Sjöström L
Department of Body Composition and Metabolism, Sahlgrenska University Hospital, Göteborg, Sweden.
Int J Obes (Lond). 2008 Dec;32 Suppl 7:S93-7. doi: 10.1038/ijo.2008.244.
Obesity is associated with increased morbidity and mortality. Intentional weight loss results in improvement of cardiovascular risk factors, but most observational studies suggest that weight reduction is associated with increased overall and cardiovascular mortality. No prospective intervention studies on mortality have earlier been reported in obese subjects. The prospective, controlled Swedish Obese Subjects Study enrolled obese subjects who either underwent bariatric surgery (n=2010) or were allocated to a contemporaneously matched, conventionally treated obese control group (n=2037). This review sums up effects on morbidity and mortality over an average of 10 years. The mean weight change of the control group was less than +/-2% over up to 15 years of weight recording. Maximum weight losses in the surgical subgroups were observed after 1-2 years. After 10 years, the weight losses from baseline were stabilized at 25, 16 and 14%, respectively. Bariatric surgery improved all traditional cardiovascular risk states except hypercholesterolemia over 10 years. There were 129 deaths in the control group compared with 101 in the surgery group. The unadjusted overall mortality was reduced by 23.7% (P=0.0419) in the surgery group (relative to controls), whereas the gender-, age- and risk factor-adjusted mortality reduction was 30.7% (P=0.0102). The most common causes of death were myocardial infarction (controls n=25, surgery n=13) and cancer (47/29). Bariatric surgery for severe obesity is associated with long-term weight loss, improved risk factors and decreased overall mortality.
肥胖与发病率和死亡率的增加相关。有意减肥可改善心血管危险因素，但大多数观察性研究表明，体重减轻与总体死亡率和心血管死亡率的增加相关。此前尚无关于肥胖受试者死亡率的前瞻性干预研究报告。前瞻性、对照性的瑞典肥胖受试者研究纳入了肥胖受试者，其中一部分接受了减肥手术（n = 2010），另一部分被分配到同期匹配的、接受常规治疗的肥胖对照组（n = 2037）。本综述总结了平均10年期间对发病率和死亡率的影响。在长达15年的体重记录中，对照组的平均体重变化小于±2%。手术亚组在1 - 2年后观察到最大体重减轻。10年后，相对于基线的体重减轻分别稳定在25%、16%和14%。减肥手术在10年内改善了除高胆固醇血症外的所有传统心血管危险因素状态。对照组有129例死亡，手术组有101例死亡。手术组未调整的总体死亡率降低了23.7%（P = 0.0419）（相对于对照组），而经性别、年龄和危险因素调整后的死亡率降低了30.7%（P = 0.0102）。最常见的死亡原因是心肌梗死（对照组n = 25，手术组n = 13）和癌症（47/29）。重度肥胖的减肥手术与长期体重减轻、危险因素改善和总体死亡率降低相关。
