Steenackers Nele, de Boer Lotte, Dekempeneer Charlotte, Deleus Ellen, Lannoo Matthias, Mertens Ann, Pazmino Sofia, Vangoitsenhoven Roman, Matthys Christophe, Van der Schueren Bart
Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, University of Leuven, Herestraat 49 - Box 7003, 3000, Leuven, Belgium.
Department of Nutrition and Movement Sciences, Research Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands.
Curr Obes Rep. 2025 Jan 31;14(1):16. doi: 10.1007/s13679-025-00606-2.
Long-term data indicate that patients who underwent metabolic bariatric surgery have a higher risk of developing nutritional complications. Therefore, it is of utmost importance to monitor their nutritional status.
A scoping literature search was conducted in MEDLINE, EMBASE, CINAHL, and TRIP database to identify clinical practice guidelines for nutritional screening before and after metabolic bariatric surgery from learned societies. For full coverage, all websites of learned societies affiliated with the World Obesity Federation were searched. Clinical practice guidelines were eligible if they contained recommendations for nutritional screening before and after sleeve gastrectomy or Roux-en-Y gastric bypass. Content was screened by two reviewers for timing, biochemical markers and cut-off values, and biochemical assays for nutritional screening.
Nine eligible clinical practice guidelines co-authored by 26 learned societies were identified. All guidelines provided recommendations for both bariatric procedures except for one. Majority of guidelines endorsed nutritional screening before surgery and at 3, 6, 12, and 24 months after surgery, and annually thereafter. Pre- and postoperative screening recommendations were available for iron, vitamin B, folate, calcium and vitamin D, but in a lesser extent for vitamin A, vitamin E, vitamin K, zinc, vitamin B, copper and magnesium. Two clinical practice guidelines provided cut-off values for the diagnosis of nutritional deficiencies.
The clinical practice guidelines exhibited a high level of consistency for timing of screening, but not for the applied biochemical markers. Going forward, the primary focus should be on harmonizing recommendations for biochemical markers, and cut-off values.
长期数据表明，接受代谢性减肥手术的患者发生营养并发症的风险更高。因此，监测他们的营养状况至关重要。
在MEDLINE、EMBASE、CINAHL和TRIP数据库中进行了一项范围界定文献检索，以确定学术团体发布的关于代谢性减肥手术前后营养筛查的临床实践指南。为确保全面覆盖，检索了世界肥胖联合会下属所有学术团体的网站。如果临床实践指南包含袖状胃切除术或Roux-en-Y胃旁路术前后营养筛查的建议，则该指南符合纳入标准。由两名审阅者对内容进行筛查，包括筛查时间、生化标志物和临界值，以及营养筛查的生化检测方法。
共确定了由26个学术团体共同撰写的9份符合纳入标准的临床实践指南。除一份指南外，所有指南都针对这两种减肥手术提供了建议。大多数指南认可在手术前以及术后3个月、6个月、12个月和24个月进行营养筛查，此后每年进行一次。术前和术后筛查建议涉及铁、维生素B、叶酸、钙和维生素D，但对维生素A、维生素E、维生素K、锌、维生素B、铜和镁的涉及较少。两份临床实践指南提供了营养缺乏诊断的临界值。
临床实践指南在筛查时间方面表现出高度一致性，但在应用的生化标志物方面并非如此。未来，主要重点应放在统一生化标志物和临界值的建议上。
