Butte Nancy F, Brandt Mary L, Wong William W, Liu Yan, Mehta Nitesh R, Wilson Theresa A, Adolph Anne L, Puyau Maurice R, Vohra Firoz A, Shypailo Roman J, Zakeri Issa F
USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
Obesity (Silver Spring). 2015 Mar;23(3):591-601. doi: 10.1002/oby.20994.
Energetic adaptations induced by bariatric surgery have not been studied in adolescents or for extended periods postsurgery. Energetic, metabolic, and neuroendocrine responses to Roux-en-Y gastric bypass (RYGB) surgery were investigated in extremely obese adolescents.
At baseline and at 1.5, 6, and 12 months post-baseline, 24-h room calorimetry, body composition, and fasting blood biochemistries were measured in 11 obese adolescents relative to five matched controls.
In the RYGB group, mean weight loss was 44 ± 19 kg at 12 months. Total energy expenditure (TEE), activity EE, basal metabolic rate (BMR), sleep EE, and walking EE significantly declined by 1.5 months (P = 0.001) and remained suppressed at 6 and 12 months. Adjusted for age, sex, fat-free mass, and fat mass, EE was still lower than baseline (P = 0.001). Decreases in serum insulin, leptin, and triiodothyronine (T3), gut hormones, and urinary norepinephrine (NE) paralleled the decline in EE. Adjusted changes in TEE, BMR, and/or sleep EE were associated with decreases in insulin, homeostatic model assessment, leptin, thyroid stimulating hormone, total T3, peptide YY3-36, glucagon-like peptide-2, and urinary NE and epinephrine (P = 0.001-0.05).
Energetic adaptations in response to RYGB-induced weight loss are associated with changes in insulin, adipokines, thyroid hormones, gut hormones, and sympathetic nervous system activity and persists 12 months postsurgery.
减肥手术引起的能量适应性变化尚未在青少年中进行研究，也未对手术后较长时间进行研究。本研究调查了极度肥胖青少年对 Roux-en-Y 胃旁路术（RYGB）手术的能量、代谢和神经内分泌反应。
在基线时以及基线后 1.5、6 和 12 个月，对 11 名肥胖青少年及 5 名匹配的对照组进行 24 小时室内热量测定、身体成分分析和空腹血液生化指标检测。
在 RYGB 组中，12 个月时平均体重减轻 44±19 千克。总能量消耗（TEE）、活动能量消耗、基础代谢率（BMR）、睡眠能量消耗和步行能量消耗在 1.5 个月时显著下降（P = 0.001），并在 6 个月和 12 个月时仍受到抑制。经年龄、性别、去脂体重和脂肪量校正后，能量消耗仍低于基线水平（P = 0.001）。血清胰岛素、瘦素和三碘甲状腺原氨酸（T3）、肠道激素以及尿去甲肾上腺素（NE）的下降与能量消耗的下降平行。TEE、BMR 和/或睡眠能量消耗的校正变化与胰岛素、稳态模型评估、瘦素、促甲状腺激素、总 T3、肽 YY3-36、胰高血糖素样肽-2 以及尿 NE 和肾上腺素的下降相关（P = 0.001-0.05）。
RYGB 诱导体重减轻后的能量适应性变化与胰岛素、脂肪因子、甲状腺激素、肠道激素和交感神经系统活动的变化有关，并在手术后持续 12 个月。
