极低热量饮食（VLCD）术前减重对重度肥胖患者胆胰分流术后体重减轻的影响
[Effects of preoperative weight loss with a very low calorie diet (VLCD) on weight loss after biliopancreatic diversion in patients with severe obesity].
作者信息
Ballesteros Pomar M D, Diez Rodríguez R, Calleja Fernández A, Vidal Casariego A, González de Francisco Tomás, González Herráez Luis, Fernández Vicente Simó, Calleja Antolín S, Olcoz Goñi J L, Cano Rodríguez I
机构信息
Unidad de Obesidad de Alto Riesgo, Complejo Asistencial Universitario de León, León.
出版信息
Nutr Hosp. 2013 Jan-Feb;28(1):71-7. doi: 10.3305/nh.2013.28.1.6265.
BACKGROUND
Weight loss before bariatric surgery, achieved by means of a very low calorie diet (VLCD) has been recently reported to be related to a lower rate of postoperative complications. However, it is controversial if preoperative weight loss after VLCD could improve postoperative weight loss.
AIMS
To assess the effectiveness of a preoperative VLCD for 6 weeks in weight loss one year after bariatric surgery. To evaluate the changes obtained in anthropometric measures and biochemical parameters after VLCD.
METHODS
Prospective uncontrolled study including severely obese patients undergoing biliopancreatic diversion in our Obesity Unit in 2008-2010. Patients included followed a VLCD providing 840 kcal and 60 g of protein (Optisource®). Descriptive data are presented as mean (standard deviation) and after checking a normal distribution is followed, they were analyzed by Student s T test, ANOVA or Pearson correlation.
RESULTS
We evaluated 107 obese patients, 43.5 (10.2) years-old, 72% women, with initial weight 122.4 (18.6) Kg and BMI 46.8 (5.5) kg/m(2). 24.5% of them lost more than 10 % of initial weight and 73.5% more than 5% after following VLCD. Mean percentage of excess weight loss (% PSP) one year after surgery was 59.6 (13.4)%, and although it was higher for those patients losing more weight after VLCD, a significant correlation was not found: those who lost more than 5% showed %PSP 59.5 (13.8) % after twelve months and 68.4 (16.2) % of percentage of excess BMI loss (%PEIMC), vs 57,9 (13,1) % and 68.5 (16.6) % if they didn t lose that amount of weight. Those patients losing more than 10% achieved %PSP 63.3 (13.7) and %PEIMC 70.9 (14.7) vs 58.2 (14.0) y 67.7 (16.7) vs those not losing that amount. Significant correlations between preoperative loss with VLCD and %PSP or %PEIMC at 3,6,9 and 12 months were not found, and only %PSP 1 month after surgery correlated with %PSP after VLCD (r = 0.454, p = 0.003).
CONCLUSIONS
Preoperative weight loss with VLCD in severely obese patients did not show to improve either %PSP or %PEIMC one year after bariatric surgery.
背景
最近有报道称，通过极低热量饮食（VLCD）在减肥手术前实现体重减轻与术后并发症发生率较低有关。然而，VLCD术后的术前体重减轻是否能改善术后体重减轻仍存在争议。
目的
评估术前6周VLCD对减肥手术后一年体重减轻的有效性。评估VLCD后人体测量指标和生化参数的变化。
方法
前瞻性非对照研究，纳入2008年至2010年在我们肥胖科接受胆胰分流术的重度肥胖患者。纳入的患者采用提供840千卡热量和60克蛋白质的VLCD（Optisource®）。描述性数据以均值（标准差）表示，在检查其符合正态分布后，采用学生t检验、方差分析或Pearson相关性分析。
结果
我们评估了107例肥胖患者，年龄43.5（10.2）岁，72%为女性，初始体重122.4（18.6）千克，BMI为46.8（5.5）千克/平方米。其中24.5%的患者体重减轻超过初始体重的10%，73.5%的患者在采用VLCD后体重减轻超过5%。术后一年平均超重减轻百分比（%PSP）为59.6（13.4）%，尽管VLCD后体重减轻更多的患者该数值更高，但未发现显著相关性：体重减轻超过5%的患者在12个月后的%PSP为59.5（13.8）%，超重BMI减轻百分比（%PEIMC）为68.4（16.2）%，而未减轻该体重的患者分别为57.9（13.1）%和68.5（16.6）%。体重减轻超过10%的患者%PSP为63.3（13.7），%PEIMC为70.9（14.7），未减轻该体重的患者分别为58.2（14.0）和67.7（16.7）。未发现术前VLCD减重与术后3、6、9和12个月的%PSP或%PEIMC之间存在显著相关性，仅术后1个月的%PSP与VLCD后的%PSP相关（r = 0.454，p = 0.003）。
结论
重度肥胖患者术前采用VLCD减重并未显示出能改善减肥手术后一年的%PSP或%PEIMC。
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