Department of Surgery, University of Alabama at Birmingham, 1720 2nd Ave South, KB 401, Birmingham, AL, 35294, USA.
Center for Surgical, Medical Acute Care Research, and Transitions, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
Surg Endosc. 2018 May;32(5):2232-2238. doi: 10.1007/s00464-017-5913-2. Epub 2017 Oct 24.
Strategies to address weight recidivism following Roux-en-Y gastric bypass (RYGB) could be developed if patients at risk were identified in advance. This study aimed to determine factors that predict weight regain.
Retrospective review was performed of patients who underwent laparoscopic RYGB at a single institution over 10 years. Group-based modeling was used to estimate trajectories of weight regain after nadir and stratify patients based on percent weight change (%WC).
Three trajectories were identified from 586 patients: 121 had ongoing weight loss, 343 were weight stable, and 122 regained weight. Male sex (p = 0.020) and white race (p < 0.001) were associated with stable weight or weight regain. Being from a neighborhood of socioeconomic advantage (p = 0.035) was associated with weight regain. Patients with weight regain experienced improved percent weight loss (%WL) at nadir (p < 0.001) and ΔBMI (p = 0.002), yet they had higher weight and BMI and lower %WL and ΔBMI than the other two groups during long-term follow-up. On multivariate analyses, those who regained weight were more likely from socioeconomically advantaged neighborhoods (OR 1.82, CI 1.18-2.79).
Several patient-related characteristics predicted an increased likelihood of weight regain. Further studies are needed to elucidate how these factors contribute to weight recidivism following bariatric surgery.
如果能够提前识别出有风险的患者，就可以制定出针对 Roux-en-Y 胃旁路术（RYGB）后体重复胖的应对策略。本研究旨在确定预测体重反弹的相关因素。
对单中心 10 年间接受腹腔镜 RYGB 的患者进行回顾性研究。采用基于群组的建模方法来估计体重最低点（nadir）后的体重反弹轨迹，并根据体重变化百分比（%WC）对患者进行分层。
从 586 名患者中识别出 3 种体重反弹轨迹：121 例患者持续减重，343 例患者体重稳定，122 例患者体重反弹。男性（p=0.020）和白种人（p<0.001）与体重稳定或体重反弹相关。来自社会经济地位较高的社区（p=0.035）与体重反弹相关。体重反弹的患者在 nadir 时（p<0.001）和 ΔBMI（p=0.002）时经历了更高的体重百分比下降（%WL），但在长期随访期间，他们的体重和 BMI 更高，%WL 和 ΔBMI 更低，与其他两组相比。在多变量分析中，那些来自社会经济地位较高社区的患者更有可能出现体重反弹（OR 1.82，CI 1.18-2.79）。
一些与患者相关的特征预测体重反弹的可能性增加。需要进一步研究阐明这些因素如何导致减重手术后的体重复胖。
