Sandhu Lakhvir Kaur, Shah Rohan M, Chand Bipan
Loyola University Chicago Stritch School of Medicine, 2160 First Ave, Maywood, IL, USA.
Feinberg School of Medicine, Chicago, IL, USA.
Surg Endosc. 2023 Nov;37(11):8532-8539. doi: 10.1007/s00464-023-10421-2. Epub 2023 Sep 29.
Bariatric surgery is commonly used in patients with body mass indexes over 35 kg/m and obesity-related comorbidities. Despite the significant clinical benefits of bariatric surgery, nutritional deficiencies post-surgery remain a challenge for both patient and healthcare provider [Toninello et al. in Nutrients 13:1565, 2021, Gasmi et al. in Eur J Nutr 61:55-67, 2022]. Nutritional supplementation is a way of reducing the likelihood of postoperative deficiencies; however, prior studies have shown varying degrees of mostly poor to moderate patient adherence [Spetz et al. in Obes Res Clin Pract 16:407-412, 2022, Mahawar et al. in Obes Surg 29:1551-1556, 2019, Santonicola et al. in J Am Nutr Assoc 41:11-19, 2022, Sherf Dagan et al. in Obes Surg 27:2258-2271, 2017]. Our present study aims to provide insights into the micronutrient biochemical profile in patients previously found to be compliant with supplementation following roux-en-y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG).
An 11-point outpatient survey was administered to consecutive patients ≥ 18 years who had undergone either RYGB or VSG to determine adherence with nutritional supplementation. Medical records were retrospectively reviewed to determine preoperative and postoperative lab values, including vitamins A, B1, B12, and D, thyroid stimulating hormone (TSH), iron binding capacity, transferrin, ferritin, folate, iron, albumin, hemoglobin A1C, zinc, glomerular filtration rate (GFR, and liver function values. Values were classified as "abnormal" or "normal." Preoperative and postoperative values were compared for differences. Postoperative values were also compared between RYGB and VSG.
There were no significant differences between preoperative and postoperative values for any nutritional marker aside from vitamin B12. A total of 51/60 patients (85.0%) had normal preoperative B12 measurements, compared with 40/65 (61.5%) patients postoperatively (P = 0.03). Notably, of 25 "abnormal" postoperative measurements, 20 (80%) were elevated values. There were no differences in postoperative deficiencies between RYGB and VSG.
Patients in our sample did not have worsened micronutrient deficiencies following bariatric surgery, and there were no differences in micronutrient deficiencies between surgical technique.
减重手术常用于身体质量指数超过35kg/m²且患有肥胖相关合并症的患者。尽管减重手术具有显著的临床益处，但术后营养缺乏对患者和医护人员来说仍是一项挑战[托尼内洛等人，《营养素》，2021年，第13卷，第1565页；加斯米等人，《欧洲营养学杂志》，2022年，第61卷，第55 - 67页]。营养补充是降低术后缺乏可能性的一种方法；然而，先前的研究表明，患者的依从性大多在不同程度上较差至中等[斯佩茨等人，《肥胖研究与临床实践》，2022年，第16卷，第407 - 第412页；马哈弗等人，《肥胖外科》，2019年，第29卷第1551 - 1556页；桑托尼科拉等人，《美国营养协会杂志》，2022年，第41卷，第11 - 19页；谢尔夫·达根等人，《肥胖外科》，2017年，第27卷，第2258 - 2271页]。我们目前的研究旨在深入了解先前发现依从补充治疗的患者在接受胃旁路术（RYGB）和垂直袖状胃切除术（VSG）后的微量营养素生化特征。
对连续接受RYGB或VSG手术且年龄≥18岁的门诊患者进行了一项11项的调查，以确定其对营养补充的依从性。回顾性查阅病历以确定术前和术后的实验室检查值，包括维生素A、B1、B12和D、促甲状腺激素（TSH）、铁结合能力、转铁蛋白、铁蛋白、叶酸、铁、白蛋白、糖化血红蛋白A1C、锌、肾小球滤过率（GFR）和肝功能值。这些值被分类为“异常”或“正常”。比较术前和术后的值以发现差异。还比较了RYGB和VSG术后的值。
除维生素B12外，任何营养指标的术前和术后值之间均无显著差异。共有51/60名患者（85.0%）术前维生素B12测量值正常，术后为40/65名患者（61.5%）（P = 0.03）。值得注意的是，在25项术后“异常”测量中，20项（80%）为升高值。RYGB和VSG术后的缺乏情况没有差异。
我们样本中的患者在减重手术后微量营养素缺乏情况并未恶化，手术技术之间的微量营养素缺乏情况也没有差异。
