Department of Gastrosurgical Research and Education, Sahlgrenska University Hospital, Institute of Clinical Sciences, Gothenburg, Sweden; Swansea University Medical School, Swansea University, Swansea, United Kingdom; Research Department, Royal College of Surgeons of England, London, United Kingdom.
College of Veterinary Medicine, University of Minnesota, Minneapolis, Minnesota.
Surg Obes Relat Dis. 2023 Oct;19(10):1154-1161. doi: 10.1016/j.soard.2023.04.326. Epub 2023 Apr 25.
Roux-en-Y gastric bypass (RYGB) among adolescents with obesity results in significant weight loss; however, depot-specific changes have been understudied.
We hypothesized that visceral adipose tissue (VAT) reduction in adolescents undergoing RYGB would be greater than other depots and associated with improvement in cardiometabolic risk factors.
Three specialized treatment centers in Sweden.
Fifty-nine adolescents underwent dual x-ray absorptiometry before surgery and at 1, 2, and 5 years after RYGB. Changes in body composition in multiple depots (total fat, lean body, gynoid fat, android fat, subcutaneous adipose tissue, and VAT) and cardiometabolic risk factors were assessed using multiple linear regression analysis and generalized estimating equations adjusting for age, sex, and baseline risk factor levels. Data are presented as percent change (95% CI) with regression models showing slopes and estimated P values.
At 1 year post-RYGB, a significant reduction was observed across all body composition measures (P < .001) with the greatest reduction observed in VAT (-65.1% [-68.7, -61.8]). From year 1 to 5 years post-RYGB, a regain was observed in all depots except lean body mass (1.2% [.3, 2.7], P = .105). A sex-specific difference in overall trajectories was only observed in lean body mass with males consistently having higher mean levels. Change in VAT at 1 year correlated with change in triglycerides (slope: .21 mg/dL/kg, P = .034) and fasting plasma insulin (slope: 44 pmol/L/kg, P = .027).
Adiposity measures all decreased after RYGB but poorly predicted change in cardiometabolic risk. Despite significant reductions at 1 year, a steady regain was observed out to 5 years, with values still well below baseline. Further research should consider control group comparison and extended follow-up.
青少年肥胖患者行 Roux-en-Y 胃旁路手术（RYGB）可显著减轻体重；然而，内脏脂肪组织（VAT）的变化尚未得到充分研究。
我们假设 RYGB 术后青少年的 VAT 减少量大于其他部位，并且与改善心血管代谢危险因素相关。
瑞典的三个专门治疗中心。
59 名青少年在手术前和 RYGB 后 1、2 和 5 年进行双能 X 线吸收法检查。使用多元线性回归分析和广义估计方程，根据年龄、性别和基线风险因素水平调整，评估多个部位（总脂肪、瘦体重、女性型脂肪、男性型脂肪、皮下脂肪组织和 VAT）的身体成分变化和心血管代谢风险因素。数据以百分比变化（95%CI）表示，回归模型显示斜率和估计 P 值。
RYGB 术后 1 年，所有身体成分测量值均显著降低（P <.001），VAT 降低幅度最大（-65.1%[-68.7，-61.8]）。从术后 1 年到 5 年，除瘦体重外，所有部位均有恢复（1.2%[.3，2.7]，P =.105）。只有在瘦体重方面观察到男女总体轨迹的性别特异性差异，男性的平均水平始终较高。1 年时 VAT 的变化与甘油三酯的变化相关（斜率：.21mg/dL/kg，P =.034）和空腹血浆胰岛素（斜率：44pmol/L/kg，P =.027）。
RYGB 后所有肥胖指标均降低，但对心血管代谢风险的变化预测不佳。尽管 1 年时显著减少，但在 5 年内仍持续恢复，数值仍远低于基线。进一步的研究应考虑对照组比较和延长随访。
