Geisinger Obesity Research Institute, Geisinger Clinic, Danville, Pennsylvania, USA.
Obesity (Silver Spring). 2014 Mar;22(3):888-94. doi: 10.1002/oby.20529. Epub 2014 Feb 6.
Gastric bypass surgery is an effective therapy for extreme obesity. However, substantial variability in weight loss outcomes exists that remains largely unexplained. Our objective was to determine whether any commonly collected preoperative clinical variables were associated with weight loss following Roux-en-Y gastric bypass (RYGB) surgery.
The analysis was based on a prospectively recruited observational cohort of 2,365 patients who underwent Roux-en-Y gastric bypass surgery from 2004 to 2009. Weight loss was stratified into three major phases, early (0-6 months), nadir, and long-term (>36 months). Multivariate regression models were constructed using a database of over 350 variables.
A total of 12-14 preoperative variables were independently associated (P < 0.05) with each of the temporal weight loss phases. Preoperative variables associated with poorer nadir and long-term weight loss included higher baseline BMI, higher preoperative weight loss, iron deficiency, use of any diabetes medication, nonuse of bupropion medication, no history of smoking, age >50 years, and the presence of fibrosis on liver biopsy.
Several variables previously associated with poorer weight loss after RYGB surgery including age, baseline BMI, and type 2 diabetes were replicated. Several others suggest possible clinical interventions for postoperative management of RYGB patients to improve weight loss outcomes.
胃旁路手术是治疗极度肥胖症的有效疗法。然而，减重效果存在很大的差异，这在很大程度上仍未得到解释。我们的目的是确定任何常见的术前临床变量是否与 Roux-en-Y 胃旁路（RYGB）手术后的体重减轻有关。
该分析基于 2004 年至 2009 年间接受 Roux-en-Y 胃旁路手术的 2365 名患者的前瞻性招募观察队列。体重减轻分为三个主要阶段，早期（0-6 个月）、最低点和长期（>36 个月）。使用超过 350 个变量的数据库构建了多变量回归模型。
共有 12-14 个术前变量与每个时间相关的体重减轻阶段独立相关（P<0.05）。与最低点和长期体重减轻较差相关的术前变量包括较高的基线 BMI、较高的术前体重减轻、缺铁、使用任何糖尿病药物、不使用安非他酮药物、无吸烟史、年龄>50 岁和肝活检纤维化的存在。
复制了先前与 RYGB 手术后体重减轻较差相关的几个变量，包括年龄、基线 BMI 和 2 型糖尿病。其他一些变量表明可能对 RYGB 患者进行术后管理以改善体重减轻效果的临床干预措施。
