Endocrine and Nutritional Management of the Post-Bariatric Surgery Patient: An Endocrine Society Clinical Practice Guideline
Endocrine and Nutritional Management of the Post-Bariatric Surgery Patient: An Endocrine Society Clinical Practice Guideline
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DOI：
10.1210/jc.2009-2128
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发表时间：
2010-11-01
影响因子：
5.8
通讯作者：
Still, Christopher
中科院分区：
文献类型：
--
作者：
Heber, David;Greenway, Frank L.;Still, Christopher
目的：我们试图为成人减肥手术后的营养和内分泌管理提供指南，包括糖尿病患者。重点放在术后即刻和长期治疗，以防止并发症、体重回升和肥胖相关合并症的进展。具体疾病的治疗仅作总结。参与者：工作组由一名主席、另外五名专家、一名方法学家和一名医学作家组成。它没有得到公司的资助或报酬。结论：减肥手术并不能保证成功减肥和维持体重。越来越多的患者体重增加，特别是那些接受限制性手术(如腹腔镜捆绑)而不是吸收不良手术(如Roux-en-Y搭桥术)的患者。对于所有接受减肥手术的患者，建议进行积极的营养患者教育和临床管理，以预防和发现营养缺乏。对于接受吸收不良手术的患者来说，管理潜在的营养缺乏尤其重要，应该采取策略来补偿接受过吸收不良手术的患者的食物不耐受，以减少临床上重要的营养缺乏的风险。为了促进减肥手术后的生活过渡，防止体重增加和营养并发症，所有患者都应该接受包括经验丰富的初级保健医生、内分泌学家或胃肠病专家在内的多学科团队的护理，并考虑在术后参加全面的营养和生活方式管理计划。未来的研究应该解决加强术后营养和内分泌护理在降低肥胖相关慢性疾病的发病率和死亡率方面的有效性。(临床内分泌代谢酶95：4823-4843,2010)
Objective: We sought to provide guidelines for the nutritional and endocrine management of adults after bariatric surgery, including those with diabetes mellitus. The focus is on the immediate postoperative period and long-term management to prevent complications, weight regain, and progression of obesity-associated comorbidities. The treatment of specific disorders is only summarized.Participants: The Task Force was composed of a chair, five additional experts, a methodologist, and a medical writer. It received no corporate funding or remuneration.Conclusions: Bariatric surgery is not a guarantee of successful weight loss and maintenance. Increasingly, patients regain weight, especially those undergoing restrictive surgeries such as laparoscopic banding rather than malabsorptive surgeries such as Roux-en-Y bypass. Active nutritional patient education and clinical management to prevent and detect nutritional deficiencies are recommended for all patients undergoing bariatric surgery. Management of potential nutritional deficiencies is particularly important for patients undergoing malabsorptive procedures, and strategies should be employed to compensate for food intolerance in patients who have had a malabsorptive procedure to reduce the risk for clinically important nutritional deficiencies. To enhance the transition to life after bariatric surgery and to prevent weight regain and nutritional complications, all patients should receive care from a multidisciplinary team including an experienced primary care physician, endocrinologist, or gastroenterologist and consider enrolling postoperatively in a comprehensive program for nutrition and lifestyle management. Future research should address the effectiveness of intensive postoperative nutritional and endocrine care in reducing morbidity and mortality from obesity-associated chronic diseases. (J Clin Endocrinol Metab 95: 4823-4843, 2010)