Wolf Anna Maria, Beisiegel Ulrike
Department for General, Visceral and Transplantation Surgery, University Hospital, Ulm, Germany.
Obes Surg. 2007 Jul;17(7):910-9. doi: 10.1007/s11695-007-9169-0.
Changes in metabolic risk factors such as dyslipidemia and hyperinsulinemia as well as levels of sex hormones and leptin were studied in morbidly obese (MO) and super-obese (SO) patients during excess weight loss (EWL), separately in males and females.
In this prospective clinical intervention study, 431 patients were included (361 females and 70 males). There were 217 patients with MO (BMI 40-49.9 kg/m2) and 214 patients with SO (BMI > or =50 kg/m2). All patients underwent restrictive bariatric operations. Metabolic parameters (lipids, insulin, leptin, hepatic transaminases, uric acid, and sex hormones) were measured before obesity surgery and at defined postoperative points of EWL (25%, 50%, 75% and 100%).
Successful weight reduction of 25% EWL was achieved by 94% of patients at 2 months. With this moderate EWL, most of the patients already improved their risk profile considerably, including normalization of insulin levels. Additional EWL led to a further amelioration of risk profile in all patients, including normalization of triglyceride levels. Male MO and SO patients had a worse metabolic situation preoperatively and a greater benefit after weight loss. Even though SO patients did not lose as much excess weight as MO patients, they did profit comparably.
Bariatric surgery is a valuable tool not only to reduce excess weight in severely obese patients but also to improve the metabolic risk profile within a short time-frame. This benefit is most pronounced in high-risk males.
分别对男性和女性病态肥胖（MO）和超级肥胖（SO）患者在体重减轻期间的血脂异常和高胰岛素血症等代谢危险因素变化以及性激素和瘦素水平进行了研究。
在这项前瞻性临床干预研究中，纳入了431例患者（361例女性和70例男性）。其中有217例MO患者（BMI 40 - 49.9 kg/m²）和214例SO患者（BMI≥50 kg/m²）。所有患者均接受了限制性减肥手术。在肥胖手术前以及术后体重减轻的特定时间点（25%、50%、75%和100%）测量代谢参数（血脂、胰岛素、瘦素、肝转氨酶、尿酸和性激素）。
94%的患者在2个月时成功减重25%。通过这种适度的体重减轻，大多数患者的风险状况已得到显著改善，包括胰岛素水平恢复正常。进一步的体重减轻使所有患者的风险状况进一步改善，包括甘油三酯水平恢复正常。男性MO和SO患者术前代谢状况较差，体重减轻后获益更大。尽管SO患者减掉的多余体重不如MO患者多，但他们获得的益处相当。
减肥手术不仅是减轻严重肥胖患者多余体重的有效工具，而且能在短时间内改善代谢风险状况。这种益处在高危男性中最为明显。
