Service des Explorations Fonctionnelles, Centre Intégré Nord Francilien de l'Obésité (CINFO), Hôpital Louis Mourier, AP-HP, and INSERM UMR 1149, Université de Paris, Paris, France.
Service de Chirurgie, Centre Intégré Nord Francilien de prise en charge de l'Obésité (CINFO), Hôpital Louis Mourier, AP-HP, Université de Paris, Paris, France.
Obes Surg. 2020 Jun;30(6):2165-2172. doi: 10.1007/s11695-020-04425-3.
Several studies reported a risk of nutritional deficiencies after sleeve gastrectomy (SG). Systematic long-term multivitamin (MV) supplementation after SG is recommended by guidelines but not followed in practice in France.
To assess the determinants of nutritional status at 2 years or more after SG in patients treated or not with MV.
Nutritional parameters were prospectively recorded in our database from 2004. All patients who came back in our institution for follow-up at 2 years or more after SG were included. The last visit available was selected. Systematic MV was stopped at 1 year after SG except if there is risk of malnutrition. A deficiency was defined by a biological deficit or the need for a specific supplement, prescribed in accordance with biological deficit.
One hundred forty-seven patients were included with a mean follow-up of 44 ± 17 months: 39 were still taking MV and 108 had stopped MV. Caloric and protein intake was lower, and albumin deficiencies were more frequent in patients still taking MV, as expected. The total number of deficiencies was not significantly different before and after SG even in patients without MV (3.7 ± 1.8 vs. 3.5 ± 1.8), but patients without MV tended to have more group B vitamin deficiencies after surgery. The main determinants of postoperative deficiencies were preoperative concentrations.
Nutritional deficiencies are not more common after than before SG, even among patients who stopped MV. The interest of targeted supplementation in patients with deficiencies rather than systematic supplementation after SG needs to be confirmed by randomized studies.
几项研究报告称袖状胃切除术（SG）后存在营养缺乏的风险。指南建议在 SG 后长期系统地补充多种维生素（MV），但在法国并未在实践中得到遵循。
评估 MV 治疗或未治疗的 SG 后 2 年以上患者的营养状况决定因素。
从 2004 年开始，前瞻性地在我们的数据库中记录营养参数。所有在 SG 后 2 年以上回到我们机构进行随访的患者均被纳入研究。选择最后一次可获得的就诊记录。除存在营养不良风险外，SG 后 1 年停止系统 MV。如果存在生物学缺陷或需要根据生物学缺陷来进行特定补充，则定义为缺乏。
共纳入 147 例患者，平均随访时间为 44±17 个月：39 例仍在服用 MV，108 例已停止 MV。正如预期的那样，仍在服用 MV 的患者热量和蛋白质摄入较低，白蛋白缺乏更为常见。即使在未服用 MV 的患者中，SG 前后的总缺乏数量也没有显著差异（3.7±1.8 与 3.5±1.8），但未服用 MV 的患者术后更倾向于出现更多的 B 族维生素缺乏。术后缺乏的主要决定因素是术前浓度。
即使在停止 MV 的患者中，SG 后营养缺乏也不比 SG 前更常见。需要通过随机研究来证实针对缺乏症患者的靶向补充而不是 SG 后系统补充的益处。
