Section of Surgical Sciences, Division of General Surgery, Vanderbilt University, 1161 Medical Center Drive, D5203, Nashville, TN 37232-7610, USA.
Surg Endosc. 2011 May;25(5):1376-82. doi: 10.1007/s00464-010-1371-9. Epub 2010 Oct 17.
Weight regain that begins 12-18 months after laparoscopic gastric bypass has been attributed to changes in resting metabolic rate (RMR), which is largely determined by lean body mass (LBM). An oral supplement containing beta-hydroxy-beta-methylbutyrate, glutamine, and arginine (HMB/Glu/Arg) has helped to restore LBM in cachexia due to cancer and in critically ill trauma patients. The objective of this study was to evaluate the effect of oral HMB/Glu/Arg on LBM and RMR following laparoscopic gastric bypass (LGB).
Patients who underwent LGB were randomized to receive 24 g of HMB/Glu/Arg dissolved in water twice daily for 8 weeks or to receive no supplement. Weight loss, LBM, and RMR were assessed preoperatively, 2 and 8 weeks postoperatively. LBM was determined by dual emission x-ray absorptiometry (DXA) and RMR was measured by indirect calorimetry.
Thirty patients were enrolled: 80% white; 20% African American; 96.7% women; mean age 46.9±8.4 years; mean weight 113.4±11.6 kg; and mean body mass index (BMI) 43.3±4.1 kg/m2. The experimental and control groups included 14 and 16 patients, respectively, and there was no difference in baseline demographics and characteristics between the two groups. At 8 weeks, weight, BMI, LBM, and RMR significantly decreased by 15.7±2.5 kg, 6.0±1.0 kg/m2, 7.8±4.0 kg, and 290.6±234.9 kcal/day, respectively (P<0.0001 for each variable). However, when comparing these changes between the two groups, no statistical significance was observed.
There is a significant decrease in weight, BMI, LBM, and RMR in all subjects after LGB, and these changes were not affected by the use of HMB/Glu/Arg. Potential preservation of LBM as a result of HMB/Glu/Arg requires further investigation. However, its consumption (78 calories per serving) did not adversely affect weight loss in the experimental group.
腹腔镜胃旁路术后 12-18 个月开始的体重反弹归因于静息代谢率（RMR）的变化，而静息代谢率主要由瘦体重（LBM）决定。一种含有β-羟基-β-甲基丁酸、谷氨酰胺和精氨酸的口服补充剂（HMB/Glu/Arg）已被证明有助于恢复因癌症而恶病质和严重创伤患者的 LBM。本研究的目的是评估口服 HMB/Glu/Arg 对腹腔镜胃旁路术（LGB）后 LBM 和 RMR 的影响。
接受 LGB 的患者被随机分为两组，每天两次口服 24 克 HMB/Glu/Arg 溶于水，持续 8 周，或不接受补充剂。术前、术后 2 周和 8 周评估体重减轻、LBM 和 RMR。LBM 通过双能 X 射线吸收测定法（DXA）确定，RMR 通过间接热量测定法测量。
共纳入 30 例患者：80%为白人；20%为非裔美国人；96.7%为女性；平均年龄 46.9±8.4 岁；平均体重 113.4±11.6kg；平均体重指数（BMI）为 43.3±4.1kg/m2。实验组和对照组分别纳入 14 例和 16 例患者，两组患者的基线人口统计学和特征无差异。8 周时，体重、BMI、LBM 和 RMR 分别显著下降 15.7±2.5kg、6.0±1.0kg/m2、7.8±4.0kg 和 290.6±234.9kcal/天（各变量 P<0.0001）。然而，当比较两组之间的这些变化时，没有观察到统计学意义。
所有患者在接受 LGB 后体重、BMI、LBM 和 RMR 均显著下降，这些变化不受 HMB/Glu/Arg 的影响。HMB/Glu/Arg 对 LBM 的潜在保护作用需要进一步研究。然而，其消耗（每份 78 卡路里）并未对实验组的体重减轻产生不利影响。
