Li Ying, Zhang Ting
Department of Gastrointestinal Surgery, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School of Nanjing Medical University, Suzhou, Jiangsu, 215000, People's Republic of China.
Diabetes Metab Syndr Obes. 2025 Jul 5;18:2191-2202. doi: 10.2147/DMSO.S518912. eCollection 2025.
Metabolic and Bariatric Surgery (MBS) is an effective treatment for severe obesity and its related complications. However, perioperative nutritional management is essential for the patient's surgical outcome and postoperative recovery. This article reviews the research progress in perioperative nutritional management of MBS. Preoperative nutritional assessment and optimization are essential, including monitoring and correction of micronutrient deficiencies, such as vitamin D, iron, folic acid, to reduce the risk of postoperative complications. In terms of preoperative dietary management, the use of a low-carbohydrate ketogenic diet (LCKD) and ready-to-eat low-carbohydrate ketogenic product (RLCKP) showed the potential to promote weight loss and liver volume reduction, creating favorable conditions for surgery. Strategies for preoperative weight loss (WL) need to be cautious, and moderate preoperative WL may help to reduce surgical difficulty and postoperative complications. In addition, the application of preoperative carbohydrate load can reduce postoperative insulin resistance and protein loss and promote postoperative recovery of patients. In terms of postoperative nutritional management, the risk of postoperative micronutrient deficiency is significantly increased. At the same time, the adjustment of postoperative dietary structure and rational use of nutritional supplements are important to maintain the nutritional status of patients and promote weight management. In conclusion, perioperative nutritional management of MBS is a multifaceted and multi-level comprehensive process that requires a multidisciplinary approach involving medical staff, dietitians, and patients. A tailor-made approach based on the patient's unique characteristics, such as nutritional status, surgical type, and personal preferences, is essential to achieve the best surgical results and improvement of patients' quality of life. Major challenges remain in perioperative nutritional management, such as the high prevalence of preoperative malnutrition and the complexity of postoperative nutritional deficiencies. In the future, more accurate preoperative nutritional assessment tools and personalized postoperative nutritional supplementation strategies should be developed.
代谢与减重手术（MBS）是治疗重度肥胖及其相关并发症的有效方法。然而，围手术期营养管理对患者的手术效果和术后恢复至关重要。本文综述了MBS围手术期营养管理的研究进展。术前营养评估和优化至关重要，包括监测和纠正微量营养素缺乏，如维生素D、铁、叶酸等，以降低术后并发症的风险。在术前饮食管理方面，使用低碳水化合物生酮饮食（LCKD）和即食低碳水化合物生酮产品（RLCKP）显示出促进体重减轻和肝脏体积缩小的潜力，为手术创造有利条件。术前减重（WL）策略需谨慎，适度的术前WL可能有助于降低手术难度和术后并发症。此外，术前碳水化合物负荷的应用可降低术后胰岛素抵抗和蛋白质流失，促进患者术后恢复。在术后营养管理方面，术后微量营养素缺乏的风险显著增加。同时，调整术后饮食结构和合理使用营养补充剂对于维持患者营养状况和促进体重管理很重要。总之，MBS围手术期营养管理是一个多方面、多层次的综合过程，需要医护人员、营养师和患者等多学科方法。基于患者独特特征（如营养状况、手术类型和个人偏好）的量身定制方法对于实现最佳手术效果和改善患者生活质量至关重要。围手术期营养管理仍面临重大挑战，如术前营养不良的高发生率和术后营养缺乏的复杂性。未来，应开发更准确的术前营养评估工具和个性化的术后营养补充策略。
