Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.
Library Public Services, Mayo Clinic, Rochester, Minnesota.
J Clin Endocrinol Metab. 2020 Dec 1;105(12). doi: 10.1210/clinem/dgaa673.
Excess adipose tissue is associated with an abnormal lipid profile that may improve with weight reduction. In this meta-analysis, we aimed to estimate the magnitude of change in lipid parameters associated with weight loss in adults who are overweight or obese.
We searched MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and Scopus from 2013 to September, 2018. We included randomized controlled trials (RCTs) that evaluated interventions to treat adult obesity (lifestyle, pharmacologic and surgical) with follow-up of 6 months or more.
We included 73 RCTs with moderate-to-low risk of bias, enrolling 32 496 patients (mean age, 48.1 years; weight, 101.6 kg; and body mass index [BMI], 36.3 kg/m2). Lifestyle interventions (diet, exercise, or both), pharmacotherapy, and bariatric surgery were associated with reduced triglyceride (TG) and low-density lipoprotein cholesterol (LDL-C) concentrations and increased high-density lipoprotein cholesterol (HDL-C) at 6 and 12 months. The following data are for changes in lipid parameters after 12 months of the intervention with 95% CI. Following lifestyle interventions, per 1 kg of weight lost, TGs were reduced by -4.0 mg/dL (95% CI, -5.24 to -2.77 mg/dL), LDL-C was reduced by -1.28 mg/dL (95% CI, -2.19 to -0.37 mg/dL), and HDL-C increased by 0.46 mg/dL (95% CI, 0.20 to 0.71 mg/dL). Following pharmacologic interventions, per 1 kg of weight lost, TGs were reduced by -1.25 mg/dL (95% CI, -2.94 to 0.43 mg/dL), LDL-C was reduced by -1.67 mg/dL (95% CI, -2.28 to -1.06 mg/dL), and HDL-C increased by 0.37 mg/dL (95% CI, 0.23 to 0.52 mg/dL). Following bariatric surgery, per 1 kg of weight lost, TGs were reduced by -2.47 mg/dL (95% CI, -3.14 to -1.80 mg/dL), LDL-C was reduced by -0.33 mg/dL (95% CI, -0.77 to 0.10 mg/dL), and HDL-C increased by 0.42 mg/dL (95% CI, 0.37 to 0.47 mg/dL). Low-carbohydrate diets resulted in reductions in TGs and increases in HDL-C, whereas low-fat diets resulted in reductions in TGs and LDL-C and increases in HDL-C. Results were consistent across malabsorptive and restrictive surgery.
Weight loss in adults is associated with statistically significant changes in serum lipids. The reported magnitude of improvement can help in setting expectations, inform shared decision making, and facilitate counseling.
过多的脂肪组织与异常的血脂谱有关，这种血脂谱可能随着体重减轻而改善。在这项荟萃分析中，我们旨在评估超重或肥胖成年人减肥后与血脂参数变化相关的幅度。
我们检索了 MEDLINE、EMBASE、Cochrane 系统评价数据库和 Scopus，检索时间从 2013 年至 2018 年 9 月。我们纳入了评估治疗成人肥胖的干预措施（生活方式、药物和手术）的随机对照试验（RCT），随访时间超过 6 个月。
我们纳入了 73 项 RCT，这些 RCT 的偏倚风险为中低度，共纳入 32496 名患者（平均年龄 48.1 岁；体重 101.6kg；体重指数[BMI]36.3kg/m2）。生活方式干预（饮食、运动或两者结合）、药物治疗和减重手术与治疗后 6 个月和 12 个月时甘油三酯（TG）和低密度脂蛋白胆固醇（LDL-C）浓度降低和高密度脂蛋白胆固醇（HDL-C）升高相关。以下是干预后 12 个月血脂参数变化的数据，95%CI。生活方式干预后，每减轻 1kg 体重，TG 降低 4.0mg/dL（95%CI，-5.24 至-2.77mg/dL），LDL-C 降低 1.28mg/dL（95%CI，-2.19 至-0.37mg/dL），HDL-C 升高 0.46mg/dL（95%CI，0.20 至 0.71mg/dL）。药物治疗后，每减轻 1kg 体重，TG 降低 1.25mg/dL（95%CI，-2.94 至 0.43mg/dL），LDL-C 降低 1.67mg/dL（95%CI，-2.28 至-1.06mg/dL），HDL-C 升高 0.37mg/dL（95%CI，0.23 至 0.52mg/dL）。减重手术后，每减轻 1kg 体重，TG 降低 2.47mg/dL（95%CI，-3.14 至-1.80mg/dL），LDL-C 降低 0.33mg/dL（95%CI，-0.77 至 0.10mg/dL），HDL-C 升高 0.42mg/dL（95%CI，0.37 至 0.47mg/dL）。低碳水化合物饮食可降低 TG 和升高 HDL-C，而低脂肪饮食可降低 TG 和 LDL-C 并升高 HDL-C。吸收不良和限制性手术的结果一致。
成年人的体重减轻与血清脂质的统计学显著变化相关。所报告的改善幅度有助于设定预期，为共同决策提供信息，并促进咨询。
