Samuels Jason M, Paddu Nina U, Rekulapeli Akhil, Madhar Ayush, Srivastava Gitanjali
Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN, 37204, USA.
Vanderbilt Weight Loss Clinics, Vanderbilt University Medical Center, Nashville, TN, 37204, USA.
Obes Surg. 2024 Jan;34(1):170-175. doi: 10.1007/s11695-023-06952-1. Epub 2023 Nov 23.
Genetic obesity susceptibility in postoperative bariatric surgery weight regain (PBSWR) remains largely unexplored.
A retrospective case series of adult (N = 27) PBSWR patients who had undergone genetic obesity testing was conducted between Sept. 2020 and March 2022.
frequency of genetic variants in patients experiencing weight regain following bariatric surgery.
prevalence of obesity-related comorbidities, nadir BMI achieved post-bariatric surgery, and percent total body weight loss (%TBWL) achieved with obesity pharmacotherapies.
Heterozygous mutations were identified in 22 (81%) patients, with the most prevalent mutations occurring in CEP290, RPGR1P1L, and LEPR genes (3 patients each). Median age was 56 years (interquartile range (IQR) 46.8-65.5), 88% female. Types of surgery were 67% RYGB, 19% SG, 4% gastric band, and 13% revisions. Median nadir BMI postoperatively was 34.0 kg/m (IQR 29.0-38.5). A high prevalence of metabolic derangements was noted; patients presented median 80 months (IQR 39-168.5) postoperative for medical weight management with 40% weight regain. BMI at initiation of anti-obesity medication (AOMs) was 41.7 kg/m (36.8-44.4). All received AOM and required at least 3 AOMs for weight regain. Semaglutide (N = 21), topiramate (N = 14), and metformin (N = 12) were most prescribed. Median %TBWL for the cohort at the first, second, and third visit was 1.7, 5.0, and 6.5 respectively. Fourteen (52%) achieved 5%TBWL, 10 (37%) achieved 10%TBWL, and 4 (15%) achieved 15%TBWL with combination AOMs and supervised medical intervention.
An unusually high prevalence of genetic obesity variants in PBSWR was found, warranting further research.
肥胖症手术后体重反弹（PBSWR）中的遗传肥胖易感性在很大程度上仍未得到充分研究。
对2020年9月至2022年3月期间接受遗传肥胖检测的27例成年PBSWR患者进行回顾性病例系列研究。
肥胖症手术后体重反弹患者中基因变异的频率。
肥胖相关合并症的患病率、肥胖症手术后达到的最低体重指数、以及肥胖症药物治疗实现的总体重减轻百分比（%TBWL）。
在22例（81%）患者中鉴定出杂合突变，最常见的突变发生在CEP290、RPGR1P1L和LEPR基因中（各3例）。中位年龄为56岁（四分位间距（IQR）46.8 - 65.5），88%为女性。手术类型为67%胃旁路术（RYGB）、19%袖状胃切除术（SG）、4%胃束带术和13%翻修手术。术后中位最低体重指数为34.0kg/m²（IQR 29.0 - 38.5）。注意到代谢紊乱的患病率很高；患者术后中位80个月（IQR 39 - 168.5）前来进行医学体重管理，体重反弹40%。开始使用抗肥胖药物（AOMs）时的体重指数为41.7kg/m²（36.8 - 44.4）。所有患者均接受AOMs治疗，且因体重反弹需要至少3种AOMs。司美格鲁肽（N = 21）、托吡酯（N = 14）和二甲双胍（N = 12）是最常开具的药物。该队列在首次、第二次和第三次就诊时的中位%TBWL分别为1.7、5.0和6.5。14例（52%）患者通过联合AOMs和监督医学干预实现了5%的TBWL，10例（37%）实现了10%的TBWL，4例（15%）实现了15%的TBWL。
发现PBSWR中遗传肥胖变异的患病率异常高，值得进一步研究。
