Einfluss der laparoskopischen Sleeve-Gastrektomie auf den Mikronährstoffstatus

Zusammenfassung

Fragestellung: Ziel der Studie war es, den Mikronährstoffstatus von Adipositaspatienten vor und nach laparoskopischer Sleeve-Gastrektomie (LSG) und den potenziellen Nutzen einer Supplementation zu untersuchen.

Material und Methodik: 53 Adipositaspatienten, die sich einer LSG in der Chirurgischen Klinik in München-Bogenhausen, Deutschland, unterzogen, wurden in die vorliegende Arbeit eingeschlossen. Körpergewicht, Körpergröße, Mikronährstoffstatus (Vitamin A, E, D, B₁, B₆, B₁₂, Folsäure, Selen, Zink und Marker des Eisenstatus) und -supplementation wurden vor und in verschiedenen Abständen bis 1 Jahr postoperativ erhoben.

Ergebnisse: Ein Jahr nach LSG konnte ein signifikanter Übergewichtsverlust von 69,9 ± 31,8 % erreicht werden. 80 % der Pateinten wiesen bereits vor der LSG mindestens ein Mikronährstoffdefizit auf. Trotz einer individuell angepassten Supplementationsempfehlung manifestierten sich verschiedenste Mikronährstoffdefizite nach dem chirurgischen Eingriff. Dies betraf insbesondere die Mikronährstoffe Vitamin D, B₁₂ und A, Folsäure, Eisen, Zink und Selen. Die durchschnittlichen Mikronährstoffkonzentrationen veränderten sich nicht signifikant, mit Ausnahme der Werte von Vitamin A, Selen und Zink, die sich im Verlauf der Studie verschlechterten.

Schlussfolgerung: Die LSG führte zu einem signifikanten Gewichtsverlust während des ersten Jahres postoperativ. Doch sie verursachte auch verschiedene Mikronährstoffdefizite, die nicht durch die routinemäßige Supplementationsempfehlung verhindert werden konnten. Da bereits vor dem chirurgischen Eingriff verschiedenste Mikronährstoffdefizite vorlagen, ist neben einer sorgfältigen Kontrolle des Mikronährstoffstatus von Patienten, die sich einer LSG unterziehen, wahrscheinlich auch eine hoch dosierte Supplementation erforderlich. Außerdem scheint es notwendig, die Patienten hinsichtlich der Umsetzung der Supplementationsempfehlung ausreichend zu motivieren.

Abstract

Purpose: The aim of this study was to examine the micronutrient status in obese patients before and after laparoscopic sleeve gastrectomy (LSG), and the potential benefit of supplementation.

Materials and Methods: Fifty-three obese subjects, undergoing LSG in the Department of General Surgery at the Surgical Clinic in Munich-Bogenhausen, Germany, were included in the analysis. Body weight, body height, micronutrient status (vitamin A, E, D, B₁, B₆, B₁₂, folate, selenium, zinc and markers of iron status) and supplementation were assessed before and in different intervals up to 1 year postoperatively.

Results: LSG led to a significant excess weight loss of 69.9 ± 31.8 % within the first year after surgery. 80 % of the patients had at least one micronutrient deficiency already prior to surgery. Despite an individual adjusted recommendation for supplementation, several micronutrient deficiencies occurred in the postoperative phase, including vitamin D, B₁₂, and A, folate, iron, zinc, and selenium deficits. Mean levels of micronutrients did not change significantly, except for vitamin A, selenium and zinc, which deteriorated during the course of the study.

Conclusions: LSG caused significant weight loss within 1 year, but also led to different micronutrient deficiencies, that could not be prevented by routine recommendations for supplementation. Since several micronutrient deficiencies already existed prior to surgery, patients who undergo LSG require a careful monitoring, and likely also high-dose supplementations. Furthermore, it seems to be important to motivate patients realizing the recommended supplementation.

