中国多学科团队治疗肥胖患者的身体成分和代谢改善。
Body Composition and Metabolic Improvement in Patients Followed Up by a Multidisciplinary Team for Obesity in China.
机构信息
Department of Endocrinology, Peking University First Hospital, China.
Department of Clinical Nutrition, Peking University First Hospital, China.
出版信息
J Diabetes Res. 2021 Jul 29;2021:8862217. doi: 10.1155/2021/8862217. eCollection 2021.
BACKGROUND
This study evaluated the effectiveness of the multidisciplinary team (including a specialist, a dietitian, a physical exercise trainer, a surgeon for bariatric surgery, an acupuncturist, and several health educators) for obesity management and the body composition change and improvements in metabolic biomarkers during a 2-year follow-up.
MATERIALS AND METHODS
A total of 119 patients participated in the multidisciplinary team for obesity. Patients were followed up at 3 months, 6 months, 1 year, 18 months, and 2 years after their first visit. Individuals were divided into the high-protein diet (HPD) and standard-protein diet (SPD) group according to their results on a diet questionnaire that they filled out during follow-up.
RESULTS
After 1.2 years, the mean body weight of the participants dropped from 89.7 kg to 80.9 kg ( < 0.001). The body adiposity index was reduced from 33.9 to 32.0 ( < 0.001), while the fat-free mass index from 17.0 to 15.2 ( = 0.043). Fasting glucose and HbA1c were also lower after treatment ( = 0.002 and 0.038 for FPG and HbA1c, respectively). Fasting insulin and HOMA-IR were reduced ( = 0.002 and <0.001 for fasting insulin and HOMA-IR, respectively). HDL-c increased along with weight loss (1.06 mmol/L vs. 1.19 mmol/L, < 0.001), and transaminase levels significantly dropped ( = 0.001 and 0.021 for ALT and AST, respectively). During treatment, mean protein intake was 29.9% in the HPD group and 19.5% in the SPD group ( < 0.001). Weight loss, reduction of visceral fat area, maintenance of lean body mass, body adiposity index, and fat-free mass index showed no statistical significance between the HPD and SPD groups, as well as glucose metabolic variables.
CONCLUSIONS
A multidisciplinary team for obesity management could significantly reduce body weight and improve metabolic indicators, including HDL-c, transaminase, and insulin resistance. A high-protein diet does not produce better weight control or body composition compared with a standard calorie-restricted diet.
背景
本研究评估了多学科团队（包括专家、营养师、运动教练、减重手术医生、针灸师和多位健康教育家）在肥胖管理中的有效性，以及在 2 年随访期间对体成分改变和代谢生物标志物的影响。
材料与方法
共有 119 名肥胖患者参加了多学科团队。患者在首次就诊后 3 个月、6 个月、1 年、18 个月和 2 年进行随访。根据患者在随访期间填写的饮食问卷结果，将他们分为高蛋白饮食（HPD）和标准蛋白饮食（SPD）组。
结果
经过 1.2 年，参与者的平均体重从 89.7kg 降至 80.9kg（<0.001）。体脂指数从 33.9 降至 32.0（<0.001），而去脂体重指数从 17.0 降至 15.2（=0.043）。治疗后空腹血糖和糖化血红蛋白也降低（FPG 和 HbA1c 分别为=0.002 和 0.038）。空腹胰岛素和 HOMA-IR 降低（空腹胰岛素和 HOMA-IR 分别为=0.002 和<0.001）。HDL-c 随着体重减轻而增加（从 1.06mmol/L 增加至 1.19mmol/L，<0.001），转氨酶水平显著下降（ALT 和 AST 分别为=0.001 和 0.021）。治疗期间，HPD 组的平均蛋白质摄入量为 29.9%，SPD 组为 19.5%（<0.001）。HPD 组和 SPD 组在体重减轻、内脏脂肪面积减少、维持瘦体重、体脂指数和去脂体重指数方面，以及葡萄糖代谢变量方面均无统计学差异。
结论
肥胖管理的多学科团队可显著减轻体重，改善代谢指标，包括 HDL-c、转氨酶和胰岛素抵抗。高蛋白饮食与标准热量限制饮食相比，在体重控制或体成分方面并未产生更好的效果。
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