医学减重与手术减重对身体成分的比较效果：一项初步随机试验
Comparative Effects of Medical Versus Surgical Weight Loss on Body Composition: a Pilot Randomized Trial.
作者信息
Varma Sanskriti, Lee Clare J, Brown Todd T, Maruthur Nisa M, Schweitzer Michael, Magnuson Thomas, Kamel Ihab, Clark Jeanne M
机构信息
The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
出版信息
Obes Surg. 2019 Aug;29(8):2503-2510. doi: 10.1007/s11695-019-03879-4.
OBJECTIVE
Bariatric surgery leads to more rapid and greater weight loss (WL) compared to medical weight loss (MWL), but the differences in body composition (BC) changes for these modalities remain unclear. Due to the known health risks associated with central adiposity, we compared the changes in regional distribution of fat mass (FM) and lean mass (LM) after surgical versus MWL.
METHODS
In this 1:1:1 randomized trial among 15 persons with type 2 diabetes and body mass index (BMI) 30-39.9 kg/m, we compared changes in BC, by dual-energy X-ray absorptiometry and abdominal computerized tomography, at time of 10%WL or 9 months after intervention (whichever came first). Participants underwent MWL, adjustable gastric banding (AGB), or Roux-en-Y gastric bypass (RYGB). Non-parametric tests evaluated BC differences (FM, LM, and visceral adipose tissue [VAT]) within and across all three arms and between pair-wise comparisons.
RESULTS
Twelve female participants (75% African American) completed the study. Patient age, BMI, and baseline anthropometric characteristics were similar across study arms. AGB lost more LM (MWL - 5.2%, AGB - 10.3%, p = 0.021) and VAT (MWL + 10.9%, AGB - 28.0%, p = 0.049) than MWL. RYGB tended to lose more VAT (MWL +10.9%, RYGB - 20.2%, p = 0.077) than MWL. AGB tended to lose more LM than RYGB (AGB - 12.38%, RYGB - 7.29%, p = 0.15).
CONCLUSIONS
At similar WL, AGB lost more LM and VAT than MWL; RYGB similarly lost more VAT. Given the metabolic benefits of reducing VAT and retaining LM, larger studies should confirm the changes in BC after surgical versus medical WL.
CLINICAL TRIAL REGISTRATION
NCTDK089557 - ClinicalTrials.gov.
目的
与药物减肥（MWL）相比，减肥手术能更快速且大幅度地减轻体重（WL），但这两种方式下身体成分（BC）变化的差异仍不明确。鉴于已知中心性肥胖相关的健康风险，我们比较了手术减肥与药物减肥后脂肪量（FM）和瘦体重（LM）的区域分布变化。
方法
在这项针对15名2型糖尿病且体重指数（BMI）为30 - 39.9kg/m²的患者的1:1:1随机试验中，我们通过双能X线吸收法和腹部计算机断层扫描，比较了干预后体重减轻10%或9个月时（以先达到者为准）的身体成分变化。参与者接受药物减肥、可调节胃束带术（AGB）或Roux - en - Y胃旁路术（RYGB）。非参数检验评估了所有三个组内及组间以及两两比较之间的身体成分差异（FM、LM和内脏脂肪组织[VAT]）。
结果
12名女性参与者（75%为非裔美国人）完成了研究。各研究组的患者年龄、BMI和基线人体测量特征相似。与药物减肥相比，可调节胃束带术减少的瘦体重更多（药物减肥 - 5.2%，可调节胃束带术 - 10.3%，p = 0.021），内脏脂肪组织减少更多（药物减肥 + 10.9%，可调节胃束带术 - 28.0%，p = 0.049）。与药物减肥相比，Roux - en - Y胃旁路术倾向于减少更多的内脏脂肪组织（药物减肥 + 10.9%，Roux - en - Y胃旁路术 - 20.2%，p = 0.077）。可调节胃束带术减少的瘦体重比Roux - en - Y胃旁路术更多（可调节胃束带术 - 12.38%，Roux - en - Y胃旁路术 - 7.29%，p = 0.15）。
结论
在体重减轻程度相似的情况下，可调节胃束带术比药物减肥减少的瘦体重和内脏脂肪组织更多；Roux - en - Y胃旁路术同样减少了更多的内脏脂肪组织。鉴于减少内脏脂肪组织和保留瘦体重的代谢益处，更大规模的研究应证实手术减肥与药物减肥后身体成分的变化。
临床试验注册
NCTDK089557 - ClinicalTrials.gov。
Zotero 插件