Resting energy expenditure and fuel metabolism following laparoscopic adjustable gastric banding in severely obese women: relationships with excess weight lost
Resting energy expenditure and fuel metabolism following laparoscopic adjustable gastric banding in severely obese women: relationships with excess weight lost
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DOI：
10.1038/sj.ijo.0803247
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发表时间：
2006-07-01
影响因子：
4.9
通讯作者：
Renard, E
中科院分区：
文献类型：
--
作者：
Galtier, F;Farret, A;Renard, E
背景：虽然可调胃束带法越来越多地被提出用于重度肥胖患者，但对此类减肥手术后静息代谢率和底物氧化的改变以及体重减轻的代谢决定因素知之甚少。目的：评估超重体重减轻、静息代谢率(RMR)和底物氧化之间的关系，并确定可调胃带术后体重减轻的代谢预测因素。分别于术前、术后(13.3+/-6.0个月，范围6.0~31.1)测定血脂和胰岛素敏感指数。按术后时间分为A组(6~12个月，n=39)、B组(12~18个月，n=21)、C组(18个月，n=13)。对与术后1年超重减重百分比(EWL)相关的代谢参数进行单因素和多因素回归分析。结果：平均减重26.2+/-11.4 kg。平均脂肪质量损失17.3+/-8.1 kg。所有与超重相关的生物学参数在手术后都有所改善。1年后超重下降：A组45.9±17.1%，B组47.4±-17.1%，C组51.4±18.5%(P=NS)。术后静息代谢率/脱脂质量略有下降(28.9+/-3.26vs30.3+/-2.8P<；0.00001)，静息代谢率/体重略有增加(18.5+/-2.8vs17.3+/-1.9P<；0.00001)。呼吸商(0.81+/-0.06vs0.82+/-0.05)和FFM调整后的脂质氧化(1.10+/-0.41vs1.05+/-0.33 mg/min/kg FFM)术后无明显改变。多元线性回归分析显示，RMR/体重差值、能量节约差值、基线BMI差值和术后时间差值与EWL显著独立相关(总R2=72.5%)。结论：可调胃束带可促进持续、渐进的体重减轻，并与长期保存脂质氧化和能量消耗有关。能量节约机制中的个体差异可以预测术后第一年的体重减轻。
Background: Although adjustable gastric banding is increasingly proposed for massively obese patients, little is known about the modifications of resting metabolic rate and substrate oxidation or about metabolic determinants of weight loss following this type of bariatric surgery.Objectives: To evaluate the relationships between excess weight loss, resting metabolic rate (RMR) and substrate oxidation, and to identify metabolic predictive factors of weight loss after adjustable gastric banding.Subjects: Seventy-three obese nondiabetic women aged 39.1 +/- 10.4 years (18.4-64.8).Design: Resting metabolic rate and substrate oxidation (indirect calorimetry), body composition (bio-impedance), lipid profile and insulin sensitivity indexes were assessed before and after (13.3 +/- 6.0 months, range 6.0-31.1) adjustable gastric banding. Patients were classified according to postsurgery time: group A (6-12 months, n=39); group B (12-18 months, n=21); group C (> 18 months, n=13). Metabolic parameters associated with the percentage of excess weight lost (EWL) 1 year after surgery were analyzed in univariate and multivariate regressions.Results: Mean weight loss was 26.2 +/- 11.4 kg. Mean fat mass loss was 17.3 +/- 8.1 kg. All biological parameters associated with excess weight improved after surgery. Excess weight lost at 1 year was 45.9 +/- 17.1% in group A, 47.4 +/- 17.1% in group B and 51.4 +/- 18.5% in group C (P=NS). Resting metabolic rate/fat-free mass (FFM) slightly decreased (28.9 +/- 3.26 vs 30.3 +/- 2.8, P < 0.00001) and RMR/body weight slightly increased (18.5 +/- 2.8 vs 17.3 +/- 1.9, P < 0.00001) after surgery. Respiratory quotient (0.81 +/- 0.06 vs 0.82 +/- 0.05) and FFM-adjusted lipid oxidation (1.10 +/- 0.41 vs 1.05 +/- 0.33 mg/min/kg FFM) were not significantly modified after surgery. In multiple linear regression analysis, difference in RMR/body weight, difference in energy sparing, baseline BMI and postsurgery time, were significantly and independently correlated with EWL (total R-2=72.5%).Conclusions: Adjustable gastric banding promotes gradual but sustained weight loss and is associated with long-term conservation of lipid oxidation and energy expenditure. The individual variability in energy sparing mechanisms predicts weight loss during the first year after surgery.