Carrasco Fernando, Papapietro Karin, Csendes Attila, Salazar Gabriela, Echenique Constanza, Lisboa Cecilia, Díaz Emma, Rojas Jorge
Department of Nutrition, Faculty of Medicine, University of Chile, Santiago, Chile.
Obes Surg. 2007 May;17(5):608-16. doi: 10.1007/s11695-007-9117-z.
The objective of this study was to evaluate changes in resting energy expenditure (REE), body composition and metabolic parameters, and to investigate predictors of the results in seriously obese patients after Roux-en-Y gastric bypass (RYGBP).
31 patients (BMI 44.4 +/- 4.8 kg/m2; 27 female, 4 male; 37.3 +/- 11.1 y) were evaluated at baseline and 6 months after RYGBP. Weight, REE, waist circumference (WC), fat mass (FM) and fat-free mass (FFM), physical activity, food intake, fasting glucose (GLU), insulin (INS), HOMA-IR and lipid concentrations were measured.
At 6 months, percentage of weight loss (%WL) was 29.0 +/- 4.4% and percentage of excess weight loss was (%EWL) 59.7 +/- 12.3%. FM loss corresponded to 77.1 +/- 12.2% of the weight loss. REE decreased from 33.4 +/- 4.1 to 30.1 +/- 2.6 kcal/kg FFM (P<0.05). Significant decreases (P<0.001) were observed in GLU, INS, HOMA-IR, LDL-cholesterol and triglycerides. %EWL was correlated with baseline INS (r=0.44; P=0.014), baseline HOMA (r=0.43; P=0.017), change in %FM (r=0.67; P<0.001) and change in WC (r=0.5; P<0.01). Decrease in REE/FFM (%) was positively correlated with baseline REE/FFM% (r=0.51; P<0.005) and change in %FM (r=0.69; P<0.001). Initial REE/FFM, baseline energy balance and FM change explain 90% of REE/FFM decrease.
RYGBP was an effective procedure to induce significant weight loss, fat mass loss and improvement in metabolic parameters in the short term. Metabolic adaptation was not related to FFM wasting but to a higher baseline REE. Fasting hyperinsulinemia was the best single predictor of weight loss after RYGBP.
本研究的目的是评估 Roux-en-Y 胃旁路术（RYGBP）后严重肥胖患者静息能量消耗（REE）、身体成分和代谢参数的变化，并探究结果的预测因素。
对 31 例患者（BMI 44.4±4.8kg/m²；27 例女性，4 例男性；37.3±11.1 岁）在基线时和 RYGBP 术后 6 个月进行评估。测量体重、REE、腰围（WC）、脂肪量（FM）和去脂体重（FFM）、身体活动、食物摄入量、空腹血糖（GLU）、胰岛素（INS）、HOMA-IR 和血脂浓度。
6 个月时，体重减轻百分比（%WL）为 29.0±4.4%，超重减轻百分比（%EWL）为 59.7±12.3%。FM 的减少相当于体重减轻的 77.1±12.2%。REE 从 33.4±4.1 降至 30.1±2.6kcal/kg FFM（P<0.05）。GLU、INS、HOMA-IR、低密度脂蛋白胆固醇和甘油三酯均显著降低（P<0.001）。%EWL 与基线 INS（r=0.44；P=0.014）、基线 HOMA（r=0.43；P=0.017）、%FM 的变化（r=0.67；P<0.001）和 WC 的变化（r=0.5；P<0.01）相关。REE/FFM（%）的降低与基线 REE/FFM%（r=0.51；P<0.005）和%FM 的变化（r=0.69；P<0.001）呈正相关。初始 REE/FFM、基线能量平衡和 FM 变化可解释 REE/FFM 降低的 90%。
RYGBP 是短期内诱导显著体重减轻、脂肪量减少和代谢参数改善的有效手术。代谢适应与 FFM 消耗无关，而是与较高的基线 REE 有关。空腹高胰岛素血症是 RYGBP 术后体重减轻的最佳单一预测因素。
