Pinho André Costa, Oliveira Ana Manuel, Silva Mariana Santos, Santos-Sousa Hugo, Resende Fernando, Preto John, Lima-da-Costa Eduardo
Integrated Responsibility Center for Obesity (CRI-O), São João Local Health Unit (ULS), Porto, Portugal.
Faculty of Medicine, University of Porto, Porto, Portugal.
J Metab Bariatr Surg. 2024 Dec;13(2):59-70. doi: 10.17476/jmbs.2024.13.2.59. Epub 2024 Dec 23.
Metabolic and bariatric surgery (MBS) is an effective treatment for patients with body mass index (BMI) above 50.0 kg/m but nutritional deficiencies (ND) may arise. This study aimed to assess if patients with BMI above 50.0 kg/m have more ND and require more supplementation after MBS compared to patients in lower BMI groups.
Retrospective single center study including all patients submitted to MBS from 2019-2020. Several parameters were collected. Statistical analysis was performed to compare ND between BMI groups (<40.0 kg/m; 40.0 to 49.9 kg/m; ≥50.0 kg/m), and between surgeries (Roux-en-Y gastric bypass [RYGB] vs. sleeve gastrectomy [SG]) in the group with BMI ≥50.0 kg/m.
We identified 951 patients, 85 (9.0%) with BMI ≥50.0 kg/m, with RYGB performed in 644 (68.4%) patients. Pre-operatively, vitamin D deficiency was observed in 80.0% of patients with BMI ≥50.0 kg/m, with significant differences between BMI groups. At follow-up there were no significant differences in ND according to BMI groups. In patients with BMI ≥50.0 kg/m, vitamin B12 deficiency was more frequent after RYGB. At 2-year follow-up, 95.4% patients were taking multivitamin supplementation, and 52.4% required additional supplements, namely vitamin D.
ND are common in patients with BMI ≥50.0 kg/m, even before MBS. After surgery, patients with BMI ≥50.0 kg/m may not have increased risk for ND, compared to other BMI groups. In these patients, RYGB resulted in an increased risk for vitamin B12 deficiency. Adequate supplementation and clinical follow-up are essential to mitigate these complications.
代谢与减重手术（MBS）是治疗体重指数（BMI）高于50.0 kg/m²患者的有效方法，但可能会出现营养缺乏（ND）。本研究旨在评估与BMI较低组的患者相比，BMI高于50.0 kg/m²的患者在MBS后是否有更多的营养缺乏且需要更多补充剂。
回顾性单中心研究，纳入了2019年至2020年接受MBS的所有患者。收集了多个参数。进行统计分析以比较BMI组（<40.0 kg/m²；40.0至49.9 kg/m²；≥50.0 kg/m²）之间以及BMI≥50.0 kg/m²组内不同手术方式（Roux-en-Y胃旁路术[RYGB]与袖状胃切除术[SG]）之间的营养缺乏情况。
我们确定了951例患者，其中85例（9.0%）BMI≥50.0 kg/m²，644例（68.4%）患者接受了RYGB手术。术前，BMI≥50.0 kg/m²的患者中80.0%存在维生素D缺乏，BMI组之间存在显著差异。随访时，根据BMI组划分的营养缺乏情况无显著差异。在BMI≥50.0 kg/m²的患者中，RYGB术后维生素B12缺乏更为常见。在2年随访时，95.4%的患者正在服用多种维生素补充剂，52.4%的患者需要额外补充，即维生素D。
营养缺乏在BMI≥50.0 kg/m²的患者中很常见，甚至在MBS之前就是如此。术后，与其他BMI组相比，BMI≥50.0 kg/m²的患者营养缺乏风险可能不会增加。在这些患者中，RYGB导致维生素B12缺乏的风险增加。充分的补充和临床随访对于减轻这些并发症至关重要。
