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单吻合口胃旁路手术对合并维生素 D 缺乏和病态肥胖患者心血管危险因素的影响:一项二次分析。

Effect of one-anastomosis gastric bypass on cardiovascular risk factors in patients with vitamin D deficiency and morbid obesity: A secondary analysis.

机构信息

Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Austria; Division of Internal Medicine, General Public Hospital of the Order of Saint Elisabeth, Klagenfurt, Austria.

Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Austria; Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Austria.

出版信息

Nutr Metab Cardiovasc Dis. 2020 Nov 27;30(12):2379-2388. doi: 10.1016/j.numecd.2020.08.011. Epub 2020 Aug 20.

Abstract

BACKGROUND AND AIMS

Bariatric patients often suffer from vitamin D (VD) deficiency, and both, morbid obesity and VD deficiency, are related to an adverse effect on cardiovascular disease (CVD) risk. Therefore, we assessed the change of known CVD risk factors and its associations during the first 12 months following one-anastomosis gastric bypass (OAGB).

METHODS AND RESULTS

In this secondary analysis, CVD risk factors, medical history and anthropometric data were assessed in fifty VD deficient (25-hydroxy-vitamin D (25(OH)D) <75 nmol/l) patients, recruited for a randomized controlled trial of VD supplementation. Based on previous results regarding bone-mass loss and the association between VD and CVD risk, the study population was divided into patients with 25(OH)D ≥50 nmol/l (adequate VD group; AVD) and into those <50 nmol/l (inadequate VD group; IVD) at 6 and 12 months (T6/12) postoperatively. In the whole cohort, substantial remission rates for hypertension (38%), diabetes (30%), and dyslipidaemia (41%) and a significant reduction in CVD risk factors were observed at T12. Changes of insulin resistance markers were associated with changes of total body fat mass (TBF%), 25(OH)D, and ferritin. Moreover, significant differences in insulin resistance markers between AVD and IVD became evident at T12.

CONCLUSION

These findings show that OAGB leads to a significant reduction in CVD risk factors and amelioration of insulin resistance markers, which might be connected to reduced TBF%, change in 25(OH)D and ferritin levels, as an indicator for subclinical inflammation, and an adequate VD status. REGISTERED AT CLINICALTRIALS.GOV: (Identifier: NCT02092376) and EudraCT (Identifier: 2013-003546-16).

摘要

背景和目的

肥胖症患者常患有维生素 D(VD)缺乏症,而病态肥胖症和 VD 缺乏症均与心血管疾病(CVD)风险的不利影响有关。因此,我们评估了在胃旁路吻合术(OAGB)后 12 个月内,已知 CVD 危险因素的变化及其相关性。

方法和结果

在这项二次分析中,对 50 名 VD 缺乏症患者(25-羟维生素 D(25(OH)D)<75 nmol/L)进行了 CVD 危险因素、病史和人体测量数据评估,这些患者是为 VD 补充的随机对照试验而招募的。基于先前关于骨量丢失的结果以及 VD 与 CVD 风险之间的关联,将研究人群分为术后 6 个月和 12 个月时 25(OH)D≥50 nmol/L(足够 VD 组;AVD)和<50 nmol/L(不足 VD 组;IVD)的患者。在整个队列中,高血压(38%)、糖尿病(30%)和血脂异常(41%)的缓解率较高,CVD 危险因素显著降低。胰岛素抵抗标志物的变化与总体脂量(TBF%)、25(OH)D 和铁蛋白的变化相关。此外,在 T12 时,AVD 和 IVD 之间的胰岛素抵抗标志物差异明显。

结论

这些发现表明,OAGB 可显著降低 CVD 危险因素并改善胰岛素抵抗标志物,这可能与 TBF%降低、25(OH)D 和铁蛋白水平变化有关,作为亚临床炎症的指标,以及适当的 VD 状态有关。在 ClinicalTrials.gov 上注册(标识符:NCT02092376)和 EudraCT(标识符:2013-003546-16)。

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