Olbers Torsten, Björkman Sofia, Lindroos Ak, Maleckas Almantas, Lönn Lars, Sjöström Lars, Lönroth Hans
Department of Surgery and Gastro Research, Sahlgrenska University Hospital, Göteborg, Sweden.
Ann Surg. 2006 Nov;244(5):715-22. doi: 10.1097/01.sla.0000218085.25902.f8.
To assess body composition, eating pattern, and basal metabolic rate in patients undergoing obesity surgery in a randomized trial.
There is limited knowledge regarding how different bariatric surgical techniques function in terms of altering body composition, dietary intake, and basic metabolic rate.
Non-superobese patients were randomized to laparoscopic Roux-en-Y gastric bypass (LGBP, n = 37) or laparoscopic vertical banded gastroplasty (LVBG, n = 46). Anthropometry, dual-energy x-ray absorptiometry (DEXA), computed tomography (CT), indirect calorimetry, and reported dietary intake were registered prior to and 1 year after surgery.
Follow-up rate was 97.6%. LGBP patients had significantly greater reduction of waist circumference and sagittal diameter compared with LVBG. DEXA demonstrated a larger reduction of body fat in all compartments after LGBP, especially at the trunk (P<0.001). CT demonstrated more reduction of the visceral fat (P=0.016). Patients were able to eat all types of food after LGBP, although about 30% claimed they avoided fats. LGBP patients decreased their proportion of dietary fat significantly more than those operated on with LVBG (P = 0.005), who consumed more sweet foods and avoided whole meat and vegetables. Lean tissue mass (LTM) was proportionally less reduced, especially in men, after LGBP. The decreases in BMR postoperatively reflected the lower body mass in a pattern that did not differ among the groups.
LGBP patients demonstrated better outcomes compared with LVBG patients in terms of body composition. Energy expenditure developed as expected postoperatively. A "steering" away from fatty foods after LGBP may be an important mechanism of action in gastric bypass.
在一项随机试验中评估接受肥胖症手术患者的身体成分、饮食模式和基础代谢率。
关于不同的减肥手术技术在改变身体成分、饮食摄入和基础代谢率方面如何发挥作用，目前了解有限。
将非超级肥胖患者随机分为腹腔镜Roux-en-Y胃旁路术（LGBP，n = 37）组或腹腔镜垂直束带胃成形术（LVBG，n = 46）组。在手术前和术后1年记录人体测量学数据、双能X线吸收法（DEXA）、计算机断层扫描（CT）、间接测热法以及报告的饮食摄入量。
随访率为97.6%。与LVBG相比，LGBP患者的腰围和矢状径显著减小。DEXA显示LGBP术后所有部位的体脂减少幅度更大，尤其是躯干部位（P<0.001）。CT显示内脏脂肪减少更多（P = 0.016）。LGBP术后患者能够食用所有类型的食物，尽管约30%的患者称他们避免食用脂肪类食物。LGBP患者饮食中脂肪比例的下降幅度明显大于接受LVBG手术的患者（P = 0.005），后者食用更多甜食，避免食用全肉和蔬菜。LGBP术后瘦组织质量（LTM）的减少比例相对较小，尤其是男性。术后基础代谢率的下降反映了体重的降低，且各组之间无差异。
在身体成分方面，LGBP患者比LVBG患者表现出更好的结果。术后能量消耗如预期发展。LGBP术后“转向”远离脂肪类食物可能是胃旁路术的一个重要作用机制。
