老年肥胖患者行袖状胃切除术和 Roux-en-Y 胃旁路术后的食物耐受性和营养风险：一项前瞻性、随机对照试验。

FOOD TOLERANCE AND NUTRITIONAL RISK AFTER SLEEVE GASTRECTOMY AND ROUX-EN-Y GASTRIC BYPASS IN ELDERLY PATIENTS WITH SEVERE OBESITY: A PROSPECTIVE, RANDOMIZED CONTROLLED TRIAL.

机构信息

Divisão de Nutrição e Dietética, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.

Unidade de Cirurgia Bariátrica e Metabólica, Disciplina de Cirurgia do Aparelho Digestivo e Coloproctologia, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.

出版信息

Arq Gastroenterol. 2022 Jul-Sep;59(3):370-374. doi: 10.1590/S0004-2803.202203000-67.

DOI:10.1590/S0004-2803.202203000-67

PMID:36102434

Abstract

BACKGROUND

Bariatric surgery is still controversial in elderly patients with severe obesity. Most publications focus on safety and early clinical outcomes. Food tolerance and nutritional postoperative risk is unknown for this population.

METHODS

Thirty-six elderly patients with severe obesity were recruited for an open-label randomized trial from September 2017 to May 2019 comparing laparoscopic sleeve gastrectomy (LSG) to Roux-en-Y Gastric Bypass (LRYGB). Food tolerance was accessed by Quality of Alimentation (QoA) questionnaire and data on weight loss, body composition, and nutritional risk were collected between 6 and 24 months after surgery.

RESULTS

Comparing LSG to LRYGB patients, the latter had higher total weight loss (22% vs 31%, P=0.01) and excess weight loss (53% vs 68%, P=0.01). Food tolerance to eight food groups was similar between groups (14 vs 15 points, P=0.270), as Suter score (23 vs 25, P=0.238). Daily protein intake was below recommendation in both groups (40 vs 51 g/d, P=0.105). Nutritional risk, evaluated through Standardized Phase Angle (-1.48 vs -1.99, P=0.027), was worse for LRYGB group.

CONCLUSION

Food tolerance and adequacy of food consumption were similar in both groups. LRYGB patients had higher nutritional risk.

摘要

背景

肥胖症老年人的减重手术仍然存在争议。大多数出版物都集中在安全性和早期临床结果上。对于这一人群，术后食物耐受性和营养风险尚不清楚。

方法

2017 年 9 月至 2019 年 5 月，我们进行了一项开放性随机试验，招募了 36 名肥胖症老年患者，比较腹腔镜袖状胃切除术（LSG）与 Roux-en-Y 胃旁路术（LRYGB）。通过营养质量问卷（QoA）评估食物耐受性，并在术后 6 至 24 个月收集体重减轻、身体成分和营养风险的数据。

结果

与 LSG 相比，LRYGB 患者的总体重减轻更多（22%比 31%，P=0.01），超重减轻更多（53%比 68%，P=0.01）。两组间 8 种食物组的食物耐受性相似（14 分比 15 分，P=0.270），Suter 评分相似（23 分比 25 分，P=0.238）。两组的蛋白质摄入量均低于推荐量（40 克/天比 51 克/天，P=0.105）。通过标准化相位角评估的营养风险（-1.48 比-1.99，P=0.027），LRYGB 组更差。