van der Beek Eva S J, Monpellier Valerie M, Eland Ingo, Tromp Ellen, van Ramshorst Bert
Department of Plastic and Reconstructive Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands,
Obes Surg. 2015 May;25(5):818-23. doi: 10.1007/s11695-014-1456-y.
Post-operative nutritional deficiencies are a common complication following bariatric surgery. The incidence and time of occurrence are not clear, and the efficacy of supplementation remains questionable. Clear guidelines for nutritional follow-up and counselling are needed.
Preoperative and post-operative deficiencies were determined in a group of 427 gastric bypass patients. The predictive value of preoperative laboratory findings for the development of post-operative deficiencies, the time of occurrence and the effect of supplementation of common deficiencies was studied.
Most common preoperative deficiencies were of folic acid (21.3%), vitamin D3 (17.5%) and iron (21.8%). Post-operative, a significant increase in the number of patients with anaemia and deficiencies of ferritin and vitamin B12 was found. Most deficiencies occur between 12 and 15 months post-operatively, but vitamin D3 deficiency occurs significantly earlier at 9.7 months. A preoperative iron, folic acid or ferritin deficiency results in a significant higher risk for developing a post-operative deficiency despite supplementation, and ferritin deficiency occurs significantly earlier in these patients. Oral treatment of post-operative vitamin B12 and vitamin D3 deficiencies was successful in more than 80% of the patients in contrast to oral treatment of anaemia which was only successful in 62.5% of the patients.
Our study emphasizes the importance of preoperative assessment and treatment of nutritional deficiencies in morbidly obese patients undergoing gastric bypass surgery. Despite limited efficacy, post-operative oral supplementation should be encouraged as it decreases the incidence of deficiencies.
术后营养缺乏是减重手术后常见的并发症。其发生率和发生时间尚不明确，补充营养的效果也仍存疑问。因此需要明确的营养随访和咨询指南。
对427例接受胃旁路手术的患者术前和术后的营养缺乏情况进行测定。研究术前实验室检查结果对术后营养缺乏发生、发生时间以及常见营养缺乏补充效果的预测价值。
术前最常见的营养缺乏为叶酸（21.3%）、维生素D3（17.5%）和铁（21.8%）。术后，贫血、铁蛋白缺乏和维生素B12缺乏的患者数量显著增加。大多数营养缺乏发生在术后12至15个月之间，但维生素D3缺乏出现得更早，为9.7个月。术前铁、叶酸或铁蛋白缺乏会导致术后即使补充营养仍有显著更高的缺乏风险，且这些患者中铁蛋白缺乏出现得更早。术后维生素B12和维生素D3缺乏的口服治疗在超过80%的患者中取得成功，而贫血的口服治疗仅在62.5%的患者中成功。
我们的研究强调了对接受胃旁路手术的病态肥胖患者术前评估和治疗营养缺乏的重要性。尽管效果有限，但仍应鼓励术后口服补充营养，因为这可降低营养缺乏的发生率。
