Benedetti G, Mingrone G, Marcoccia S, Benedetti M, Giancaterini A, Greco A V, Castagneto M, Gasbarrini G
Cattedra di Medicina Interna II, CNR Centro di Fisiopatologia dello Shock, Università Cattolica del Sacro Cuore, Rome, Italy.
J Am Coll Nutr. 2000 Apr;19(2):270-4. doi: 10.1080/07315724.2000.10718926.
To assess the effectiveness of biliopancreatic diversion (BPD) in the treatment of morbid obesity and to evaluate how the procedure affects body weight.
Fourteen morbidly obese subjects studied before and 30 months after BPD and fifteen healthy volunteers matched for age, sex and height (controls).
Comparison of the following parameters were made in the study groups before surgery and 30 months after BPD and with those of the controls group: fat mass, fat-free mass, non-protein substrate oxidation, basal metabolic rate, plasma glucose, insulin and free fatty acid concentrations.
Obese subjects lost 60.38+/-10.71 kg of weight during 18 months following surgery and then remained stable for another 12 months, when this study was performed. Weight loss was substantially due to a loss of fat mass (FM: 60.13+/-13.01 kg before and 19.02+/-8.61 kg after BPD; p<0.001). FM were not statistically different between post-obese subjects and controls; however, post-obese patients retained significantly more fat free mass (FFM) than controls. Subsequently, basal metabolic rates of post-obese subjects were higher than those of the control group (p<0.05). Fasting non-protein respiratory quotient (npRQ) was significantly lower before BPD than 30 months after the surgery (0.798+/-0.04 vs. 0.90+/-0.048, p<0.001), suggesting that, while obese, patients oxidized more lipids than carbohydrates. Moreover, fasting and two-hour plasma glucose and insulin concentrations decreased significantly after BPD to values comparable to those of the control group.
Weight loss in obese patients after BPD is mainly due to lipid malabsorption, but increased energy expenditure associated with retaining a high FFM in physically active post-obese subjects may also play a role, enabling them to maintain long-term reduced body weights.
评估胆胰转流术（BPD）治疗病态肥胖症的有效性，并评估该手术对体重的影响。
14名病态肥胖受试者在接受BPD手术前及术后30个月进行研究，以及15名年龄、性别和身高匹配的健康志愿者（对照组）。
比较研究组手术前、BPD术后30个月以及对照组的以下参数：脂肪量、去脂体重、非蛋白底物氧化、基础代谢率、血浆葡萄糖、胰岛素和游离脂肪酸浓度。
肥胖受试者在术后18个月内体重减轻了60.38±10.71千克，然后在本研究进行时的另外12个月内保持稳定。体重减轻主要归因于脂肪量的减少（BPD术前脂肪量：60.13±13.01千克，术后：19.02±8.61千克；p<0.001）。肥胖后受试者与对照组之间的脂肪量无统计学差异；然而，肥胖后患者保留的去脂体重（FFM）明显多于对照组。随后，肥胖后受试者的基础代谢率高于对照组（p<0.05）。空腹非蛋白呼吸商（npRQ）在BPD术前显著低于术后30个月（0.798±0.04对0.90±0.048，p<0.001），这表明肥胖患者在肥胖时氧化的脂质比碳水化合物更多。此外，BPD术后空腹及两小时血浆葡萄糖和胰岛素浓度显著降低至与对照组相当的值。
BPD术后肥胖患者体重减轻主要归因于脂质吸收不良，但在身体活跃的肥胖后受试者中，与保留高FFM相关的能量消耗增加也可能起作用，使他们能够维持长期减轻的体重。
