长期体重变化：困扰社区指数与减重手术后长期体重变化的关联。
The long weight: association between distressed communities index and long-term weight outcomes following bariatric surgery.
机构信息
Department of Surgery, University of California, Davis, 2335 Stockton Blvd, 6thFloor, Sacramento, CA, 95817, USA.
Division of Foregut, Metabolic, and General Surgery, University of California, Davis, Sacramento, USA.
出版信息
Surg Endosc. 2023 Sep;37(9):7218-7225. doi: 10.1007/s00464-023-10158-y. Epub 2023 Jun 27.
BACKGROUND
Socioeconomic status (SES) is multifactorial, and its effect on post-bariatric weight recurrence is unclear. Distressed Community Index (DCI) is a composite SES score measuring community economic well-being. This study aims to evaluate the effect of DCI on long-term post-bariatric weight outcomes.
METHODS
Retrospective analysis of patients undergoing primary laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy between 2015 and 2020 was performed. All weights in the electronic medical record (EMR), including non-bariatric visits, were captured. Patients were stratified into low tier (LT) and high tier (HT) DCI groups.
RESULTS
Of 583 patients, 431 (73.9%) were HT and 152 (26.1%) were LT. Average bariatric follow up was 1.78 ± 1.6 years and average postoperative weight in the EMR was 3.96 ± 2.26 years. Rates of bariatric follow up within the last year were similar (13.8% LT vs 16.2% HT, p = 0.47). LT had higher percent total body weight loss (%TWL; 26% LT vs 23% HT, p < 0.01) and percent excess weight loss (%EWL; 62% vs 57%, p = 0.04) at 1 year on univariate analysis. On multivariate linear regression adjusting for baseline characteristics and surgery type, there were no differences in %EWL between groups at 1 year (p = 0.22), ≥ 3 years (p = 0.53) or ≥ 5 years (p = 0.34) postop. While on univariate analysis LT only trended towards greater percentage of patients with > 15% increase from their 1-year weight (33.3% LT vs 21.0% HT, p = 0.06), on multivariate analysis this difference was significant (OR 2.0, LT 95%CI 1.41-2.84). There were no differences in the percentage of patients with > 15% decrease in %EWL from 1 to 3 + years postop between groups (OR 0.98, LT 95% CI 0.72-1.35).
CONCLUSIONS
While low tier patients had similar weight loss at 1 year, they were twice as likely to have weight recurrence at ≥ 3 years. Further studies are needed to identify factors contributing to greater weight recurrence among this population.
背景
社会经济地位（SES）是多因素的，其对减重后体重复发的影响尚不清楚。困境社区指数（DCI）是一种衡量社区经济福利的综合 SES 评分。本研究旨在评估 DCI 对长期减重后体重结果的影响。
方法
对 2015 年至 2020 年间接受腹腔镜 Roux-en-Y 胃旁路术或袖状胃切除术的患者进行回顾性分析。电子病历（EMR）中的所有体重数据，包括非减重就诊时的体重数据，均被捕获。患者分为低 tier（LT）和高 tier（HT）DCI 组。
结果
在 583 名患者中，431 名（73.9%）为 HT，152 名（26.1%）为 LT。平均减重随访时间为 1.78±1.6 年，EMR 中的平均术后体重为 3.96±2.26 年。最近一年的减重随访率相似（LT 组为 13.8%，HT 组为 16.2%，p=0.47）。LT 组在单变量分析中的总体重减轻百分比（%TWL；26% LT 与 23% HT，p<0.01）和多余体重减轻百分比（%EWL；62% 与 57%，p=0.04）更高。在调整基线特征和手术类型的多变量线性回归中，两组在 1 年（p=0.22）、≥3 年（p=0.53）或≥5 年（p=0.34）的术后 %EWL 无差异。虽然在单变量分析中 LT 组仅在从 1 年体重增加超过 15%的患者百分比上呈趋势较大（LT 组为 33.3%，HT 组为 21.0%，p=0.06），但在多变量分析中，这种差异具有统计学意义（OR 2.0，LT 95%CI 1.41-2.84）。在 1 至 3+ 年的术后时间内，两组间从 1 年的 %EWL 减少超过 15%的患者百分比无差异（OR 0.98，LT 95%CI 0.72-1.35）。
结论
虽然低 tier 患者在 1 年内的减重效果相似，但他们在≥3 年内体重复发的可能性是两倍。需要进一步研究以确定导致该人群体重复发性更高的因素。
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