Department of Internal Medicine, University of Utah School of Medicine, 420 Chipeta Way, Room 1160, Salt Lake City, UT 84108, USA.
JAMA. 2012 Sep 19;308(11):1122-31. doi: 10.1001/2012.jama.11164.
Extreme obesity is associated with health and cardiovascular disease risks. Although gastric bypass surgery induces rapid weight loss and ameliorates many of these risks in the short term, long-term outcomes are uncertain.
To examine the association of Roux-en-Y gastric bypass (RYGB) surgery with weight loss, diabetes mellitus, and other health risks 6 years after surgery.
DESIGN, SETTING, AND PARTICIPANTS: A prospective Utah-based study conducted between July 2000 and June 2011 of 1156 severely obese (body mass index [BMI] ≥ 35) participants aged 18 to 72 years (82% women; mean BMI, 45.9; 95% CI, 31.2-60.6) who sought and received RYGB surgery (n = 418), sought but did not have surgery (n = 417; control group 1), or who were randomly selected from a population-based sample not seeking weight loss surgery (n = 321; control group 2).
Weight loss, diabetes, hypertension, dyslipidemia, and health-related quality of life were compared between participants having RYGB surgery and control participants using propensity score adjustment.
Six years after surgery, patients who received RYGB surgery (with 92.6% follow-up) lost 27.7% (95% CI, 26.6%-28.9%) of their initial body weight compared with 0.2% (95% CI, -1.1% to 1.4%) gain in control group 1 and 0% (95% CI, -1.2% to 1.2%) in control group 2. Weight loss maintenance was superior in patients who received RYGB surgery, with 94% (95% CI, 92%-96%) and 76% (95% CI, 72%-81%) of patients receiving RYGB surgery maintaining at least 20% weight loss 2 and 6 years after surgery, respectively. Diabetes remission rates 6 years after surgery were 62% (95% CI, 49%-75%) in the RYGB surgery group, 8% (95% CI, 0%-16%) in control group 1, and 6% (95% CI, 0%-13%) in control group 2, with remission odds ratios (ORs) of 16.5 (95% CI, 4.7-57.6; P < .001) vs control group 1 and 21.5 (95% CI, 5.4-85.6; P < .001) vs control group 2. The incidence of diabetes throughout the course of the study was reduced after RYGB surgery (2%; 95% CI, 0%-4%; vs 17%; 95% CI, 10%-24%; OR, 0.11; 95% CI, 0.04-0.34 compared with control group 1 and 15%; 95% CI, 9%-21%; OR, 0.21; 95% CI, 0.06-0.67 compared with control group 2; both P < .001). The numbers of participants with bariatric surgery-related hospitalizations were 33 (7.9%), 13 (3.9%), and 6 (2.0%) for the RYGB surgery group and 2 control groups, respectively.
Among severely obese patients, compared with nonsurgical control patients, the use of RYGB surgery was associated with higher rates of diabetes remission and lower risk of cardiovascular and other health outcomes over 6 years.
极度肥胖与健康和心血管疾病风险相关。虽然胃旁路手术能在短期内迅速减轻体重并改善其中许多风险，但长期效果仍不确定。
研究 Roux-en-Y 胃旁路（RYGB）手术 6 年后与体重减轻、糖尿病和其他健康风险的关联。
设计、地点和参与者：这是一项前瞻性犹他州研究，于 2000 年 7 月至 2011 年 6 月期间对 1156 名严重肥胖（体重指数[BMI]≥35）的参与者进行了研究，参与者年龄在 18 至 72 岁之间（82%为女性；平均 BMI，45.9；95%CI，31.2-60.6），他们寻求并接受了 RYGB 手术（n=418）、寻求但未进行手术（n=417；对照组 1），或从未寻求减肥手术的人群样本中随机选择（n=321；对照组 2）。
使用倾向评分调整比较接受 RYGB 手术的参与者和对照组参与者之间的体重减轻、糖尿病、高血压、血脂异常和健康相关生活质量。
手术后 6 年，接受 RYGB 手术的患者（随访率为 92.6%）体重减轻了 27.7%（95%CI，26.6%-28.9%），而对照组 1 体重增加了 0.2%（95%CI，-1.1%至 1.4%），对照组 2 体重增加了 0%（95%CI，-1.2%至 1.2%）。RYGB 手术患者的体重维持效果更好，94%（95%CI，92%-96%）和 76%（95%CI，72%-81%）的患者分别在手术后 2 年和 6 年时维持至少 20%的体重减轻。手术后 6 年的糖尿病缓解率分别为 RYGB 手术组 62%（95%CI，49%-75%）、对照组 1 组 8%（95%CI，0%-16%）和对照组 2 组 6%（95%CI，0%-13%），缓解率优势比（OR）分别为 16.5（95%CI，4.7-57.6；P<.001）与对照组 1，21.5（95%CI，5.4-85.6；P<.001）与对照组 2。RYGB 手术后糖尿病的发生率降低（2%；95%CI，0%-4%；vs 17%；95%CI，10%-24%；OR，0.11；95%CI，0.04-0.34 与对照组 1，15%；95%CI，9%-21%；OR，0.21；95%CI，0.06-0.67 与对照组 2；均 P<.001）。RYGB 手术组和两个对照组的与减肥手术相关的住院人数分别为 33（7.9%）、13（3.9%）和 6（2.0%）。
在严重肥胖患者中，与非手术对照组相比，使用 RYGB 手术与 6 年内更高的糖尿病缓解率和更低的心血管和其他健康结果风险相关。
