Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK.
Metabolic and Bariatric Surgery Program, Temple University Hospital, Philadelphia, Pennsylvania, USA.
Obes Rev. 2024 Dec;25(12):e13831. doi: 10.1111/obr.13831. Epub 2024 Sep 11.
Clinical practice recommendations for macronutrient intake in Metabolic and Bariatric Surgery (MBS) are insufficiently grounded in the research, possibly due to a paucity of research in key areas necessary to support macronutrient recommendations. An initial scoping review, prior to any systematic review, was determined to be vital.
To identify topical areas in macronutrients and MBS with a sufficient evidence base to guide nutrition recommendations.
PubMed, Cochrane, Ovid Medline, and Embase were initially searched in January 2019 (updated November 1, 2023) with terms encompassing current bariatric surgeries and macronutrients. Out of 757 records identified, 98 were included. A template was created. Five types of outcomes were identified for extraction: dietary intake, anthropometrics, adverse symptoms, health, and metabolic outcomes. All stages of screening and extraction were conducted independently by at least two authors and disagreements were resolved via team discussion. Macronutrient-related dietary treatments were classified as either innovative or standard of care. Descriptions of dietary arms were extracted in detail for a qualitatively generated typology of dietary or nutritional treatments. Heatmaps (treatments by outcomes) were produced to identify promising topics for further systematic analyses.
We identified protein supplementation and "food-focused" (e.g., portion-controlled meals, particular foods in the diet, etc.) topical areas in MBS nutrition care with potentially sufficient evidence to create specific MBS Macronutrients guidelines and identified topical areas with little research.
Clinical practice regarding macronutrient intake remains guided by consensus and indirect evidence. We detail ways that leadership at the profession level may remedy this.
代谢和减重外科（MBS）中宏量营养素摄入的临床实践建议在研究中基础不足，这可能是由于缺乏支持宏量营养素建议的关键领域的研究。因此，在进行任何系统评价之前，进行初步的范围评价被认为是至关重要的。
确定在宏量营养素和 MBS 中有足够证据基础的主题领域，以指导营养建议。
2019 年 1 月（更新于 2023 年 11 月 1 日），我们最初在 PubMed、Cochrane、Ovid Medline 和 Embase 中搜索了包含当前减重手术和宏量营养素的术语。在确定的 757 条记录中，有 98 条被纳入。创建了一个模板。确定了 5 种类型的提取结果：饮食摄入、人体测量学、不良症状、健康和代谢结果。所有的筛选和提取阶段都由至少两名作者独立进行，如果出现分歧，则通过团队讨论解决。与宏量营养素相关的饮食治疗被归类为创新或常规护理。详细提取了饮食臂的描述，以对饮食或营养治疗进行定性生成分类。生成了热图（治疗方法与结果），以确定有进一步系统分析前景的主题。
我们确定了 MBS 营养护理中蛋白质补充和“以食物为中心”（例如，部分控制的膳食、饮食中的特定食物等）的主题领域，这些领域可能有足够的证据来制定特定的 MBS 宏量营养素指南，并确定了研究较少的主题领域。
关于宏量营养素摄入的临床实践仍然以共识和间接证据为指导。我们详细说明了专业层面的领导可以采取哪些措施来纠正这种情况。
