严重肥胖受试者中期显著体重减轻对血清瘦素水平和身体成分的影响。

Effect of significant intermediate-term weight loss on serum leptin levels and body composition in severely obese subjects.

作者信息

Infanger David, Baldinger Reto, Branson Ruth, Barbier Thomas, Steffen Rudolf, Horber Fritz F

机构信息

Klinik Hirslanden, Zürich, Switzerland.

出版信息

Obes Surg. 2003 Dec;13(6):879-88. doi: 10.1381/096089203322618704.

DOI:10.1381/096089203322618704

PMID:14738675

Abstract

BACKGROUND

Leptin, produced by adipose tissue, signals body fat content to the hypothalamus. Serum leptin levels (SLL), elevated in obese humans, decrease with weight loss. This study investigated the reduction of SLL and fat mass following restrictive bariatric surgery.

METHODS

Obese subjects (body mass index [BMI] >35 kg/m2, n=154) undergoing gastric banding (weight-reduced subjects) were investigated for SLL and body composition before surgery and for 2 years after. Overweight subjects matched for fat mass and gender (fat mass-matched overweight controls, n=194) and subjects who had never been obese (normal weight controls, n=158) were studied for comparison.

RESULTS

SLL were highest in weight-reduced subjects and decreased with weight loss (P <0.001), remaining elevated compared with normal weight controls (P <0.001) but lower than fat mass-matched overweight controls (women: P <0.04). At 2 years, SLL normalized for fat mass (allowing comparison between various levels of adiposity) were lower in weight-reduced subjects compared with fat mass-matched overweight controls (women: P =0.003), yet were similar for weight-reduced subjects at 2 years compared with normal weight controls despite 14 kg greater fat mass. Relative lean mass of extremities in weight-reduced subjects increased with weight loss (P <0.001).

CONCLUSION

SLL decreased after considerable weight loss more than could be accounted for by fat mass or BMI reduction alone. This disproportionate decrease in SLL might point to a mechanism that evolved as adaptation to starvation during times of famine. Thus, post-obese subjects may be at risk of weight-regain due to disproportionately low SLL and increased appetite via the leptin-melanocortin pathway.

摘要

背景

脂肪组织产生的瘦素将身体脂肪含量信号传递至下丘脑。肥胖人群的血清瘦素水平（SLL）升高，体重减轻时该水平会降低。本研究调查了限制性减肥手术后SLL和脂肪量的减少情况。

方法

对接受胃束带手术的肥胖受试者（体重指数[BMI]>35 kg/m²，n = 154）在手术前及术后2年进行SLL和身体成分调查。选取脂肪量和性别匹配的超重受试者（脂肪量匹配的超重对照组，n = 194）以及从未肥胖过的受试者（正常体重对照组，n = 158）进行比较研究。

结果

体重减轻的受试者SLL最高，且随体重减轻而降低（P<0.001），与正常体重对照组相比仍升高（P<0.001），但低于脂肪量匹配的超重对照组（女性：P<0.04）。2年后，按脂肪量进行标准化后的SLL（以便在不同肥胖水平之间进行比较），体重减轻的受试者低于脂肪量匹配的超重对照组（女性：P = 0.003），然而，尽管体重减轻的受试者脂肪量比正常体重对照组多14 kg，但2年后其SLL与正常体重对照组相似。体重减轻的受试者四肢相对瘦体重随体重减轻而增加（P<0.001）。