Department of General Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, A100, Cleveland, OH, 44195, USA.
Center for Populations Health Research, Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
Surg Endosc. 2024 Nov;38(11):6827-6838. doi: 10.1007/s00464-024-11175-1. Epub 2024 Aug 21.
Food insecurity has been linked to higher rates of obesity. It has also been shown to diminish the effectiveness of weight loss strategies, including intensive lifestyle interventions. One essential component of food insecurity is having a geospatial disadvantage in access to healthy, affordable food, such as living within a food desert. This study aims to determine if food insecurity also impacts weight loss and nutritional outcomes in patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG).
Clinical outcomes of patients who underwent RYGB or SG at Cleveland Clinic or affiliate regional hospitals in the United States from 2010 to 2018 were collected. Modified Retail Food Environmental Index (mRFEI) data was collected from the Center for Disease Control and merged with patient census tract data, allowing the patient cohort to be divided into those living in areas identified as food secure (mRFEI > 10%), food swamps (mRFEI = 1-10%), or food deserts (mRFEI = 0). Postoperative weight change was evaluated with quadratic growth mixture models and stratified by surgery type.
A total of 5097 patients were included in this study cohort, including 3424 patients who underwent RYGB and 1673 who underwent SG. The median duration of follow-up was 2.3 years (IQR 0.89-3.6 years). Food security status was not associated with postoperative weight change (RYGB p = 0.73, SG p = 0.60), weight loss nadir (RYGB p = 0.60, SG p = 0.79), or weight regain (RYGB p = 0.93, SG p = 0.85). Deficiencies in nutritional markers at 1-2 years after surgery were also not significantly different between food security groups.
Despite the established relationship between food insecurity and obesity, food insecurity does not negatively impact weight loss or nutritional outcomes following RYGB or SG, demonstrating metabolic surgery as a powerful and equitable tool for treating obesity.
IV.
食物不安全与更高的肥胖率有关。它还被证明会降低减肥策略的有效性，包括强化生活方式干预。食物不安全的一个重要组成部分是在获得健康、负担得起的食物方面存在地理空间劣势，例如生活在食品荒漠中。本研究旨在确定食物不安全是否也会影响在美国克利夫兰诊所或附属地区医院接受 Roux-en-Y 胃旁路术（RYGB）或袖状胃切除术（SG）的患者的减肥和营养结果。
收集了 2010 年至 2018 年期间在美国克利夫兰诊所或附属地区医院接受 RYGB 或 SG 的患者的临床结果。从疾病控制中心收集了改良零售食品环境指数（mRFEI）数据，并与患者普查区数据合并，使患者队列分为生活在被认为是食物安全（mRFEI＞10%）、食物沼泽（mRFEI=1-10%）或食物荒漠（mRFEI=0）地区的患者。通过二次增长混合模型评估术后体重变化，并按手术类型进行分层。
本研究队列共纳入 5097 例患者，其中 3424 例接受 RYGB，1673 例接受 SG。中位随访时间为 2.3 年（IQR 0.89-3.6 年）。食物安全状况与术后体重变化（RYGB p=0.73，SG p=0.60）、体重减轻最低点（RYGB p=0.60，SG p=0.79）或体重反弹（RYGB p=0.93，SG p=0.85）无关。手术后 1-2 年内营养标志物的缺乏在食物安全组之间也没有显著差异。
尽管食物不安全与肥胖之间存在既定关系，但食物不安全不会对 RYGB 或 SG 后的减肥或营养结果产生负面影响，这表明代谢手术是治疗肥胖的强大而公平的工具。
IV。
