Paisey Richard, Daniels Charles, Howitt Will, Greatorex Derek, Campbell Claire, Paisey Christopher, Paisey Rosamund, Frost Julie, Bromige Robert
Diabetic Department, Torbay and South Devon NHS Foundation Trust, Torquay, UK.
General Practice, Chilcote Surgery Dewerstone Practice, Torquay, UK.
BMJ Nutr Prev Health. 2022 Mar 4;5(1):55-61. doi: 10.1136/bmjnph-2021-000363. eCollection 2022.
To assess weight loss maintenance, diabetes status, mortality and morbidity 15 years after a very low calorie diet programme (VLCD) in patients with obesity.
General practice data bases were interrogated for subjects coded for group therapy with VLCD in the 1990s. Causes of death, occurrence of vascular disease and remission or development of diabetes were ascertained from patient records and national stroke and cardiovascular disease data bases.
325 subjects engaged in the programme and had sufficient data for analysis. Baseline characteristics were: age 47.8±12. 8 years; body mass index (BMI) 36.1±6.8 kg/m; 79.1% female/20.9% male; 13.5% had type 2 diabetes. After 15±4 years weight had changed from 97.9±19 kg at baseline to 100±20.8 kg. 10 with diabetes at baseline were in remission at 3 months, but only two remained in remission at 5 years. 50 new cases of type 2 diabetes and 11 of impaired fasting glucose developed during follow-up. Only 5.9% who remained healthy at follow-up had maintained >10% body weight reduction. Neither diabetes incidence nor diabetes free survival were related to percentage body weight lost during VLCD. Only baseline BMI was related to development of new impaired fasting glucose or diabetes by 15 years (p=0.007). 37 subjects had a cardiovascular event. Age (p=0.000002) and degree of weight loss after VLCD (p=0.03) were significantly associated with subsequent vascular events.
Long-term maintenance of weight loss after VLCD was rare in this single centre retrospective study 15 years later. Glucose intolerance developed in 21.4%. Lasting remission of type 2 diabetes or prevention of later glucose intolerance were not achieved. Vascular events were more frequent in those who lost most weight. Risk management during weight regain should be studied in future to assess potential for reduction in adverse cardiovascular outcomes.
评估极低热量饮食计划（VLCD）实施15年后肥胖患者的体重减轻维持情况、糖尿病状态、死亡率和发病率。
对20世纪90年代采用VLCD进行团体治疗编码的受试者的全科医疗数据库进行查询。从患者记录以及国家中风和心血管疾病数据库中确定死亡原因、血管疾病的发生情况以及糖尿病的缓解或发展情况。
325名受试者参与了该计划并拥有足够的分析数据。基线特征为：年龄47.8±12.8岁；体重指数（BMI）36.1±6.8kg/m²；79.1%为女性/20.9%为男性；13.5%患有2型糖尿病。15±4年后，体重从基线时的97.9±19kg变为100±20.8kg。10名基线时患有糖尿病的患者在3个月时病情缓解，但5年后只有2人仍处于缓解状态。随访期间出现了50例新的2型糖尿病病例和11例空腹血糖受损病例。随访时保持健康的患者中只有5.9%体重减轻超过10%。糖尿病发病率和无糖尿病生存率均与VLCD期间体重减轻的百分比无关。只有基线BMI与15年后新出现的空腹血糖受损或糖尿病的发生有关（p=0.007）。37名受试者发生了心血管事件。年龄（p=0.000002）和VLCD后体重减轻程度（p=0.03）与随后的血管事件显著相关。
在这项15年后的单中心回顾性研究中，VLCD后体重减轻的长期维持情况很少见。21.4%出现了葡萄糖不耐受。未实现2型糖尿病的持久缓解或预防后期葡萄糖不耐受。体重减轻最多的人群中血管事件更为频繁。未来应研究体重反弹期间的风险管理，以评估降低不良心血管结局的可能性。
