Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
JAMA Netw Open. 2022 Jul 1;5(7):e2223927. doi: 10.1001/jamanetworkopen.2022.23927.
There is a lack of studies evaluating sleeve gastrectomy compared with intensive lifestyle treatment in patients with class 1 obesity (body mass index [BMI] 30 to <35 [calculated as weight in kilograms divided by height in meters squared]).
To compare outcomes and safety of sleeve gastrectomy compared with intensive nonoperative obesity treatment in patients with class 1 obesity.
DESIGN, SETTING, AND PARTICIPANTS: This matched, nationwide cohort study included patients with class 1 obesity who underwent a sleeve gastrectomy or intensive lifestyle treatment between January 1, 2012, and December 31, 2017, and who were registered in the Scandinavian Obesity Surgery Registry or the Itrim health database. Participants with class 1 obesity were matched 1:2 using a propensity score including age, sex, BMI, treatment year, education level, income, cardiovascular disease, and use of antibiotic drugs, antidepressants, and anxiolytics.
Sleeve gastrectomy or intensive lifestyle treatment.
Outcomes included weight loss after intervention, changes in metabolic comorbidities, substance use disorders, self-harm, and major cardiovascular events retrieved from the National Patient Register, Prescribed Drug Register, and Cause of Death Register as well as the Scandinavian Obesity Surgery Registry and the Itrim health database. Data were analyzed from December 1, 2021 until May 31, 2022.
The study included 1216 surgery patients and 2432 lifestyle participants with similar mean (SD) BMI (32.8 [1.4] vs 32.9 [1.4]), mean (SD) age (42.4 [9.7] vs 42.6 [12.7] years), and sex (1091 [89.7%] vs 2191 [90.1%] women). Surgery patients had greater 1-year weight loss compared with controls (22.9 kg vs 11.9 kg; mean difference, 10.7 kg; 95% CI, 10.0-11.5 kg; P < .001). Over a median follow-up of 5.1 years (IQR, 3.9-6.2 years), surgery patients had a lower risk of incident use of diabetes drugs (59.7 vs 100.4 events per 10 000 person-years; hazard ratio [HR], 0.60; 95% CI, 0.39-0.92; P = .02) and greater 2-year diabetes drug remission (48.4% vs 22.0%; risk difference 26.4%; 95% CI, 11.7%-41.0%; P < .001), but higher risk for substance use disorder (94 vs 50 events per 10 000 person-years; HR, 1.86; 95% CI, 1.30-2.67; P < .001) and self-harm (45 vs 25 events per 10 000 person-years; HR, 1.81; 95% CI, 1.09-3.01; P = .02). No between-group difference in occurrence of major cardiovascular events was observed (23.4 vs 24.8 events per 10 000 person-years; HR, 0.96; 95% CI, 0.49-1.91; P = .92).
In this cohort study, compared with intensive nonoperative obesity treatment, sleeve gastrectomy in patients with class 1 obesity was associated with greater weight loss, diabetes prevention, and diabetes remission but a higher incidence of substance use disorder and self-harm.
背景： 对于 BMI 在 30 至 <35 之间的 1 类肥胖患者（体重指数[BMI]，以千克为单位除以身高的平方米数），与强化生活方式治疗相比，袖状胃切除术的研究较为缺乏。
目的： 比较 1 类肥胖患者中接受袖状胃切除术与强化非手术肥胖治疗的结果和安全性。
设计、地点和参与者： 这是一项匹配的全国性队列研究，纳入了 2012 年 1 月 1 日至 2017 年 12 月 31 日期间接受袖状胃切除术或强化生活方式治疗的 1 类肥胖患者，并在斯堪的纳维亚肥胖手术登记处或 Itrim 健康数据库中注册。使用包括年龄、性别、BMI、治疗年份、教育程度、收入、心血管疾病以及抗生素药物、抗抑郁药和抗焦虑药的使用情况在内的倾向评分对 1 类肥胖患者进行 1:2 匹配。
干预措施： 袖状胃切除术或强化生活方式治疗。
主要结局和措施： 结果包括术后干预的体重减轻、代谢合并症的变化、物质使用障碍、自伤和重大心血管事件，这些数据从国家患者登记处、处方药物登记处和死因登记处以及斯堪的纳维亚肥胖手术登记处和 Itrim 健康数据库中检索获得。数据分析于 2021 年 12 月 1 日至 2022 年 5 月 31 日进行。
结果： 该研究纳入了 1216 名手术患者和 2432 名生活方式参与者，两组的平均（标准差）BMI（32.8[1.4]比 32.9[1.4]）、平均（标准差）年龄（42.4[9.7]比 42.6[12.7]岁）和性别（1091[89.7%]比 2191[90.1%]女性）相似。与对照组相比，手术患者的 1 年体重减轻更大（22.9 千克比 11.9 千克；平均差异，10.7 千克；95%置信区间，10.0-11.5 千克；P<0.001）。在中位数为 5.1 年（四分位距，3.9-6.2 年）的随访中，手术患者发生新的使用糖尿病药物的风险较低（59.7 例比 100.4 例/10000 人年；风险比[HR]，0.60；95%置信区间，0.39-0.92；P=0.02），2 年糖尿病药物缓解的比例更高（48.4%比 22.0%；风险差异 26.4%；95%置信区间，11.7%-41.0%；P<0.001），但发生物质使用障碍的风险更高（94 例比 50 例/10000 人年；HR，1.86；95%置信区间，1.30-2.67；P<0.001）和自伤（45 例比 25 例/10000 人年；HR，1.81；95%置信区间，1.09-3.01；P=0.02）的风险更高。两组之间主要心血管事件的发生没有差异（23.4 例比 24.8 例/10000 人年；HR，0.96；95%置信区间，0.49-1.91；P=0.92）。
结论和相关性： 在这项队列研究中，与强化非手术肥胖治疗相比，1 类肥胖患者接受袖状胃切除术与更大的体重减轻、糖尿病预防和糖尿病缓解相关，但物质使用障碍和自伤的发生率更高。
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