Simancas-Racines Daniel, Reytor-González Claudia, Parise-Vasco Juan Marcos, Angamarca-Iguago Jaime, Garcia-Velasquez Eloisa, Cuzco-Macias Ashley Carolina, Frias-Toral Evelyn, Schiavo Luigi
Universidad UTE, Facultad de Ciencias de la Salud Eugenio Espejo, Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Quito 170527, Ecuador.
Clinical Nutrition Service, Grupo Hospitalario Kennedy, Guayaquil 090902, Ecuador.
Nutrients. 2025 Apr 30;17(9):1533. doi: 10.3390/nu17091533.
: Preoperative nutritional interventions, including low-calorie diets (LCDs) and very low-calorie diets (VLCDs), are commonly implemented in metabolic and bariatric surgery. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of preoperative dietary interventions in patients undergoing bariatric surgery, with primary outcomes including perioperative complications, operative time, and length of hospital stay. : A systematic review and meta-analysis were conducted, including studies that compared LCD and VLCD with regular diets in adults undergoing bariatric surgery. The primary outcomes assessed were perioperative complications, operative time, and length of hospital stay. Random- and fixed effects models were used for quantitative synthesis. Risk of bias was evaluated using the Cochrane Risk of Bias tool and ROBINS-I, while the certainty of evidence was assessed using the GRADE approach. : Eight trials comprising 1197 patients were included in the meta-analysis. VLCDs were associated with a significant reduction in perioperative complications (OR 0.59; 95% CI: 0.37-0.94; = 0.03), whereas LCDs showed no significant effect on complications (OR 1.64; 95% CI: 0.71-3.78; = 0.25). No significant reduction in operative time was observed (MD -2.64 min; 95% CI: -6.01 to 0.73; = 0.12). Hospital stay was slightly reduced (MD -0.17 days; = 0.0001), though the clinical significance remains uncertain. The certainty of evidence was low, primarily due to the risk of bias and small sample sizes. : VLCDs may lower the risk of perioperative complications, while LCDs do not appear to provide this benefit. However, the evidence is limited by methodological heterogeneity and low certainty. Further high-quality studies are needed to establish optimal preoperative nutritional protocols.
术前营养干预措施，包括低热量饮食（LCDs）和极低热量饮食（VLCDs），在代谢和减重手术中普遍应用。本系统评价和荟萃分析旨在评估术前饮食干预对接受减重手术患者的疗效和安全性，主要结局包括围手术期并发症、手术时间和住院时间。
进行了一项系统评价和荟萃分析，纳入了比较LCD和VLCD与接受减重手术的成年人常规饮食的研究。评估的主要结局为围手术期并发症、手术时间和住院时间。采用随机效应模型和固定效应模型进行定量合成。使用Cochrane偏倚风险工具和ROBINS-I评估偏倚风险，同时采用GRADE方法评估证据的确定性。
荟萃分析纳入了八项试验，共1197例患者。VLCDs与围手术期并发症显著减少相关（比值比[OR]0.59；95%置信区间[CI]：0.37 - 0.94；P = 0.03），而LCDs对并发症无显著影响（OR 1.64；95% CI：0.71 - 3.78；P = 0.25）。未观察到手术时间有显著缩短（平均差[MD] -2.64分钟；95% CI：-6.01至0.73；P = 0.12）。住院时间略有缩短（MD -0.17天；P = 0.0001），但其临床意义仍不确定。证据的确定性较低，主要是由于存在偏倚风险和样本量较小。
VLCDs可能会降低围手术期并发症的风险，而LCDs似乎未提供此益处。然而，证据受到方法学异质性和低确定性的限制。需要进一步的高质量研究来制定最佳的术前营养方案。
