence of severe obesity, combined with the failure of conservative treatments, has led to a significant spread of bariatric surgical procedures. The aim of this study was to emphasize the need of adequate presurgery patient selection and close follow-up after malabsorptive procedures for bariatric surgery.
The study retrospectively evaluated 25 (20 F, 5 M; mean age 43 ± 13 y) obese patients (mean weight before intervention 134 ± 30.7 kg, body mass index 50.7 ± 10.1 kg/m(2)) attending our outpatient clinical nutrition unit for severe malabsorption and secondary malnutrition after surgical intervention that had been performed outside the regional area.
All patients received personalized dietetic indications; in 12 of 25 (48%) cases integrated by oral protein supplements and in 5 of 25 (20%) by medium chain triglycerides. According to screening exams, patients were prescribed oral/parenteral iron, vitamins A, B group, D, and folate supplementation. In 14 of 25 (56%) patients, parenteral hydration and in 4 of 25 (16%), long-term parenteral nutrition was required. Five patients required hospitalization for severely complicated protein-energy malnutrition.
Nutritional deficiencies are common after malabsorptive procedures for bariatric surgery; these can be present or latent before surgery, frequently going unrecognized and/or inadequately treated particularly when patients are not strictly followed up by the operating center. Despite the adequate-even intensive-intervention, clinical nutritional status moderately improved in all patients.
重度肥胖的患病率不断上升，加上保守治疗效果不佳，导致减肥手术程序广泛传播。本研究的目的是强调减肥手术吸收不良手术后进行充分的术前患者选择和密切随访的必要性。
本研究回顾性评估了25例（20例女性，5例男性；平均年龄43±13岁）肥胖患者（干预前平均体重134±30.7 kg，体重指数50.7±10.1 kg/m²），这些患者因在区域外进行手术干预后出现严重吸收不良和继发性营养不良而到我们的门诊临床营养科就诊。
所有患者均获得个性化饮食指导；25例中有12例（48%）通过口服蛋白质补充剂进行补充，25例中有5例（20%）通过中链甘油三酯进行补充。根据筛查检查结果，为患者开具了口服/肠外铁、维生素A、B族、D和叶酸补充剂。25例中有14例（56%）患者需要肠外补液，25例中有4例（16%）需要长期肠外营养。5例患者因严重复杂的蛋白质-能量营养不良需要住院治疗。
减肥手术吸收不良手术后营养缺乏很常见；这些缺乏在手术前可能已经存在或潜在存在，常常未被识别和/或治疗不充分，特别是当患者未被手术中心严格随访时。尽管进行了充分甚至强化的干预，但所有患者的临床营养状况仍有适度改善。
