Li Shaobo, Zhang Pin, Di Jianzhong, Han Xiaodong, Tu Yinfang, Yang Di, Xu Rongrong, Xiao Yunfeng, Zhou Jian, Bao Yuqian, Yin Jun, Yu Haoyong, Jia Weiping, Han Junfeng
Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China.
Department of General Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Obesity (Silver Spring). 2024 May;32(5):871-887. doi: 10.1002/oby.24003. Epub 2024 Mar 22.
The objective of this study was to determine the role of body fat percentage (BFP) changes in diabetes remission (DR) and the association between baseline body composition and its changes after bariatric surgery.
We analyzed 203 patients with type 2 diabetes who underwent Roux-en-Y gastric bypass. Body composition was measured using a gold-standard-derived predictive equation and magnetic resonance imaging. Body composition changes were calculated as 100 × (baseline value - follow-up value)/baseline value. We verified the results in a laparoscopic sleeve gastrectomy cohort with 311 patients.
Compared with non-remission patients in the Roux-en-Y gastric bypass cohort, those who achieved DR showed a higher baseline fat-free mass index (FFMI) and experienced the most significant changes in BFP (p < 0.001). In comparative analyses, BFP changes were significantly better than BMI changes in identifying short- and long-term DR. Linear regression analysis identified FFMI as the most significant baseline variable correlated with BFP changes (p < 0.001). Baseline BMI was positively correlated with changes in BFP but negatively correlated with changes in FFMI. These findings were replicated in the laparoscopic sleeve gastrectomy cohort.
BFP changes determine DR after bariatric surgery, and baseline FFMI is crucial for BFP changes. A low initial BMI is associated with a smaller BFP reduction and greater FFMI loss after bariatric surgery.
本研究的目的是确定体脂百分比（BFP）变化在糖尿病缓解（DR）中的作用，以及基线身体组成与减肥手术后其变化之间的关联。
我们分析了203例接受Roux-en-Y胃旁路手术的2型糖尿病患者。使用源自金标准的预测方程和磁共振成像测量身体组成。身体组成变化计算为100×（基线值 - 随访值）/基线值。我们在一个有311例患者的腹腔镜袖状胃切除术队列中验证了结果。
与Roux-en-Y胃旁路手术队列中的未缓解患者相比，实现DR的患者显示出更高的基线去脂体重指数（FFMI），并且BFP变化最为显著（p < 0.001）。在比较分析中，在识别短期和长期DR方面，BFP变化显著优于BMI变化。线性回归分析确定FFMI是与BFP变化最显著相关的基线变量（p < 0.001）。基线BMI与BFP变化呈正相关，但与FFMI变化呈负相关。这些发现在腹腔镜袖状胃切除术队列中得到了重复。
BFP变化决定减肥手术后的DR，并且基线FFMI对BFP变化至关重要。低初始BMI与减肥手术后较小的BFP降低和更大的FFMI损失相关。
