Iannelli Antonio, Martini Francesco, Rodolphe Anty, Schneck Anne-Sophie, Gual Philippe, Tran Albert, Hébuterne Xavier, Gugenheim Jean
Digestive Unit, Archet 2 Hospital, University Hospital of Nice, 06202, Nice, France,
Surg Endosc. 2014 Feb;28(2):500-7. doi: 10.1007/s00464-013-3191-1. Epub 2013 Sep 7.
Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is currently the most common bariatric procedure and results in a substantial weight loss and recovery from obesity-related comorbidities, both of which are maintained in the long term. However, besides the desired loss of fat mass, LRYGBP is also followed by the loss of fat-free mass (FFM). We aimed to determine the factors associated with the loss of ≥20 % of the initial FFM 1 year after LRYGBP in a prospective series of 115 Caucasian, premenopausal women.
Anthropometrics, body composition (bioelectrical impedance analysis), resting energy expenditure (REE) (indirect calorimetry), inflammation, insulin resistance, and lipid disturbances were determined before and 1 year after LRYGBP.
The mean loss of initial FFM was 15.3 ± 13.8 %. 1 year after LRYGBP, 81 women lost <20 % (<20 % FFM group) and 35 lost ≥20 % (≥20 % FFM group) of the initial FFM. Before surgery, the FFM, weight, BMI, excess BMI, brachial circumference, waist circumference, and REE were significantly higher in the ≥20 % FFM group while inflammation, insulin resistance, and lipid disturbances were comparable between the two groups. 1 year after LRYGBP, the FFM, weight, BMI, excess BMI, brachial circumference, waist circumference, and REE decreased significantly and were comparable between the two groups. Inflammation, insulin resistance, and lipid disturbances improved comparably between the two groups after surgery. The only variable associated with the loss of ≥20 % of the initial FFM in the multivariable analysis was the presence of more FFM before surgery (67.0 ± 9.9 vs. 53.5 ± 6.7 kg).
One year after LRYGBP the loss of ≥20 % of the initial FFM occurred mainly in women with more FFM before surgery and resulted in the same body composition of women who lost <20 % of the initial FFM.
腹腔镜Roux-en-Y胃旁路术（LRYGBP）是目前最常见的减肥手术，可实现显著的体重减轻，并使肥胖相关合并症得到缓解，且这两者在长期内均可维持。然而，除了预期的脂肪量减少外，LRYGBP术后还会出现去脂体重（FFM）的减少。我们旨在确定在一项针对115名白种绝经前女性的前瞻性研究中，与LRYGBP术后1年初始FFM减少≥20%相关的因素。
在LRYGBP术前及术后1年测定人体测量学指标、身体成分（生物电阻抗分析）、静息能量消耗（REE）（间接测热法）、炎症指标、胰岛素抵抗及血脂紊乱情况。
初始FFM的平均减少量为15.3±13.8%。LRYGBP术后1年，81名女性FFM减少<20%（<20% FFM组），35名女性FFM减少≥20%（≥20% FFM组）。术前，≥20% FFM组的FFM、体重、BMI、超重BMI、臂围、腰围和REE显著更高，而两组间炎症、胰岛素抵抗和血脂紊乱情况相当。LRYGBP术后1年，FFM、体重、BMI、超重BMI、臂围、腰围和REE均显著下降，两组间相当。术后两组间炎症、胰岛素抵抗和血脂紊乱情况改善程度相当。多变量分析中，与初始FFM减少≥20%相关的唯一变量是术前FFM较多（67.0±9.9 vs. 53.5±6.7 kg）。
LRYGBP术后1年，初始FFM减少≥20%主要发生在术前FFM较多的女性中，且这些女性术后的身体成分与FFM减少<20%的女性相同。
