Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy.
Clinical Psychology; Policlinico di Monza, 20900 Monza, Italy.
J Clin Endocrinol Metab. 2021 Jul 13;106(8):e3087-e3097. doi: 10.1210/clinem/dgab161.
Laparoscopic sleeve gastrectomy (LSG) is a recognized effective procedure of bariatric surgery, but a poor response in weight loss may still represent a clinical problem. To date there are no validated predictors useful to better perform patient selection.
To establish the association of baseline anthropometric, metabolic, and psychologic features with the percent total weight loss (%TWL) and percent excess weight loss (%EWL) 12 months after surgery.
Retrospective longitudinal analysis of a set of data about obese patients attending the outpatient service of a single obesity center from June 2016 to June 2019.
A total of 106 obese patients underwent LSG with presurgery evaluation and follow-up at 12 months after surgery.
Weight loss 12 months after LSG.
Patients who achieved a %TWL higher than the observed median (≥34%) were younger, with a lower fasting plasma glucose and glycated hemoglobin, with a lower prevalence of hypertension and with a lower score in the impulsiveness scale, compared with patients with a %TWL < 34%. Similar findings were found when %EWL was considered. Multivariable stepwise regression analysis showed that younger age, lower impulsiveness, higher-than-normal urinary free cortisol, and lower HbA1c were associated with higher %TWL, explaining about 31.5% of the weight loss.
Metabolic and psychologic features at baseline were independently associated with weight loss and explained a non-negligible effect on the response to LSG. These data suggest that careful metabolic and psychologic profiling could help in sharper indications and personalized pre- and postsurgical follow-up protocols in candidates for LSG.
腹腔镜袖状胃切除术（LSG）是一种公认的有效的减重手术方法，但减肥效果不佳仍然是一个临床问题。迄今为止，还没有经过验证的预测指标可以更好地进行患者选择。
确定基线人体测量学、代谢和心理特征与术后 12 个月的总体重减轻百分比（%TWL）和超重体重减轻百分比（%EWL）之间的相关性。
对 2016 年 6 月至 2019 年 6 月期间在一家肥胖症中心的门诊就诊的一组肥胖患者的数据进行回顾性纵向分析。
共 106 名肥胖患者接受 LSG 手术，术前评估并在术后 12 个月进行随访。
LSG 术后 12 个月的体重减轻情况。
与 %TWL＜34%的患者相比，达到观察到的中位数（≥34%）的患者更年轻，空腹血糖和糖化血红蛋白水平更低，高血压患病率更低，冲动量表评分更低。当考虑到%EWL 时，也发现了类似的结果。多变量逐步回归分析表明，年龄较小、冲动性较低、尿游离皮质醇高于正常、HbA1c 较低与更高的%TWL 相关，解释了约 31.5%的体重减轻。
基线时的代谢和心理特征与体重减轻独立相关，并对 LSG 的反应解释了不可忽视的影响。这些数据表明，在 LSG 候选者中进行仔细的代谢和心理特征分析，可以帮助更明确地进行指示，并制定个性化的术前和术后随访方案。
