Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Nutrition Department, Sorbonne University, Institute of Cardiometabolism and Nutrition (ICAN), 47-83 boulevard de l'Hôpital, 75013, Paris, France.
Sorbonne Université, INSERM, Nutrition and obesities; systemic approaches (NutriOmics), Paris, France.
Obes Surg. 2024 Feb;34(2):363-370. doi: 10.1007/s11695-023-06842-6. Epub 2023 Dec 21.
Bariatric surgery (BS) results in major and sustained weight loss and improves comorbidities in patients with obesity but can also lead to malnutrition, especially through severe malabsorption and/or surgical complications. Little is known about the efficacy of artificial nutrition (AN) in this setting.
In this case series, we describe data from consecutive severely malnourished patients after BS (resectional and non-resectional), managed by AN at our hospital unit over a 4-year period.
Between January 2018 and June 2022, 18 patients (mean ± SD age 42.2 ± 10.4 years, 94% women) required AN following BS complications. At the time of AN initiation, more than half of the patients (53%) had multiple revisional surgeries (up to four). Mean BMI was 49.7 ± 11.3 kg/m before BS and 29.6 ± 9.6 kg/m when AN was initiated. Most patients (n=16, 90%) received enteral nutrition. AN management resulted in weight regain (+4.7kg ± 8.0, p=0.034), increased serum albumin (+28%, p=0.02), pre-albumin (+88%, p=0.002), and handgrip strength (+38%, p=0.078). No major AN complication nor death was observed. Median total AN duration was 4.5 months [1-12]. During follow-up, the cumulative duration of hospitalization was 33 days [4-88] with a median of 2.5 hospitalizations [1-8] per patient.
Malnutrition can occur after any BS procedure, and AN when required in this setting appears safe and effective on nutritional parameters. It is important to recognize the potential risk factors for malnutrition, which include excessive weight loss resulting from surgical complications, eating disorders, multiple revisional BS, and pregnancy.
减重手术（BS）可显著且持续地减轻体重，并改善肥胖患者的合并症，但也可能导致营养不良，尤其是严重的吸收不良和/或手术并发症。在这种情况下，人工营养（AN）的疗效知之甚少。
在本病例系列中，我们描述了在过去 4 年中，我们医院单元对接受 BS（切除术和非切除术）后严重营养不良的连续患者进行 AN 管理的数据。
在 2018 年 1 月至 2022 年 6 月期间，18 名患者（平均年龄±标准差为 42.2±10.4 岁，94%为女性）因 BS 并发症需要 AN。在开始 AN 时，超过一半的患者（53%）进行了多次翻修手术（最多 4 次）。BS 前平均 BMI 为 49.7±11.3kg/m2，开始 AN 时为 29.6±9.6kg/m2。大多数患者（n=16，90%）接受肠内营养。AN 管理导致体重增加（+4.7kg±8.0，p=0.034），血清白蛋白增加（+28%，p=0.02），前白蛋白增加（+88%，p=0.002）和握力增加（+38%，p=0.078）。未观察到重大 AN 并发症或死亡。AN 总持续时间中位数为 4.5 个月[1-12]。在随访期间，住院总天数为 33 天[4-88]，每位患者的中位数为 2.5 次住院[1-8]。
BS 后的任何手术程序都可能导致营养不良，在这种情况下，需要进行 AN，从营养参数来看，这种方法似乎是安全有效的。认识到营养不良的潜在危险因素很重要，这些危险因素包括手术并发症导致的体重过度减轻、饮食失调、多次 BS 翻修和妊娠。
