Hutcheon Deborah A, Byham-Gray Laura D, Marcus Andrea Fleisch, Scott John D, Miller Megan
Department of Nutritional Sciences, Graduate Programs in Clinical Nutrition, School of Health Professions, Rutgers University, Newark, New Jersey.
Department of Nutritional Sciences, Graduate Programs in Clinical Nutrition, School of Health Professions, Rutgers University, Newark, New Jersey.
Surg Obes Relat Dis. 2017 Jun;13(6):1041-1051. doi: 10.1016/j.soard.2016.12.026. Epub 2016 Dec 29.
Achieving program-mandated preoperative weight loss poses a challenge for many bariatric surgery candidates. No systematic method exists to identify at-risk patients early in preoperative care.
This study sought to explore predictors of preoperative weight loss achievement and to develop a treatment algorithm for guiding clinical decision-making.
Greenville Health System, South Carolina.
A retrospective chart review was conducted for 378 patients who followed a program-mandated low-calorie diet (LCD) for 4 weeks to achieve≥8% excess weight loss (EWL). Associations between weight loss achievement and patient demographic, nutrition, psychological, clinical, anthropometric, and treatment characteristics documented at 5 preoperative evaluation events were analyzed using logistic regression.
During the LCD, 62.7% of patients achieved≥8% EWL. Independent predictors of achievement (all P<.05) were male sex (OR 2.31, 95% CI 1.21-4.42), Caucasian race (OR 2.45, 95% CI 1.38-4.34), body mass index (BMI) at surgeon evaluation (50.0-59.9 kg/m: OR .44, 95% CI .20-.97;≥60 kg/m: OR .15, 95% CI .05-.42), number of co-morbidities (OR .83, 95% CI .74-.93), hypertension diagnosis (OR 2.42, 95% CI 1.42-4.13), prediet weight change (OR 1.08, 95% CI 1.01-1.16), and time between surgeon evaluation and preoperative LCD initiation (61-90 d: OR .46, 95% CI .23-.93).
Patients of female sex or non-Caucasian race; with a BMI≥50 kg/m, many co-morbidities, or no hypertension diagnosis at surgeon evaluation; who demonstrate prediet weight loss or extended wait time between surgeon evaluation and preoperative LCD initiation may be at risk for preoperative weight loss failure and may require preemptive diet modification to improve outcomes.
实现手术方案规定的术前体重减轻对许多肥胖症手术候选人来说是一项挑战。目前尚无系统的方法能在术前护理早期识别出有风险的患者。
本研究旨在探索术前体重减轻达标的预测因素，并制定一种治疗算法以指导临床决策。
南卡罗来纳州格林维尔健康系统。
对378例遵循手术方案规定的低热量饮食（LCD）4周以实现≥8%超重减轻（EWL）的患者进行了回顾性病历审查。使用逻辑回归分析在5次术前评估时记录的体重减轻达标情况与患者人口统计学、营养、心理、临床、人体测量学和治疗特征之间的关联。
在LCD期间，62.7%的患者实现了≥8%的EWL。达标的独立预测因素（均P<.05）为男性（比值比[OR]2.31，95%置信区间[CI]1.21 - 4.42）、白种人（OR 2.45，95% CI 1.38 - 4.34）、外科医生评估时的体重指数（BMI）（50.0 - 59.9 kg/m²：OR 0.44，95% CI 0.20 - 0.97；≥60 kg/m²：OR 0.15，95% CI 0.05 - 0.42）、合并症数量（OR 0.83，95% CI 0.74 - 0.93）、高血压诊断（OR 2.42，95% CI 1.42 - 4.13）、节食前体重变化（OR 1.08，95% CI 1.01 - 1.16）以及外科医生评估与术前LCD开始之间的时间（61 - 90天：OR 0.46，95% CI 0.23 - 0.93）。
女性或非白种人患者；外科医生评估时BMI≥50 kg/m²、合并症多或无高血压诊断的患者；节食前体重减轻或外科医生评估与术前LCD开始之间等待时间延长的患者，可能存在术前体重减轻未达标的风险，可能需要预先调整饮食以改善结果。
