Roux-en-Y gastric bypass surgery resulted in a 31.8% incidence of malnutrition at 12 months in obese patients with T2DM, with female gender (OR 2.702) and diabetes duration ≥5 years (OR 4.890) as independent risk factors.
Cohort (n=195)
No
A clinical risk prediction model incorporating six preoperative factors can accurately identify obese patients with type 2 diabetes at high risk for malnutrition 12 months after Roux-en-Y gastric bypass.
Effect estimate: OR 2.702 for female gender, OR 4.890 for diabetes duration ≥5 years; protective factors OR 0.682 for albumin, OR 0.850 for hemoglobin, OR 0.984 for ferritin, OR 0.909 for 25-hydroxyvitamin D (95% CI 95% CI for female gender OR: 1.034–7.058; diabetes duration OR: 1.416–16.894; albumin OR: 0.557–0.834; hemoglobin OR: 0.800–0.904; ferritin OR: 0.974–0.994; 25-hydroxyvitamin D OR: 0.845–0.978)
Absolute Event Rate: 31.8% vs 68.2%
p-value: p < 0.05 for all predictors
Obese patients with type 2 diabetes mellitus (T2DM) face unique long-term nutritional risks following Roux-en-Y gastric bypass (RYGB) surgery. This study aims to evaluate postoperative nutritional status in this population, identify key preoperative predictive factors, and develop and validate a clinical scoring system for predicting the risk of postoperative malnutrition. This single-center retrospective cohort study consecutively included obese T2DM patients (body mass index BMI ≥ 32.5 kg/m²) who underwent RYGB between January 2020 and January 2023. The primary outcome was a composite endpoint of malnutrition at 12 months postoperatively, defined as moderate anemia (hemoglobin < 100 g/L) or hypoalbuminemia (albumin < 30 g/L). Univariate and multivariate logistic regression analyses were performed to identify independent predictors. Discrimination of the nomogram-based predictive model was assessed by the area under the receiver operating characteristic curve (AUC). Calibration was evaluated using bootstrap calibration plots. A total of 195 patients were included in the final analysis, with a 12-month postoperative malnutrition incidence of 31.8% (62/195). Female gender (odds ratio OR = 2.702, 95% confidence interval CI: 1.034–7.058) and diabetes duration ≥ 5 years (OR = 4.890, 95% CI: 1.416–16.894) were independent risk factors for postoperative malnutrition, whereas higher preoperative levels of albumin, hemoglobin, ferritin, and 25-hydroxyvitamin D were protective factors. The joint predictive model incorporating these six factors demonstrated excellent discriminative ability for predicting postoperative malnutrition and good calibration. The preoperative clinical risk prediction model based on six readily available indicators shows robust predictive performance, guiding individualized nutritional management.
Deng et al. (Mon,) conducted a cohort in Obese patients with type 2 diabetes mellitus and BMI ≥ 32.5 kg/m² undergoing Roux-en-Y gastric bypass surgery (n=195). Roux-en-Y gastric bypass surgery was evaluated on Composite malnutrition at 12 months postoperatively defined as moderate anemia (hemoglobin < 100 g/L) or hypoalbuminemia (albumin < 30 g/L) (OR 2.702 for female gender, OR 4.890 for diabetes duration ≥5 years; protective factors OR 0.682 for albumin, OR 0.850 for hemoglobin, OR 0.984 for ferritin, OR 0.909 for 25-hydroxyvitamin D, 95% CI 95% CI for female gender OR: 1.034–7.058; diabetes duration OR: 1.416–16.894; albumin OR: 0.557–0.834; hemoglobin OR: 0.800–0.904; ferritin OR: 0.974–0.994; 25-hydroxyvitamin D OR: 0.845–0.978, p=p < 0.05 for all predictors). Roux-en-Y gastric bypass surgery resulted in a 31.8% incidence of malnutrition at 12 months in obese patients with T2DM, with female gender (OR 2.702) and diabetes duration ≥5 years (OR 4.890) as independent risk factors.