肥胖患者前瞻性对照研究：减肥手术对早发性和成年发病肥胖的影响。
Effects of Bariatric Surgery in Early- and Adult-Onset Obesity in the Prospective Controlled Swedish Obese Subjects Study.
机构信息
Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
出版信息
Diabetes Care. 2020 Apr;43(4):860-866. doi: 10.2337/dc19-1909. Epub 2020 Jan 23.
OBJECTIVE
Bariatric surgery is an effective treatment for obesity, but it is unknown if outcomes differ between adults with early- versus adult-onset obesity. We investigated how obesity status at 20 years of age affects outcomes after bariatric surgery later in life.
RESEARCH DESIGN AND METHODS
The Swedish Obese Subjects study is a prospective matched study performed at 25 surgical departments and 480 primary health care centers. Participants aged 37-60 years with BMI ≥34 kg/m (men) or ≥38 kg/m (women) were recruited between 1987 and 2001; 2,007 participants received bariatric surgery and 2,040 usual care. Self-reported body weight at 20 years of age was used to stratify patients into subgroups with normal BMI (<25 kg/m), overweight (BMI 25-29.9 kg/m), or obesity (BMI ≥30 kg/m). Body weight, energy intake, and type 2 diabetes status were examined over 10 years, and incidence of cardiovascular and microvascular disease was determined over up to 26 years using data from health registers.
RESULTS
There were small but statistically significant differences in reduction of body weight among the subgroups after bariatric surgery (interaction = 0.032), with the largest reductions among those with obesity aged 20 years. Bariatric surgery increased type 2 diabetes remission (odds ratios 4.51, 4.90, and 5.58 in subgroups with normal BMI, overweight, or obesity at 20 years of age, respectively; interaction = 0.951), reduced type 2 diabetes incidence (odds ratios 0.15, 0.13, and 0.15, respectively; interaction = 0.972), and reduced microvascular complications independent of obesity status at 20 years of age (interaction = 0.650). The association between bariatric surgery and cardiovascular disease was similar in the subgroups (interaction = 0.674). Surgical complications were similar in the subgroups.
CONCLUSIONS
The treatment benefits of bariatric surgery in adults are similar regardless of obesity status at 20 years of age.
目的
减重手术是肥胖症的有效治疗方法，但尚不清楚成年人的早发性肥胖与成年后发生的肥胖在手术效果上是否存在差异。本研究旨在探讨 20 岁时的肥胖状况对以后接受减重手术的影响。
研究设计和方法
该研究是在瑞典进行的一项前瞻性、匹配队列研究，共纳入了 25 个外科科室和 480 个初级保健中心的参与者。研究对象为年龄在 37-60 岁之间、BMI≥34kg/m2（男性）或≥38kg/m2（女性）的患者。这些患者在 1987 年至 2001 年间被招募，其中 2007 名患者接受了减重手术，2040 名患者接受了常规护理。根据患者在 20 岁时的自我报告体重，将其分为正常 BMI（<25kg/m2）、超重（BMI 25-29.9kg/m2）或肥胖（BMI≥30kg/m2）亚组。通过健康登记处的数据，在 10 年内检测体重、能量摄入和 2 型糖尿病的发病情况，并在长达 26 年内检测心血管和微血管疾病的发病情况。
结果
与其他亚组相比，20 岁时肥胖的患者在减重手术后体重下降幅度较小，但具有统计学意义（交互作用 = 0.032）。接受减重手术的患者中，20 岁时 BMI 正常、超重或肥胖的患者的 2 型糖尿病缓解率分别为 4.51、4.90 和 5.58（交互作用 = 0.951），2 型糖尿病的发病率分别为 0.15、0.13 和 0.15（交互作用 = 0.972），微血管并发症的发生率分别为 0.15、0.13 和 0.15（交互作用 = 0.650），均有所降低，且不受 20 岁时的肥胖状况影响。在各个亚组中，减重手术与心血管疾病之间的关联相似（交互作用 = 0.674）。手术并发症在各亚组中相似。
结论
无论 20 岁时的肥胖状况如何，减重手术对成年人的治疗效果是相似的。
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