Obesity Clinic, Hospital Juárez de México, Mexico City, Mexico.
Department of Physiology of Nutrition, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico.
Med Princ Pract. 2022;31(3):254-261. doi: 10.1159/000524805. Epub 2022 May 6.
Hepatic steatosis is associated with increased surgical complications in bariatric surgery patients. We aimed to evaluate the effect of phentermine in reducing hepatic steatosis, adipose tissue, and surgical complications in patients undergoing bariatric surgery.
This was a two-arm, double-blind, randomized, controlled pilot trial of 64 adult subjects with BMI >35 kg/m2 selected for bariatric surgery randomized into phentermine group (15 mg once daily) or placebo group for 8 weeks. Both groups adhered to a hypocaloric diet (500 calories/day) and an individualized exercise program. The primary endpoint was reducing the frequency of hepatic steatosis measured by ultrasound and reducing adipose tissue through fat mass in total kilograms or percentage. Key secondary points were the prevalence of surgical complications. Baseline and final biochemical parameters and blood pressure too were assessments.
In the phentermine group, the frequency of hepatic steatosis decreased by 19%, and the percentage of patients with a normal ultrasound increased from 9% to 28% (p = 0.05). Likewise, the decrease in fat mass in kilograms was more significant in the phentermine group (56.1 kg vs. 51.8 kg, p = 0.02). A significant reduction in the HOMA-IR index was observed regardless of weight loss. No differences in surgical complications were observed between groups. Phentermine was well-tolerated; no differences were observed in the frequency of adverse events between the groups.
Phentermine decreased the proportion of individuals with hepatic steatosis by 19% and promoted a more significant fat mass loss in kilograms among candidates for bariatric surgery.
肝脂肪变性与减重手术患者的手术并发症增加有关。我们旨在评估芬特明对减少肝脂肪变性、脂肪组织和减重手术患者手术并发症的影响。
这是一项为期 8 周的、采用双盲、随机、对照的、针对 64 名 BMI>35kg/m2 的成人患者的双臂、双盲、随机、对照的初步试验，患者被随机分为芬特明组（每天 15mg 一次）或安慰剂组。两组均采用低热量饮食（每天 500 卡路里）和个体化运动方案。主要终点是通过超声减少肝脂肪变性的频率，并通过总公斤或百分比减少脂肪组织。关键次要终点是手术并发症的发生率。还评估了基线和最终的生化参数和血压。
在芬特明组中，肝脂肪变性的频率降低了 19%，正常超声的患者比例从 9%增加到 28%（p=0.05）。同样，芬特明组的公斤脂肪量减少更为显著（56.1kg 与 51.8kg，p=0.02）。无论体重减轻与否，HOMA-IR 指数均显著降低。两组之间未观察到手术并发症的差异。芬特明耐受良好；两组之间不良事件的频率无差异。
芬特明将肝脂肪变性的个体比例降低了 19%，并促进了减重手术候选者公斤脂肪量的更大幅度减少。
