胃旁路术后2型糖尿病缓解与不同体重减轻指标之间的关系：反对代谢手术中过度减重的观点。

Relationships between type 2 diabetes remission after gastric bypass and different weight loss metrics: arguments against excess weight loss in metabolic surgery.

作者信息

van de Laar A W, de Brauw L M, Meesters E W

机构信息

Bariatric Center of Excellence Slotervaartziekenhuis, Amsterdam, The Netherlands.

出版信息

Surg Obes Relat Dis. 2016 Feb;12(2):274-82. doi: 10.1016/j.soard.2015.07.005. Epub 2015 Jul 9.

DOI:10.1016/j.soard.2015.07.005

PMID:26476492

Abstract

BACKGROUND

Percentage excess weight loss (%EWL) outcome of bariatric surgery is distorted by deviations in baseline body mass index (BMI). It has been reported that this can lead to false conclusions, most likely because bariatric weight loss in fact is baseline-BMI independent.

OBJECTIVES

If the metabolic effect of bariatric surgery is baseline-BMI independent as well, could %EWL also lead to false conclusions on metabolic surgery?

SETTING

Bariatric Center of Excellence, general hospital, Netherlands.

METHODS

Retrospective analysis of 1-year outcome of all consecutive primary gastric bypass patients with type 2 diabetes (T2DM). Metabolic outcome (glycated hemoglobin [HbA1c], T2DM medication) was compared with bariatric outcome (weight loss) using 3 different metrics: %EWL, the most popular weight loss metric among bariatric surgeons; percentage (total) weight loss (%WL), most commonly used by nonsurgical professionals; and percentage alterable weight loss (%AWL), the only metric rendering weight loss outcome independent of baseline BMI. Metabolic success (HbA1c≤6.0%, T2DM remission) was compared with different definitions of bariatric success (≥50 %EWL, BMI<35 kg/m(2), %AWL percentiles; Mann-Whitney test; P< .05).

RESULTS

Until May 2014, 2001 patients underwent primary laparoscopic Roux-en-Y gastric bypass (LRYGB), of whom 449 had T2DM with baseline BMI 43.3 kg/m(2), mean 1.6 number of T2DM medication and HbA1c 7.5%. At 1 year 95% follow-up, with BMI 30.5 kg/m(2), 52.1% T2DM remission, 86.9% HbA1c<7.0%, and 63.6% without T2DM medication. No significant differences in T2DM outcome and weight loss were found with different baseline BMI, except for %EWL (P<.001). Weight loss was significantly better with better T2DM outcome, but for %EWL contradictory relationships were found in baseline-BMI subgroups. T2DM outcome was not less successful for patients with<50 %EWL.

CONCLUSION

In T2DM patients, weight loss after gastric bypass does not depend on BMI, HbA1c, or T2DM medication at baseline. The popular %EWL metric and the 50 %EWL success criterion are problematic in comparing bariatric and metabolic outcome of gastric bypass surgery. They should be abandoned. The %WL metric is the best and most commonly used alternative, whereas %AWL is ideal for selected logistics in bariatric research. Weight loss percentiles are best suited for defining bariatric success in metabolic surgery.

摘要

背景

减重手术的超重体重减轻百分比（%EWL）结果会因基线体重指数（BMI）的偏差而失真。据报道，这可能会导致错误的结论，很可能是因为减重手术的体重减轻实际上与基线BMI无关。

目的

如果减重手术的代谢效应也与基线BMI无关，那么%EWL是否也会在代谢手术方面导致错误结论呢？

地点

荷兰一家综合医院的卓越减重中心。

方法

对所有连续接受初次胃旁路手术的2型糖尿病（T2DM）患者的1年结果进行回顾性分析。使用3种不同指标将代谢结果（糖化血红蛋白[HbA1c]、T2DM药物治疗情况）与减重结果（体重减轻情况）进行比较：%EWL，这是减重外科医生中最常用的体重减轻指标；（总体）体重减轻百分比（%WL），非手术专业人员最常用；可改变体重减轻百分比（%AWL），这是唯一使体重减轻结果独立于基线BMI的指标。将代谢成功（HbA1c≤6.0%，T2DM缓解）与不同的减重成功定义（≥50%EWL、BMI<35 kg/m²、%AWL百分位数）进行比较；采用Mann-Whitney检验；P<0.05。

结果

截至2014年5月，2001例患者接受了初次腹腔镜Roux-en-Y胃旁路手术（LRYGB），其中449例患有T2DM，基线BMI为43.3 kg/m²，平均服用T2DM药物1.6种，HbA1c为7.5%。在1年95%的随访时，BMI为30.5 kg/m²，52.1%的T2DM缓解，86.9%的HbA1c<7.0%，63.6%的患者无需服用T2DM药物。除%EWL外（P<0.001），不同基线BMI的T2DM结果和体重减轻情况未发现显著差异。T2DM结果越好，体重减轻越显著，但对于%EWL，在基线BMI亚组中发现了相互矛盾的关系。%EWL<50%的患者的T2DM结果并不差。

结论

在T2DM患者中，胃旁路手术后的体重减轻不取决于基线时的BMI、HbA1c或T2DM药物治疗情况。在比较胃旁路手术的减重和代谢结果时，常用的%EWL指标和50%EWL的成功标准存在问题。应摒弃它们。%WL指标是最佳且最常用的替代指标，而%AWL对于减重研究中的特定逻辑分析是理想的。体重减轻百分位数最适合用于定义代谢手术中的减重成功情况。