Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan.
Department of Surgery, Bhumibol Adulyadej Hospital, Royal Thai Airforce, Bangkok, Thailand.
Surg Obes Relat Dis. 2019 Mar;15(3):488-496. doi: 10.1016/j.soard.2018.12.022. Epub 2018 Dec 22.
Bariatric surgery for morbidly obese patients has been shown to ameliorate their quality of life (QOL). Little data are available in mildly obese patients undergoing metabolic surgery.
To investigate the impact of metabolic surgery for diabetic patients with body mass index <35 kg/m on health-related QOL (HR-QOL), food tolerance, and food satisfaction in a single institution.
Private practice, Japan.
Fifty-one consecutive mildly obese, diabetic patients underwent laparoscopic sleeve gastrectomy with duodenojejunal bypass were initially enrolled. Only 46 returned for follow-up and were eventually included in the final population. Preoperatively, the mean weight and body mass index were 89.1 ± 11.9 kg and 31.7 ± 2.2 kg/m, respectively. The mean fasting plasma glucose and glycated hemoglobin were 196 ± 69 mg/dL and 9.0 ± 1.5%, respectively. The mean duration of diabetes was 9.0 ± 6.1 years. Before surgery, 40 patients (78.4%) were treated with oral hypoglycemic agents and 28 patients (54.9%) were treated with subcutaneous insulin. The 36-item Short Form Survey was used to gauge HR-QOL at the preoperative phase and at 1 year after surgery. Questionnaires regarding food tolerance, food satisfaction, and dietary intake were also distributed to the enrolled patients.
The follow-up rate at 1 year was 90.2%. At this point, there was a decrease in mean weight and body mass index were 67.5 ± 11.6 kg and 23.9 ± 2.8 kg/m, respectively (P < .001). This accounted for the mean percent total weight loss of 24.4 ± 8.3%. The mean fasting plasma glucose and glycated hemoglobin were 114 ± 35 mg/dL and 6.5 ± 1.1%, respectively (P < .001). Remission of diabetes was seen in 52.2% of the patients. With regard to the HR-QOL, significant improvements were observed in the aspects of physical functioning, bodily pain, general health, vitality, and mental health. Dietary intake significantly decreased from 2679 ± 952 kcal/d at baseline to 1346 ± 483 kcal/d at 1 year (P < .001). Food tolerance score significantly decreased from 21.6 ± .6 to 18.7 ± 3.9 (P < .001). By contrast, food satisfaction score significantly increased from 3.0 ± 1.1 to 3.5 ± 1.1 (P = .015).
In mildly obese patients associated with severe diabetes who underwent laparoscopic sleeve gastrectomy with duodenojejunal bypass, marked amelioration in glycemic control was observed and, although the amount of food intake and food tolerance were affected, the overall HR-QOL as well as food satisfaction improved significantly.
减重手术已被证明可以改善病态肥胖患者的生活质量（QOL）。对于接受代谢手术的轻度肥胖患者，相关数据很少。
研究在一家机构中，对 BMI<35kg/m2 的糖尿病患者进行代谢手术对健康相关生活质量（HR-QOL）、食物耐受性和食物满意度的影响。
日本的私人诊所。
51 例连续轻度肥胖、糖尿病患者接受腹腔镜袖状胃切除术联合空肠空肠旁路术，最初入组。只有 46 例患者返回随访，并最终纳入最终人群。术前，平均体重和体重指数分别为 89.1±11.9kg 和 31.7±2.2kg/m2。空腹血糖和糖化血红蛋白的平均值分别为 196±69mg/dL 和 9.0±1.5%。糖尿病的平均病程为 9.0±6.1 年。术前，40 例（78.4%）患者接受口服降糖药治疗，28 例（54.9%）患者接受皮下胰岛素治疗。使用 36 项简明健康调查问卷（SF-36）在术前阶段和术后 1 年评估 HR-QOL。还向入组患者发放了关于食物耐受性、食物满意度和饮食摄入的问卷。
1 年的随访率为 90.2%。此时，平均体重和体重指数分别下降至 67.5±11.6kg 和 23.9±2.8kg/m2（P<0.001）。这意味着体重总减轻率达到 24.4±8.3%。空腹血糖和糖化血红蛋白的平均值分别为 114±35mg/dL 和 6.5±1.1%（P<0.001）。52.2%的患者糖尿病缓解。在 HR-QOL 方面，身体功能、躯体疼痛、一般健康、活力和心理健康方面均有显著改善。饮食摄入从基线时的 2679±952kcal/d 显著减少到 1 年后的 1346±483kcal/d（P<0.001）。食物耐受性评分从 21.6±0.6 显著下降到 18.7±3.9（P<0.001）。相比之下，食物满意度评分从 3.0±1.1 显著增加到 3.5±1.1（P=0.015）。
在接受腹腔镜袖状胃切除术联合空肠空肠旁路术的严重糖尿病相关轻度肥胖患者中，血糖控制明显改善，尽管食物摄入量和食物耐受性受到影响，但总体 HR-QOL 以及食物满意度显著提高。
