Department of Endocrinology, Singapore General Hospital, Singapore, Singapore.
Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore, Singapore.
Obes Surg. 2020 Jun;30(6):2099-2107. doi: 10.1007/s11695-020-04446-y.
The effect of preoperative weight loss via very low caloric diet (VLCD) on long-term weight loss post-bariatric surgery (BS) is conflicting. We analysed its impact on weight loss and other outcomes post-BS.
Patients (n = 306) who underwent sleeve gastrectomy or gastric bypass from 2008 to 2018 were studied. VLCD was prescribed for 14 days preoperatively. Patients were followed up for 5 years. Postoperative weight loss was compared in patients with preoperative weight gain or weight loss < 5% (WL < 5%), and weight loss ≥ 5% (WL ≥ 5%). Preoperative WL compared weight before and after VLCD; postoperative WL compared post-VLCD weight and follow-up weight. Total weight loss (TWL) encompassed pre- and postoperative WL.
WL was < 5% in 87.3% and ≥ 5% in 12.7%. There was no significant difference in complication rate, duration of surgery or length of stay, regardless of surgical type. Patients with WL < 5% lost more weight postoperatively compared with WL ≥ 5% for up to 60 months (%postoperative WL at 1 month: WL < 5% = 13.7%, WL ≥ 5% = 10%, p = <0.001; 60 months: WL < 5% = 30.6%, WL ≥ 5% = 23.9%, p = 0.041). However, when TWL and percentage of excess body mass index loss (%EBMIL) were measured, there was no difference beyond 6 months. A predictive multivariable model for 1-year %EBMIL was formed. Significant variables included pre-VLCD BMI and preoperative WL, and the relationship between the two.
Preoperative WL via VLCD was associated with reduced postoperative WL after BS, with no significant effect on complications, long-term TWL or %EBMIL. This challenges the notion that preoperative WL via VLCD should be mandated for better postoperative outcomes.
极低热量饮食（VLCD）术前减肥对减重手术后（BS）长期减肥的效果存在争议。我们分析了其对 BS 后减肥和其他结果的影响。
研究了 2008 年至 2018 年间接受袖状胃切除术或胃旁路术的 306 例患者。术前规定 VLCD 治疗 14 天。患者随访 5 年。比较术前体重增加或体重减轻<5%（WL<5%）和体重减轻≥5%（WL≥5%）患者的术后体重减轻情况。术前 WL 比较 VLCD 前后的体重；术后 WL 比较 VLCD 后体重和随访体重。总体重减轻（TWL）包括术前和术后 WL。
87.3%的患者 WL<5%，12.7%的患者 WL≥5%。无论手术类型如何，并发症发生率、手术持续时间或住院时间均无显著差异。在术后 1 个月时，与 WL≥5%的患者相比，WL<5%的患者体重减轻更多（术后 WL%：WL<5%=13.7%，WL≥5%=10%，p<0.001；60 个月时：WL<5%=30.6%，WL≥5%=23.9%，p=0.041）。然而，当测量 TWL 和多余体重指数损失百分比（%EBMIL）时，6 个月后没有差异。建立了 1 年 %EBMIL 的预测多变量模型。显著变量包括 VLCD 术前 BMI 和术前 WL 以及两者之间的关系。
BS 前通过 VLCD 减轻体重与术后体重减轻减少相关，但对并发症、长期 TWL 或%EBMIL 无显著影响。这挑战了通过 VLCD 术前减轻体重以获得更好的术后效果的观点。
