Gobato Renata Cristina, Seixas Chaves Daniela Fojo, Chaim Elinton Adami
Nutricionist Postgraduate in Nutrition in the Digestive System (UNICAMP), Campinas, São Paulo, Brazil; Faculdade de Ciências Médicas- Departamento de Cirurgia do Hospital de Clínicas UNICAMP, Campinas, São Paulo, Brazil.
Laboratório de Nutrição e Metabolismo- Departamento de Biodinâmica do Movimento Humano-Escola de Educação Física e Esporte - USP, São Paulo, Brazil.
Surg Obes Relat Dis. 2014 Sep-Oct;10(5):944-51. doi: 10.1016/j.soard.2014.05.011. Epub 2014 May 20.
Bariatric surgery is considered an effective method for sustained weight loss, but may cause various nutritional complications. The aim of this study was to evaluate the nutritional status of minerals and vitamins, food consumption, and to monitor physiologic parameters in patients with obesity before and 6 months after Roux-en-Y gastric bypass surgery (RYGB).
Thirty-six patients who had undergone RYGB were prospectively evaluated before and 6 months after surgery. At each phase their weight, height, body mass index (BMI), Electro Sensor Complex (ES Complex) data, food consumption, and total protein serum levels, albumin, prealbumin, parathyroid hormone (PTH), zinc (Zn), B12 vitamin (VitB12), iron (Fe), ferritin, copper (Cu), ionic calcium (CaI), magnesium (Mg), and folic acid were assessed.
The mean weight loss from baseline to 6 months after surgery was 35.34±4.82%. Markers of autonomic nervous system balance (P<.01), stiffness index (P<.01), standard deviation of normal-to-normal R-R intervals (SDNN) (P<.01), and insulin resistance (P<.001) were also improved. With regard to the micronutrients measured, 34 patients demonstrated some kind of deficiency. There was a high percentage of Zn deficiency in both pre- (55.55%) and postoperative (61.11%) patients, and 33.33% of the patients were deficient in prealbumin postoperatively. The protein intake after 6 months of surgery was below the recommended intake (<70 g/d) for 88.88% of the patients. Laboratory analyses demonstrated an average decrease in total protein (P<.05), prealbumin (P = .002), and PTH (P = .008) between pre- and postsurgery, and a decrease in the percentage of deficiencies for Mg (P<.05), CaI (P<.05), and Fe (P = .021).
Despite improvements in the autonomic nervous system balance, stiffness index markers and insulin resistance, we found a high prevalence of hypozincemia at 6 months post-RYGB. Furthermore, protein supplements were needed to maintain an adequate protein intake up to 6 months postsurgery.
减重手术被认为是实现持续体重减轻的有效方法，但可能会引发各种营养并发症。本研究的目的是评估接受Roux-en-Y胃旁路手术（RYGB）的肥胖患者术前及术后6个月的矿物质和维生素营养状况、食物摄入量，并监测生理参数。
对36例行RYGB手术的患者在术前及术后6个月进行前瞻性评估。在每个阶段，评估他们的体重、身高、体重指数（BMI）、电子传感器综合指标（ES综合指标）数据、食物摄入量以及血清总蛋白水平、白蛋白、前白蛋白、甲状旁腺激素（PTH）、锌（Zn）、维生素B12（VitB12）、铁（Fe）、铁蛋白、铜（Cu）、离子钙（CaI）、镁（Mg）和叶酸。
从基线到术后6个月，平均体重减轻了35.34±4.82%。自主神经系统平衡指标（P<0.01）、硬度指数（P<0.01）、正常到正常R-R间期标准差（SDNN）（P<0.01）和胰岛素抵抗（P<0.001）也有所改善。在所测量的微量营养素方面，34例患者存在某种程度的缺乏。术前（55.55%）和术后（61.11%）患者中锌缺乏的比例都很高，术后33.33%的患者前白蛋白缺乏。术后6个月，88.88%的患者蛋白质摄入量低于推荐摄入量（<70 g/d）。实验室分析显示，术前与术后相比，总蛋白（P<0.05）、前白蛋白（P = 0.002）和PTH（P = 0.008）平均下降，镁（P<0.05）、离子钙（P<0.05）和铁（P = 0.021）缺乏的百分比下降。
尽管自主神经系统平衡、硬度指数指标和胰岛素抵抗有所改善，但我们发现RYGB术后6个月低锌血症的患病率很高。此外，术后6个月需要补充蛋白质以维持足够的蛋白质摄入量。