Schlüsselwörter

bariatrische Chirurgie - laparoskopische Sleeve-Gastrektomie - Mikronährstoffe - Ernährungsstatus - Vitamine

Keywords

bariatric surgery - laparoscopic sleeve gastrectomy - micronutrients - nutritional status - vitamins

• Literatur

• 1 Ribaric G, Buchwald JN, McGlennon TW. Diabetes and weight in comparative studies of bariatric surgery vs conventional medical therapy: a systematic review and meta-analysis. Obes Surg 2014; 24: 437-455
• 2 Ricci C, Gaeta M, Rausa E et al. Early impact of bariatric surgery on type II diabetes, hypertension, and hyperlipidemia: a systematic review, meta-analysis and meta-regression on 6,587 patients. Obes Surg 2014; 24: 522-528
• 3 Sjöström L, Lindroos A, Peltonen M et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004; 351: 2683-2693
• 4 Sjöström L. Review of the key results from the Swedish Obese Subjects (SOS) trial – a prospective controlled intervention study of bariatric surgery. J Intern Med 2013; 273: 219-234
• 5 Peterli R, Borbély Y, Kern B et al. Early results of the Swiss Multicentre Bypass or Sleeve Study (SM-BOSS): a prospective randomized trial comparing laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass. Ann Surg 2013; 258: 690-695
• 6 Telem DA, Talamini M, Laurie Shroyer A et al. Long-term mortality rates (8-year) improve as compared to the general and obese population following bariatric surgery. Surg Endosc 2015; 29: 529-536
• 7 Sieber P, Gass M, Kern B et al. Five-year results of laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 2014; 10: 243-249
• 8 Karamanakos SN, Vagenas K, Kalfarentzos F et al. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg 2008; 247: 401-407
• 9 Melissas J, Koukouraki S, Askoxylakis J et al. Sleeve gastrectomy: a restrictive procedure?. Obes Surg 2007; 17: 57-62
• 10 Runkel N, Colombo-Benkmann M, Hüttl TP et al. Bariatric surgery. Dtsch Arztebl Int 2011; 108: 341-346
• 11 Afsar B, Ozdemir NF, Sezer S et al. Quality of life is not related with liver disease severity but with anemia, malnutrition, and depression in HCV-infected hemodialysis patients. Hemodial Int 2009; 13: 62-71
• 12 Sheard JM, Ash S, Mellick GD et al. Improved nutritional status is related to improved quality of life in Parkinson’s disease. BMC Neurol 2014; 14: 212
• 13 Sargento L, Satendra M, Almeida I et al. Nutritional status of geriatric outpatients with systolic heart failure and its prognostic value regarding death or hospitalization, biomarkers and quality of life. J Nutr Health Aging 2013; 17: 300-304
• 14 Bosaeus I, Daneryd P, Lundholm K. Dietary intake, resting energy expenditure, weight loss and survival in cancer patients. J Nutr 2002; 132 (Suppl. 11) 3465S-3466S
• 15 Saltzman E, Karl JP. Nutrient deficiencies after gastric bypass surgery. Annu Rev Nutr 2013; 33: 183-203
• 16 van Rutte PWJ, Aarts EO, Smulders JF et al. Nutrient deficiencies before and after sleeve gastrectomy. Obes Surg 2014; 24: 1639-1646
• 17 Damms-Machado A, Friedrich A, Kramer KM et al. Pre- and postoperative nutritional deficiencies in obese patients undergoing laparoscopic sleeve gastrectomy. Obes Surg 2012; 22: 881-889
• 18 Sánchez-Santos R, Masdevall C, Baltasar A et al. Short- and mid-term outcomes of sleeve gastrectomy for morbid obesity: the experience of the Spanish National Registry. Obes Surg 2009; 19: 1203-1210
• 19 Parizadeh SMR, Moohebati M, Ghafoori F et al. Serum selenium and glutathione peroxidase concentrations in Iranian patients with angiography-defined coronary artery disease. Angiology 2009; 60: 186-191
• 20 Alasfar F, Ben-Nakhi M, Khoursheed M et al. Selenium is significantly depleted among morbidly obese female patients seeking bariatric surgery. Obes Surg 2011; 21: 1710-1713
