Cooiman Mellody I, Alsters Suzanne I M, Duquesnoy Maeva, Hazebroek Eric J, Meijers-Heijboer Hanne J, Chahal Harvinder, Le Beyec-Le Bihan Johanne, Clément Karine, Soula Hedi, Blakemore Alex I, Poitou Christine, van Haelst Mieke M
Department of Bariatric Surgery, Rijnstate Hospital/Vitalys Clinic, Wagnerlaan 55, Arnhem, the Netherlands.
Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
Obes Surg. 2022 Mar;32(3):837-844. doi: 10.1007/s11695-021-05869-x. Epub 2022 Jan 4.
Pathogenic heterozygous MC4R variants are associated with hyperphagia and variable degrees of obesity. Several research groups have reported short-term weight loss outcomes after bariatric surgery in a few patients with MC4R variants, but lack of longer-term data prevents evidence-based clinical decision-making.
Bariatric surgery patients with heterozygous (likely) pathogenic MC4R variants, from three collaborating centers in the Netherlands, France, and the UK, were compared to matched controls (matched 2:1 for age, sex, preoperative BMI, surgical procedure, and diabetes mellitus, but without MC4R mutations). Weight loss and regain outcomes up to 6 years of follow-up were compared.
At 60 months of follow-up after RYGB, cases with MC4R variants showed weight regain with a mean of 12.8% (± 10.4 SD) total weight loss (TWL) from nadir, compared to 7.9% (± 10.5 SD) in the controls (p = 0.062). Among patients receiving SG, the cases with MC4R variants experienced inferior weight loss (22.6% TWL) during the first year of follow-up compared to the controls (29.9% TWL) (p = 0.010).
This multicenter study reveals inferior mid-term weight outcomes of cases with MC4R variants after SG, compared to RYGB. Since adequate weight loss outcomes were observed after RYGB, this procedure would appear to be an appropriate surgical approach for this group. However, the pattern of weight regain seen in cases with MC4R variants after both RYGB and SG highlights the need for pro-active lifelong management to prevent relapse, as well as careful expectation management.
致病性杂合MC4R变异与食欲亢进及不同程度的肥胖有关。几个研究小组报告了一些携带MC4R变异的患者在接受减肥手术后的短期体重减轻结果，但缺乏长期数据，无法进行基于证据的临床决策。
来自荷兰、法国和英国三个合作中心的携带杂合（可能）致病性MC4R变异的减肥手术患者与匹配的对照组（年龄、性别、术前BMI、手术方式和糖尿病相匹配，比例为2:1，但无MC4R突变）进行比较。比较了长达6年随访期的体重减轻和体重反弹结果。
在RYGB术后60个月的随访中，携带MC4R变异的病例出现体重反弹，自最低点起总体重减轻（TWL）平均为12.8%（±10.4标准差），而对照组为7.9%（±10.5标准差）（p = 0.062）。在接受SG的患者中，携带MC4R变异的病例在随访的第一年体重减轻情况（TWL为22.6%）不如对照组（TWL为29.9%）（p = 0.010）。
这项多中心研究表明，与RYGB相比，携带MC4R变异的病例在接受SG后的中期体重结果较差。由于RYGB术后观察到了足够的体重减轻效果，该手术似乎是适合这一群体的手术方式。然而，RYGB和SG术后携带MC4R变异的病例出现的体重反弹模式凸显了积极进行终身管理以防止复发的必要性，以及谨慎进行预期管理的必要性。
