Nilsen Inger, Andersson Agneta, Laurenius Anna, Österberg Johanna
Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden.
Center for Clinical Research Dalarna, Falun, Sweden.
Obes Rev. 2025 Apr;26(4):e13876. doi: 10.1111/obr.13876. Epub 2024 Dec 3.
There is no consensus regarding energy content or duration of hypocaloric diets used for preoperative optimization of patients before metabolic bariatric surgery. In this systematic review, we aimed to compare the effect of different hypocaloric diets on reductions in total body weight, liver volume, glucose and insulin concentrations, and side effects. Six databases were searched for articles including adults with BMI ≥35 kg/m treated with hypocaloric diets before metabolic bariatric surgery. Hypocaloric diets were categorized as (1) low-energy diet containing 800-1200 kcal/day for 2-4 weeks, (2) very low-energy diet containing 450-<800 kcal/day for 2-4 weeks, and (3) low-energy diet containing 800-1200 kcal/day for >4 weeks. Thirty-three articles (1868 patients) were included, and if data were sufficient, synthesis without meta-analysis was conducted. A low-energy diet and very low-energy diet for 2-4 weeks resulted in similar reductions in total body weight, but longer treatment correlated to a more pronounced weight reduction. In addition, a low-energy diet for 2-4 weeks led to decreased liver volume, which might facilitate the surgical procedure. Insulin resistance was generally reduced after a low-energy diet for 2-4 weeks. However, most studies were within-group control, and since more than 60% of the studies lacked variance measures for our outcomes, we did not perform a meta-analysis. Accordingly, our results should be interpreted carefully. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with registration number: CRD42022295757; available at: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=295757.
对于代谢性减肥手术前用于患者术前优化的低热量饮食的能量含量或持续时间，目前尚无共识。在这项系统评价中，我们旨在比较不同低热量饮食对总体重减轻、肝脏体积、血糖和胰岛素浓度降低以及副作用的影响。我们在六个数据库中检索了相关文章，纳入了在代谢性减肥手术前接受低热量饮食治疗的BMI≥35 kg/m²的成年人。低热量饮食分为三类：（1）每天800 - 1200千卡的低能量饮食，持续2 - 4周；（2）每天450 - <800千卡的极低能量饮食，持续2 - 4周；（3）每天800 - 1200千卡的低能量饮食，持续超过4周。共纳入33篇文章（1868例患者），如果数据充足，则进行无荟萃分析的综合分析。持续2 - 4周的低能量饮食和极低能量饮食导致总体重减轻相似，但治疗时间越长，体重减轻越明显。此外，持续2 - 4周的低能量饮食可使肝脏体积减小，这可能有利于手术操作。持续2 - 4周的低能量饮食后，胰岛素抵抗通常会降低。然而，大多数研究为组内对照，且由于超过60%的研究缺乏我们所关注结局的方差测量，我们未进行荟萃分析。因此，我们的结果应谨慎解读。该方案已在国际系统评价前瞻性注册库（PROSPERO）注册，注册号：CRD42022295757；可在以下网址获取：https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=295757 。