• 21 Madan AK, Orth WS, Tichansky DS et al. Vitamin and trace mineral levels after laparoscopic gastric bypass. Obes Surg 2006; 16: 603-606
• 22 Toh SY, Zarshenas N, Jorgensen J. Prevalence of nutrient deficiencies in bariatric patients. Nutrition 2009; 25: 1150-1156
• 23 Alexandrou A, Armeni E, Kouskouni E et al. Cross-sectional long-term micronutrient deficiencies after sleeve gastrectomy versus Roux-en-Y gastric bypass: a pilot study. Surg Obes Relat Dis 2014; 10: 262-268
• 24 Alvarez V, Cuevas A, Olivos C et al. Déficit de micronutrientes a más de un año postoperatorio de gastrectomía en manga. Nutr Hosp 2014; 29: 73-79
• 25 Aasheim ET, Björkman S, Søvik TT et al. Vitamin status after bariatric surgery: a randomized study of gastric bypass and duodenal switch. Am J Clin Nutr 2009; 90: 15-22
• 26 Aasheim ET, Johnson LK, Hofsø D et al. Vitamin status after gastric bypass and lifestyle intervention: a comparative prospective study. Surg Obes Relat Dis 2012; 8: 169-175
• 27 Stroh C, Meyer F, Manger T. Beriberi, a severe complication after metabolic surgery – review of the literature. Obes Facts 2014; 7: 246-252
• 28 Aasheim ET. Wernicke encephalopathy after bariatric surgery: a systematic review. Ann Surg 2008; 248: 714-720
• 29 Saab R, El Khoury M, Farhat S. Wernicke’s encephalopathy three weeks after sleeve gastrectomy. Surg Obes Relat Dis 2014; 10: 992-994
• 30 Schollenberger AE, Heinze JM, Meile T et al. Markers of Bone Metabolism in Obese Individuals Undergoing Laparoscopic Sleeve Gastrectomy. Obes Surg 2015; 25: 1439-1445
• 31 Blum M, Dolnikowski G, Seyoum E et al. Vitamin D(3) in fat tissue. Endocrine 2008; 33: 90-94
• 32 Lin E, Armstrong-Moore D, Liang Z et al. Contribution of adipose tissue to plasma 25-hydroxyvitamin D concentrations during weight loss following gastric bypass surgery. Obesity (Silver Spring) 2011; 19: 588-594
• 33 Ruz M, Cavan KR, Bettger WJ et al. Development of a dietary model for the study of mild zinc deficiency in humans and evaluation of some biochemical and functional indices of zinc status. Am J Clin Nutr 1991; 53: 1295-1303
• 34 Di Martino G, Matera MG, de Martino B et al. Relationship between zinc and obesity. J Med 1993; 24: 177-183
• 35 Sallé A, Demarsy D, Poirier AL et al. Zinc deficiency: a frequent and underestimated complication after bariatric surgery. Obes Surg 2010; 20: 1660-1670
• 36 Saif T, Strain GW, Dakin G et al. Evaluation of nutrient status after laparoscopic sleeve gastrectomy 1, 3, and 5 years after surgery. Surg Obes Relat Dis 2012; 8: 542-547
• 37 Gletsu-Miller N, Wright BN. Mineral malnutrition following bariatric surgery. Adv Nutr 2013; 4: 506-517
• 38 Marreiro DDN, Fisberg M, Cozzolino SMF. Zinc nutritional status and its relationships with hyperinsulinemia in obese children and adolescents. Biol Trace Elem Res 2004; 100: 137-149
• 39 Ruiz-Tovar J, Oller I, Llavero C et al. Hair loss in females after sleeve gastrectomy: predictive value of serum zinc and iron levels. Am Surg 2014; 80: 466-471
• 40 Pech N, Meyer F, Lippert H et al. Complications and nutrient deficiencies two years after sleeve gastrectomy. BMC Surg 2012; 12: 13
• 41 Hakeam HA, O’Regan PJ, Salem AM et al. Impact of laparoscopic sleeve gastrectomy on iron indices: 1 year follow-up. Obes Surg 2009; 19: 1491-1496
• 42 Ruiz-Tovar J, Oller I, Tomas A et al. Mid-term effects of sleeve gastrectomy on calcium metabolism parameters, vitamin D and parathormone (PTH) in morbid obese women. Obes Surg 2012; 22: 797-801
• 43 Muñoz M, Botella-Romero F, Gómez-Ramírez S et al. Iron deficiency and anaemia in bariatric surgical patients: causes, diagnosis and proper management. Nutr Hosp 2009; 24: 640-654
• 44 Flancbaum L, Belsley S, Drake V et al. Preoperative nutritional status of patients undergoing Roux-en-Y gastric bypass for morbid obesity. J Gastrointest Surg 2006; 10: 1033-1037