营养治疗对减重术后身体成分及静息能量消耗的影响

doi:10.16139/j.1007-9610.2022.03.012

摘要/Abstract

摘要：

目的：探讨营养治疗对减重手术前后肥胖病人身体成分及静息能量消耗（resting energy expenditure, REE）的影响。方法：腹腔镜袖状胃切除减重手术的47例病人行术后3个月六阶段的营养治疗,分别于术前、术后1个月、术后3个月测量身体成分指标、REE及营养相关生化指标水平。应用Bernestin Formula公式计算预测REE。病人各指标的变化行重复测量方差分析。结果：术后1个月、3个月的肌肉量分别下降8.33%±3.49%、2.86%±3.96%。术后1个月、3个月体脂肪量分别下降14.73%±5.44%、16.61%±8.26%。病人术前及术后3个月REE与预测REE值的差异均无统计学意义：术前（9 339.16±2 620.59） kJ比（9 058.06±2 098.61） kJ,P=0.593;术后3个月（7 228.20±2 066.61） kJ 比（7 973.15±1 747.49） kJ,P=0.098。术后1个月,预测REE值明显高于REE值,（8 286.81±1 764.25） kJ 比（7 418.33±1 764.25） kJ,P=0.032。术前、术后1个月和术后3个月血清维生素（A、B₁、B₂、B₆和C）以及血清铁蛋白水平的差异均无统计学意义（P>0.05）;而C反应蛋白水平显著下降。术前为（9.03±9.42） mg/L,术后1个月（6.61±7.89） mg/L与术后3个月（4.69±4.66） mg/L,P=0.020。结论：减重术后3个月内营养治疗措施可延缓骨骼肌量的减少和REE的适应,一定程度降低病人炎症水平。

关键词: 减重手术, 营养治疗, 身体成分, 静息能量消耗

Abstract:

Objectives To investigate the effect of nutritional therapy on body composition and resting energy expenditure(REE) post bariatric surgery in patients with obesity. Methods Six-step post-operative nutrition therapy during 3 months was performed for 47 patients undergoing bariatric surgery with laparoscopic sleeve gastrectomy. Body composition, REE and nutritonal biochemical indexes were determined in pre-surgery and post-surgery 1, 3 months. Predictive REE was calculated with Bernestin Formula. Repeated ANOVA analysis was done for the changes in the indicators of patients. Results Muscle mass reduced 8.33%±3.49% in post-surgery 1 month, and 2.86%±3.96% in post-surgery 3 months. Fat mass reduced 14.73%±5.44% in post-surgery 1 month and 16.61%±8.26% in post-surgery 3 months. There was no significant difference between REE and predicted REE with (9 339.16±2 620.59) kJ vs. (9 058.06±2 098.61) kJ in pre-surgery, P=0.593; and (7 228.20±2 066.61) kJ vs. (7 973.15±1 747.49) kJ in post-surgery 3 months, P=0.098. However, predicted REE (8 286.81±1 764.25) kJ was significant higher than REE (7 418.33±1 764.25) kJ in post-surgery 1 month, P=0.032. There was no significant difference in levels of vitamin-A, vitamin-B₁, vitamin-B₂, vitamin-B₆, vitamin-C and serum ferritin between pre-surgery and post-surgery 1 month and post-surgery 3 months(P>0.05). A significant reduction of C-reactive protein was present with (9.03±9.42) mg/L in pre-surgery, (6.61±7.89) mg/L in post-surgery 1 month and (4.69±4.66) mg/L in post-surgery 3 months, P=0.020. Conclusions Nutritional therapy after bariatric surgery 3 months could delay the loss of skeletal muscle mass and adapt REE and reduce the inflammation level in patients with obesity.

Key words: Bariatric surgery, Nutritional therapy, Body composition, Resting energy expenditure

中图分类号:

宣呈杰, 卞冬生, 蒋咏梅, 陈宇菲, 金佳斌, 施咏梅. 营养治疗对减重术后身体成分及静息能量消耗的影响[J]. 外科理论与实践, 2022, 27(03): 244-248.

XUAN Chengjie, BIAN Dongsheng, JIANG Yongmei, CHEN Yufei, JIN Jiabin, SHI Yongmei. Effect of nutritional therapy on body composition and resting energy expenditure post bariatric surgery[J]. Journal of Surgery Concepts & Practice, 2022, 27(03): 244-248.

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指标	术前	术后1个月	术后3个月	F值	P值
体重（kg）	121.03±26.04	108.96±23.62	99.62±22.11	384.833	<0.001^a）
BMI（kg/m²）	42.62±6.85	38.41±6.44	35.08±6.06	419.465	<0.001^a）
FFM（kg）	62.38±14.32	58.01±12.55	56.47±13.11	91.384	<0.001^a）
肌肉量（kg）	35.16±8.57	32.21±7.57	31.29±7.96	110	<0.001^a）
FM（kg）	58.65±14.43	50.81±14.24	43.49±13.65	243.558	<0.001^a）
内脏脂肪面积（cm²）	243.81±28.17	224.21±39.22	195.11±48.52	97.489	<0.001^a）
细胞总水分（L）	465.85±10.57	42.76±9.18	41.41±19.56	84.785	<0.001^a）

指标	术前	术后1个月	术后3个月	F值	P值
C反应蛋白（mg/L）	9.03±9.42	6.61±7.89	4.69±4.66	6.945	0.020^b）
前白蛋白（mg/L）	216.41±38.41	177.70±33.79	184.92±34.10	28.868	<0.001^b）
白蛋白（mg/L）	38.57±4.31	36.18±2.98	37.29±3.15	1.156	0.384
糖化血红蛋白^a）	6.29%±1.10%	5.60%±0.48%	5.09%±0.73%	22.208	<0.001^b）
维生素A（μmol/L）	0.91±0.40	0.98±0.49	1.02±0.81	0.494	0.613
维生素B₁（μmol/L）	65.23±16.46	63.15±9.39	62.62±8.41	0.566	0.571
维生素B₂（μmol/L）	261.95±73.83	284.42±127.69	241.92±38.61	1.349 6	0.234
维生素B₆（μmol/L）	29.62±18.60	32.04±17.87	29.62±14.80	0.3	0.742
维生素C（μmol/L）	39.89±5.27	38.69±5.21	40.89±7.87	0.95	0.394
铁蛋白（μg/L）	149.64±158.71	136.03±121.01	114.29±107.65	4.752	0.013^b）