胃旁路术后肥胖缓解女性体脂百分比对代谢的影响独立于体重指数。
Metabolic Impact of Body Fat Percentage Independent of Body Mass Index in Women with Obesity Remission After Gastric Bypass.
机构信息
Department of Medicine (H7), Karolinska Institutet, Karolinska University Hospital, Huddinge, 141 86, Stockholm, Sweden.
Department of Clinical Sciences, Danderyd Hospital & Department of Surgery, Ersta Hospital, Karolinska Institutet, 116 91, Stockholm, Sweden.
出版信息
Obes Surg. 2020 Mar;30(3):1086-1092. doi: 10.1007/s11695-019-04304-6.
BACKGROUND/OBJECTIVE: Body mass index (BMI) is central when evaluating treatment effect after gastric bypass. The metabolic impact of BMI-independent differences in body fat percentage (BF%) after gastric bypass is not fully understood. We compared metabolic and adipose tissue characteristics in women with high versus low BF% independent of BMI after obesity remission following gastric bypass.
SUBJECTS/METHODS: A cohort of 215 women was included at baseline. A total of 166 women were re-examined 2 years after gastric bypass, whereof 130 had obesity remission (BMI < 30 kg/m). Anthropometric parameters, blood pressure, and lipids were measured. Total and regional body fat mass was determined by dual-energy X-ray absorptiometry. Insulin sensitivity was assessed by homeostasis model assessment of insulin resistance (HOMA-IR) and hyperinsulinemic euglycemic clamp (M value). Adipocyte size and number were determined.
RESULTS
Of the 130 women with obesity remission, 64 had BF% ≥ 35 and 65 < 35. Independent of BMI, high BF% were associated with higher HOMA-IR (P = 0.021), lower M value (P = 0.0046), higher triglycerides (P = 0.013), higher visceral/total and android/gynoid fat mass ratios (P = 0.0032 and 0.0003 respectively), and larger subcutaneous fat cell volume (P < 0.0001) 2 years after gastric bypass. No differences in anthropometric measures, glucose, blood pressure, or fat cell number were observed.
CONCLUSIONS
Independent of BMI, patients with higher BF% displayed lower insulin sensitivity, higher triglyceride levels, central fat distribution, and larger subcutaneous adipocytes 2 years after gastric bypass. Thus, determination of BF% provides additional information of metabolic characteristics at follow-up of non-obese patients after gastric bypass.
背景/目的：体重指数（BMI）是评估胃旁路术后治疗效果的核心指标。然而，胃旁路术后 BMI 以外的体脂百分比（BF%）的变化对代谢的影响尚未完全阐明。本研究旨在比较肥胖缓解后胃旁路术后 2 年，BMI 独立的高 BF%与低 BF%患者的代谢和脂肪组织特征。
方法
本研究纳入了 215 名基线患者。其中，166 名患者在肥胖缓解（BMI<30kg/m）后 2 年进行了复查。通过双能 X 射线吸收法测量人体成分，评估了总脂肪量和各部位脂肪量。通过稳态模型评估的胰岛素抵抗指数（HOMA-IR）和高胰岛素正葡萄糖钳夹试验（M 值）评估胰岛素敏感性。通过测定脂肪细胞大小和数量评估脂肪组织。
结果
在肥胖缓解的 130 名患者中，64 名患者的 BF%≥35%，65 名患者的 BF%<35%。无论 BMI 如何，高 BF%患者的 HOMA-IR 更高（P=0.021），M 值更低（P=0.0046），甘油三酯水平更高（P=0.013），内脏/总脂肪和腹型/女性型脂肪比率更高（P=0.0032 和 0.0003），皮下脂肪细胞体积更大（P<0.0001）。此外，我们还发现两组患者的体重、腰围、臀围、血压和脂肪细胞数量均无显著差异。
结论
胃旁路术后 2 年，与 BMI 独立的高 BF%患者相比，低 BF%患者的胰岛素敏感性更低，甘油三酯水平更高，中心性肥胖更为明显，且皮下脂肪细胞体积更大。因此，BF%的测定可提供肥胖缓解患者胃旁路术后随访时的代谢特征信息。
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