Franken Rutger, Zwartjes Max, Senff Ashley, Hutten Barbara, de Rotte Maurits, Gerdes Victor, van de Laar Arnold, Nieuwdorp Max
Department of Metabolic and Bariatric Surgery and Internal Medicine, Spaarne Ziekenhuis, Hoofddorp, Netherlands.
Department of Cardiology, Wellington Hospital, Wellington, New Zealand.
Obes Surg. 2025 Sep 10. doi: 10.1007/s11695-025-08244-2.
Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are common bariatric procedures that lead to substantial and sustained weight loss. Although both procedures induce hormonal and physiological effects, RYGB includes both a restrictive and malabsorptive component due to anatomical rerouting, whereas SG is considered primarily restrictive. This study aimed to quantify differences in energy and fat absorption between both procedures using near-infrared spectroscopy (NIRS).
Female patients, 12-24 months post-RYGB or SG, followed a strictly controlled, tailor-made diet for 6 days. Faecal samples collected over the final 3 days were analysed using NIRS to assess energy and fat malabsorption. Physical activity and stool consistency were also evaluated.
Twenty-nine patients were initially included; one RYGB patient was excluded due to implausibly high reported energy intake leaving 14 RYGB and 14 SG patients. We found higher (p = 0.03) malabsorption in patients after RYGB (194.8 malabsorbed kcal, 13.2%) as compared to patients after SG (111.7 malabsorbed kcal, 7.6%). Furthermore, in the RYGB group, malabsorbed fat was higher (p = 0.01) with 9.7 g (15.4%) malabsorbed as compared to 3.9 g (6.1%) malabsorbed in SG. Even when adjusting for percentage weight loss, both differences remained statistically significant.
Fat and energy malabsorption are significantly higher following RYGB compared to SG, and NIRS proves to be a feasible method for assessing these differences. However, the differences are relatively modest and do not appear to be directly proportional to the reduction in functional intestinal length exposed to nutrients.
Roux-en-Y胃旁路术（RYGB）和袖状胃切除术（SG）是常见的减肥手术，可导致显著且持续的体重减轻。尽管这两种手术都会引起激素和生理效应，但由于解剖结构的重新布线，RYGB包括限制和吸收不良两个部分，而SG主要被认为是限制性的。本研究旨在使用近红外光谱（NIRS）量化两种手术之间能量和脂肪吸收的差异。
接受RYGB或SG手术12 - 24个月后的女性患者遵循严格控制的定制饮食6天。使用NIRS分析在最后3天收集的粪便样本，以评估能量和脂肪吸收不良情况。还评估了身体活动和粪便稠度。
最初纳入29例患者；1例RYGB患者因报告的能量摄入量高得难以置信而被排除，最终留下14例RYGB患者和14例SG患者。我们发现，与SG术后患者（吸收不良111.7千卡，7.6%）相比，RYGB术后患者的吸收不良更高（p = 0.03）（吸收不良194.8千卡，13.2%）。此外，在RYGB组中，脂肪吸收不良更高（p = 0.01），吸收不良9.7克（15.4%），而SG组为3.9克（6.1%）。即使调整体重减轻百分比，这两个差异仍具有统计学意义。
与SG相比，RYGB术后脂肪和能量吸收不良明显更高，并且NIRS被证明是评估这些差异的可行方法。然而，这些差异相对较小，并且似乎与暴露于营养物质的功能性肠长度的减少不成正比。
