Dipartimento di Scienze della Salute, Università degli studi di Milano, Milano, Italy.
Surg Obes Relat Dis. 2013 Nov-Dec;9(6):894-900. doi: 10.1016/j.soard.2013.04.001. Epub 2013 Apr 17.
Bariatric surgery leads to resolution of arterial hypertension and diabetes mellitus; isolated reports indicate that response to bariatric surgery is lower in aged patients. The aim of this study was to evaluate the role of age and of duration of obesity on the frequency of co-morbidities in morbid obesity, as well as on improvement of co-morbidities.
A total of 837 consecutive patients with known duration of obesity, undergoing gastric banding, were considered for this study; they were divided into quartiles of age and of duration of obesity. Presence of co-morbidities (diabetes mellitus, arterial hypertension, metabolic syndrome), metabolic variables (cholesterol and HDL-C, triglycerides, blood glucose), anthropometric variables, and loss of weight during 24 months were considered.
Older patients had a higher frequency of co-morbidities; duration of obesity only affected frequency of co-morbidities, but not response to surgery. At logistic regression, duration of obesity had a moderate independent effect on the frequency of diabetes. Older patients lost less weight than younger patients, but diabetes mellitus and arterial hypertension improved to the same extent in patients of different ages, and metabolic syndrome disappeared more in older patients, associated with a greater decrease of blood glucose. Frequency of removal of gastric banding and loss to follow-up were not different in different quartiles of age or in different quartiles of duration of obesity.
Older patients, despite lower weight loss, have a response to bariatric surgery that is similar to that of younger patients; age and duration of obesity should not be considered as limits to indications to bariatric surgery.
减重手术可使动脉高血压和糖尿病得到缓解；有孤立报道指出，老年患者对减重手术的反应较低。本研究旨在评估年龄和肥胖持续时间在肥胖症共病中的作用，以及对共病改善的作用。
共纳入 837 例已知肥胖持续时间的连续接受胃带术的患者进行本研究；将其分为年龄和肥胖持续时间的四分位数。考虑了共病（糖尿病、动脉高血压、代谢综合征）、代谢变量（胆固醇和 HDL-C、甘油三酯、血糖）、人体测量变量以及 24 个月期间的体重减轻情况。
老年患者共病的发生率更高；肥胖持续时间仅影响共病的发生率，而不影响手术的反应。在逻辑回归中，肥胖持续时间对糖尿病的发生率有中度独立影响。老年患者的体重减轻量少于年轻患者，但不同年龄组的糖尿病和动脉高血压的改善程度相同，代谢综合征在老年患者中消失的更多，与血糖下降幅度更大相关。不同年龄四分位数或肥胖持续时间四分位数之间，胃带移除的频率和随访丢失率没有差异。
尽管老年患者的体重减轻量较低，但对减重手术的反应与年轻患者相似；年龄和肥胖持续时间不应被视为减重手术适应证的限制。
