Geisinger Clinic Obesity Institute, Danville, Pennsylvania; Philadelphia College of Osteopathic Medicine (PCOM) Department of Psychology, Philadelphia, Pennsylvania.
Geisinger Department of Biomedical and Translational Informatics, Danville, Pennsylvania.
Surg Obes Relat Dis. 2018 Nov;14(11):1680-1685. doi: 10.1016/j.soard.2018.07.023. Epub 2018 Jul 30.
Weight change trajectories after weight-loss surgery may vary significantly.
This study evaluated the weight trajectories of Roux-en-Y gastric bypass (RYGB) patients and identified the distinct clinical, behavioral, and demographic features of patients by trajectory.
Data from 2918 RYGB patients from a comprehensive medical center between January 2004 and November 2016 were included.
This retrospective, observational study used data for RYGB patients up to year 7 postsurgery. Group-based trajectory models were fitted for percentage weight change. Variables evaluated by trajectory included age, sex, diagnoses, medications, smoking, presurgical body mass index, preoperative weight loss, and early postoperative weight loss.
Of 3215 possible patients, 2918 (90.8%) were included (mean age = 46.2 ± 11.2 yr, body mass index = 46.9 ± 7.9 kg/m at the time of surgery). Three weight change trajectories were identified (above average, average, and below average). Mean percentage weight change at the nadir for the above average group was -42.85% ± 5.7% compared with -31.57% ± 5.0% in the average group and -22.74% ± 5.7% in the below average group. Compared with the above average group, the below average group was more likely to be male (odds ratio [OR] = 2.40, P < .0001) and have diabetes (noninsulin users, OR = 2.08, P < .0001), but less likely to have a smoking history (OR = .62, P = .0007) or take sleep medications (OR = .50, P = .005). Below average group patients had a lower BMI at the time of surgery (OR = .91, P < .0001). Lower initial weight loss postsurgery was associated with a greater chance of a poorer weight outcomes (OR = 1.64, P < .0001).
Select clinical, demographic, and behavioral factors may increase or decrease the chance for better weight loss after RYGB.
减重手术后的体重变化轨迹可能存在显著差异。
本研究评估了 Roux-en-Y 胃旁路术（RYGB）患者的体重轨迹，并通过轨迹识别出具有不同临床、行为和人口统计学特征的患者。
纳入了 2004 年 1 月至 2016 年 11 月期间来自综合医疗中心的 2918 例 RYGB 患者的数据。
本回顾性观察性研究使用了 RYGB 患者术后 7 年内的数据。使用基于群组的轨迹模型拟合体重变化百分比。通过轨迹评估的变量包括年龄、性别、诊断、药物、吸烟、术前体重指数、术前减重和术后早期减重。
在 3215 例可能的患者中，纳入了 2918 例（平均年龄 46.2 ± 11.2 岁，手术时体重指数 46.9 ± 7.9 kg/m）。确定了 3 种体重变化轨迹（高于平均水平、平均水平和低于平均水平）。高于平均水平组体重最低点的平均体重百分比变化为-42.85%±5.7%，而平均水平组为-31.57%±5.0%，低于平均水平组为-22.74%±5.7%。与高于平均水平组相比，低于平均水平组更可能为男性（比值比[OR] 2.40，P <.0001），且更可能患有糖尿病（非胰岛素使用者，OR 2.08，P <.0001），但更可能没有吸烟史（OR 0.62，P =.0007）或服用睡眠药物（OR 0.50，P =.005）。低于平均水平组患者手术时的 BMI 较低（OR 0.91，P <.0001）。术后初始减重较少与更好的减重结果的机会增加相关（OR 1.64，P <.0001）。
某些临床、人口统计学和行为因素可能会增加或降低 RYGB 后更好减重的机会。
