Coupaye Muriel, Bouillot Jean-Luc, Coussieu Christiane, Guy-Grand Bernard, Basdevant Arnaud, Oppert Jean-Michel
Department of Nutrition, Hôtel-Dieu Hospital (AP-HP), 5181 Paris, France.
Obes Surg. 2005 Jun-Jul;15(6):827-33. doi: 10.1381/0960892054222768.
Weight loss is associated with a decrease in both energy expenditure and circulating leptin levels. Whether this holds true when the influence of body composition on energy expenditure and leptin is taken into account remains controversial. The aim of the study was to assess changes in resting metabolic rate (RMR) and serum leptin adjusted for body composition during surgically induced weight loss.
In 36 women (age 42.7+/-8.7 years; BMI 47.2+/-8.5 kg/m(2); mean+/-SD) undergoing laparoscopic adjustable gastric banding (LAGB) for morbid obesity, we measured RMR (by indirect calorimetry), body composition (by dual-energy X-ray absorptiometry) and serum leptin (by immunoradiometry), immediately before and 1 year after surgery.
1 year after LAGB, there were significant decreases in body weight (-23.7+/-11.6 kg, P<0.001), fat mass (FM: -20.9+/-11.3 kg, P<0.0001), lean body mass (LBM: -3+/-5.3 kg, P=0.005), RMR (-298+/-309 kcal/day, P<0.0001), serum leptin (-24.0+/-18.4 ng/ml, P<0.0001), RMR/LBM ratio (-3.9+/-5.8 kcal/kg LBM/day, P<0.01) and leptin/FM ratio (-0.21+/-0.29 ng/kg FM/ml, P<0.001). RMR values after surgery were correctly predicted by the regression equation relating RMR to LBM and FM at baseline, whereas this was not the case for serum leptin (in relation to FM).
Changes in RMR 1 year after LAGB were explained by changes in body composition whereas changes in serum leptin were not. The data provide no evidence for a metabolic adaptation of RMR with weight loss, but suggest that serum leptin is decreased beyond expected values based on body composition, a factor that may favor weight regain after surgically induced weight loss.
体重减轻与能量消耗及循环瘦素水平的降低相关。当考虑身体成分对能量消耗和瘦素的影响时，这一情况是否依然成立仍存在争议。本研究的目的是评估手术诱导体重减轻期间，经身体成分调整后的静息代谢率（RMR）和血清瘦素的变化。
对36名因病态肥胖接受腹腔镜可调节胃束带术（LAGB）的女性（年龄42.7±8.7岁；体重指数47.2±8.5kg/m²；均值±标准差），在手术前及术后1年，测量其RMR（通过间接测热法）、身体成分（通过双能X线吸收法）和血清瘦素（通过免疫放射测定法）。
LAGB术后1年，体重（-23.7±11.6kg，P<0.001）、脂肪量（FM：-20.9±11.3kg，P<0.0001）、去脂体重（LBM：-3±5.3kg，P=0.005）、RMR（-298±309kcal/天，P<0.0001）、血清瘦素（-24.0±18.4ng/ml，P<0.0001）、RMR/LBM比值（-3.9±5.8kcal/kg LBM/天，P<0.01）和瘦素/FM比值（-0.21±0.29ng/kg FM/ml，P<0.001）均显著降低。术后RMR值可通过术前RMR与LBM及FM的回归方程正确预测，而血清瘦素（与FM相关）则不然。
LAGB术后1年RMR的变化可由身体成分的变化解释，而血清瘦素的变化则不能。数据未提供RMR随体重减轻发生代谢适应的证据，但表明血清瘦素的降低超过基于身体成分的预期值，这一因素可能有利于手术诱导体重减轻后体重的恢复。
