Boshier Piers R, Fehervari Matyas, Markar Sheraz R, Purkayastha Sanjay, Spanel Patrik, Smith David, Hanna George B
Department of Surgery and Cancer, Imperial College London, St Marys Hospital, London, UK.
J. Heyrovský Institute of Physical Chemistry of the Czech Academy of Sciences, Prague, Czech Republic.
Obes Surg. 2018 Aug;28(8):2439-2446. doi: 10.1007/s11695-018-3180-5.
Dietary restriction together with alteration of the gastrointestinal tract results in major metabolic changes and significant weight loss in patients undergoing bariatric surgery. Current methods of measuring these changes are often inaccurate and lack a molecular basis. The objective of this study was to determine the role of exhaled ketones as non-invasive markers of nutritional status in patients undergoing surgical treatment of obesity.
Patients at different stages of treatment for obesity were recruited to this single-centre cross-sectional study. The sample time points were as follows: (i) at the time of initial attendance prior to dietary or surgical interventions, (ii) on the day of surgery following a low carbohydrate diet, and (iii) > 3 months after either Roux-en-Y gastric bypass or sleeve gastrectomy. The concentrations of ketones within breath samples were analysed by selected ion flow tube mass spectrometry.
Forty patients were recruited into each of the three study groups. Exhaled acetone concentrations increased significantly following pre-operative diet (1396 ppb) and bariatric surgery (1693 ppb) compared to the start of treatment (410 ppb, P < 0.0001). In comparison, concentrations of heptanone (6.5 vs. 4.1 vs. 1.4 ppb, P = 0.021) and octanone (3.0 vs. 1.4 vs. 0.7 ppb, P = 0.021) decreased significantly after dieting and surgical intervention. Exhaled acetone (ρ - 0.264, P = 0.005) and octanone (ρ 0.215, P = 0.022) concentrations were observed to correlate with excess body weight at the time of sampling. Acetone and octanone also correlated with neutrophil and triglyceride levels (P < 0.05).
Findings confirm breath ketones, particularly acetone, to be a potentially clinically useful method of non-invasive nutritional assessment in obese patients.
饮食限制以及胃肠道改变会导致接受减肥手术的患者出现重大代谢变化和显著体重减轻。目前测量这些变化的方法往往不准确且缺乏分子基础。本研究的目的是确定呼出酮类作为肥胖手术治疗患者营养状况非侵入性标志物的作用。
招募处于肥胖治疗不同阶段的患者参与这项单中心横断面研究。样本时间点如下：（i）在饮食或手术干预前初次就诊时；（ii）低碳水化合物饮食后手术当天；（iii） Roux-en-Y胃旁路术或袖状胃切除术后3个月以上。通过选择离子流管质谱法分析呼吸样本中的酮类浓度。
三个研究组各招募了40名患者。与治疗开始时（410 ppb，P < 0.0001）相比，术前饮食（1396 ppb）和减肥手术后呼出丙酮浓度显著增加（1693 ppb）。相比之下，节食和手术干预后庚酮（6.5对4.1对1.4 ppb，P = 0.021）和辛酮（3.0对1.4对0.7 ppb，P = 0.021）浓度显著降低。观察到呼出丙酮（ρ - 0.264，P = 0.005）和辛酮（ρ 0.215，P = 0.022）浓度与采样时的超重体重相关。丙酮和辛酮也与中性粒细胞和甘油三酯水平相关（P < 0.05）。
研究结果证实呼吸酮类，尤其是丙酮，是肥胖患者无创营养评估的一种潜在临床有用方法。
