Pre-operative Predictors of Weight Loss and Weight Regain Following Roux-en-Y Gastric Bypass Surgery: a Prospective Human Study
Pre-operative Predictors of Weight Loss and Weight Regain Following Roux-en-Y Gastric Bypass Surgery: a Prospective Human Study
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DOI：
10.1007/s11695-020-04877-7
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发表时间：
2020-08-03
期刊：
影响因子：
2.9
通讯作者：
Tavakkoli, Ali
中科院分区：
文献类型：
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作者：
Aliakbarian, Hassan;Bhutta, Hina Y.;Tavakkoli, Ali
背景：目前，减肥手术后的初始和长期体重减轻的术前预测因子很少。目的我们评估了术前患者特征以及基线肠道和脂肪源性激素在预测Roux-en-Y胃旁路术（RYGB）手术后最大全身重量减轻（WLmax）和体重恢复风险（WR）中的作用。方法前瞻性纳入105例接受初次RYGB的成人患者。记录基线人口统计学数据，并在手术当天测量空腹血糖、糖化血红蛋白（A1 C）、胰岛素、胰高血糖素、瘦素、活性生长素释放肽、胰高血糖素样肽1（GLP-1）和葡萄糖依赖性促胰岛素多肽（GIP）水平。结果我们的队列平均年龄为44.4 ± 13.0岁，初始BMI（体重指数）为45.1 ± 6.7 kg/m2，平均术后随访40个月。80例患者为女性，26例患有2型糖尿病（T2 D）。平均WL（最大值）为35.3 ± 7.4%。在单变量分析中，较高的基线空腹ghrelin、较低的年龄、较低的CRP（C反应蛋白）、较低的A1 C和阴性T2 D状态与较大的WLmax相关（p < 0.05）。使用逐步多元回归控制这些变量，只有较高的空腹ghrelin和较年轻的年龄与较大的WLmax显著相关（p < 0.05）。在T2 D患者的亚组多变量回归分析中，较高的ghrelin和胰高血糖素与较大的WLmax显著相关。在逐步多变量回归分析后，较低的初始BMI和较低的胰高血糖素与较大的WR相关（p < 0.05）。结论：纳入基线生物学和激素标志物可能有助于开发更准确的减肥手术后体重减轻的预测模型，有助于为患者提供咨询和决策。
Background There are currently few pre-operative predictors of initial and long-term weight loss following bariatric surgery. Objectives We evaluated the role of pre-operative patient characteristics and baseline gut and adipose-derived hormones in predicting maximal total body weight loss (WLmax) and risk of weight regain (WR) after Roux-en-Y gastric bypass (RYGB) surgery. Methods One hundred five adult patients undergoing primary RYGB were prospectively recruited. Baseline demographics were recorded and fasting plasma glucose, glycosylated hemoglobin (A1C), insulin, glucagon, leptin, active ghrelin, glucagon-like peptide 1 (GLP-1), and glucose-dependent insulinotropic polypeptide (GIP) levels were measured on day of surgery. Results Our cohort had a mean age of 44.4 +/- 13.0 years, and initial BMI (body mass index) of 45.1 +/- 6.7 kg/m(2)with mean post-operative follow-up of 40 months. Eighty patients were female and 26 had type 2 diabetes mellitus (T2D). Average WL(max)was 35.3 +/- 7.4%. On univariate analysis, higher baseline fasting ghrelin, lower age, lower CRP (C-reactive protein), lower A1C, and negative T2D status were associated with greater WLmax(p < 0.05). Controlling for these variables using stepwise multivariate regression, only higher fasting ghrelin and younger age were associated significantly with greater WLmax(p < 0.05). In subgroup multivariate regression analysis of T2D patients, higher ghrelin and glucagon were significantly associated with greater WLmax. Following stepwise multivariate regression, lower initial BMI and lower glucagon were associated with greater WR (p < 0.05). Conclusions Incorporation of baseline biological and hormonal markers may help in developing more accurate predictive models for weight loss following bariatric surgery that help inform patient counseling and decision-making.