Department of Nutrition & Dietetics, Logan Hospital, Loganholme, QLD, Australia.
School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia.
J Hum Nutr Diet. 2021 Feb;34(1):188-198. doi: 10.1111/jhn.12819. Epub 2020 Oct 5.
Elective surgery in obese adults carries a higher risk of post-operative infection and prolonged hospital stays, and surgeons may postpone surgery for patients with obesity until they lose weight. The present study aimed to determine the efficacy of a dietitian-led very low calorie diet (VLCD)-based model of care with respect to achieving weight loss for obese patients prior to surgery.
This mixed-methods study included a medical chart audit of patients referred to a VLCD-based model over 23 months, as well as a survey of recently treated patients and surgeons who utilised the model. Preoperative weight loss targets were set by surgeons, and the dietitian prescribed individualised VLCD-based treatment. Efficacy was determined as weight loss considered sufficient for surgery, clinical safety of VLCD-based treatment, feasibility, and stakeholder value. Pre/post-intervention differences in clinical measures were explored by paired t-test or Wilcoxon tests as appropriate.
Data on seventy-eight eligible patients [mean (SD) 45 (13) years, 90% female, body mass index 44.3 (6.2) kg m ] demonstrated significant mean (SD) weight loss of 7.4% (5.3%) body weight (P < 0.05). Most patients (70%, n = 50/71) achieved sufficient weight loss to proceed to surgery. Fifty-six per cent of patients reported mild side effects (n = 43/77) and none led to treatment cessation. Surgeons reported VLCD-based treatment made operations easier (83%, n = 10/12) and shorter (75%, n = 9/12) and all recommended the model of care. All surveyed patients (n = 24) reported satisfaction with their VLCD-based model experience.
A dietitian-led VLCD-based model achieved sufficient weight loss to facilitate elective surgery for most patients. The approach was feasible, highly valued by patients and surgeons, and resulted in perceived surgical benefits.
肥胖成年人的择期手术术后感染风险较高，住院时间延长，外科医生可能会推迟肥胖患者的手术，直到他们减肥。本研究旨在确定营养师主导的极低卡路里饮食（VLCD）为肥胖患者提供术前减肥的效果。
这项混合方法研究包括对 23 个月来接受 VLCD 模型治疗的患者进行病历审核，以及对最近接受治疗的患者和使用该模型的外科医生进行调查。术前体重减轻目标由外科医生设定，营养师开个性化 VLCD 治疗方案。疗效通过外科医生认为手术减肥效果足够、VLCD 治疗的临床安全性、可行性和利益相关者价值来确定。通过配对 t 检验或 Wilcoxon 检验等适当方法探索临床测量的干预前后差异。
纳入 78 名符合条件的患者（平均[标准差]45[13]岁，90%为女性，体重指数 44.3[6.2]kg/m ）数据显示体重显著减轻 7.4%（5.3%）（P<0.05）。大多数患者（70%，n=50/71）体重减轻足够进行手术。56%的患者报告有轻度副作用（n=43/77），无一人因副作用停止治疗。外科医生报告说 VLCD 治疗使手术更容易（83%，n=10/12）和更短（75%，n=9/12），并全部推荐这种治疗模式。所有接受调查的患者（n=24）均报告对其 VLCD 治疗模式感到满意。
营养师主导的 VLCD 模型为大多数患者提供了足够的体重减轻，以促进择期手术。该方法可行，深受患者和外科医生的重视，并带来了手术效益。
