Boyce Stephen G, Goriparthi Richie, Clark Jennifer, Cameron Krystal, Roslin Mitchell S
New Life Center for Bariatric Surgery, Knoxville, TN, USA.
Department of Surgery, Northshore-LIJ-Lenox Hill Hospital, 100 E 77th Street, New York, NY, 10075, USA.
Obes Surg. 2016 May;26(5):966-71. doi: 10.1007/s11695-015-1853-x.
Nutritional deficiencies occur after weight loss surgery. Despite knowledge of nutritional risk, there is little uniformity of postoperative vitamin and mineral supplementation. The objective of this study was to evaluate a composite supplement based on the clinical practice guidelines proposed in 2008 regarding vitamin and mineral supplementation after Roux-en-Y gastric bypass. The composite included iron (Fe) and calcium as well.
A retrospective chart review of 309 patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) was evaluated for the development of deficiencies in iron and vitamins A, B1, B12, and D. Patients were instructed to take a custom vitamin and mineral supplement that was based on society-approved guidelines. The clinical practice guidelines were modified to include 1600 international units (IU) of vitamin D3 instead of the recommended 800 IU.
The compliant patients' deficiency rates were significantly lower than those of the noncompliant patients for iron (p = 0.001), vitamin A (p = 0.01), vitamin B12 (p ≈ 0.02), and vitamin D (p < 0.0001). Women's menstrual status did not significantly influence the development of iron deficiency.
Use of a composite based on guidelines proposed by the AACE, TOS, and the ASMBS appears to be effective for preventing iron and vitamins A, B1, B12, and D deficiencies in the LRYGB patients during the first postoperative year. Separation of calcium and Fe does not need to be mandatory. Even with simplification, compliance is far from universal.
减肥手术后会出现营养缺乏。尽管了解营养风险，但术后维生素和矿物质补充缺乏一致性。本研究的目的是根据2008年提出的关于Roux-en-Y胃旁路术后维生素和矿物质补充的临床实践指南，评估一种复合补充剂。该复合补充剂还包括铁（Fe）和钙。
对309例行腹腔镜Roux-en-Y胃旁路术（LRYGB）患者进行回顾性病历审查，评估铁、维生素A、B1、B12和D缺乏情况。指导患者服用基于协会认可指南的定制维生素和矿物质补充剂。临床实践指南进行了修改，将维生素D3的剂量从推荐的800国际单位（IU）增加到1600 IU。
依从患者的铁（p = 0.001）、维生素A（p = 0.01）、维生素B12（p ≈ 0.02）和维生素D（p < 0.0001）缺乏率显著低于不依从患者。女性的月经状况对缺铁的发生没有显著影响。
使用基于美国临床内分泌医师协会（AACE）、肥胖症协会（TOS）和美国代谢与减重外科学会（ASMBS）指南的复合补充剂，似乎对预防LRYGB患者术后第一年的铁、维生素A、B1、B12和D缺乏有效。钙和铁无需强制分开。即使简化后，依从性也远未普及。
