Nonnormative Eating Behaviors and Eating Disorders and Their Associations With Weight Loss and Quality of Life During 6 Years Following Obesity Surgery.
Nonnormative Eating Behaviors and Eating Disorders and Their Associations With Weight Loss and Quality of Life During 6 Years Following Obesity Surgery.
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DOI：
10.1001/jamanetworkopen.2022.26244
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发表时间：
2022-08-01
影响因子：
13.8
通讯作者：
中科院分区：
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饮食紊乱和不规范的饮食行为是否与肥胖手术后长达6年的体重减轻和健康相关的生活质量(HRQOL)相关？在一项对748名接受肥胖症手术的患者进行的多中心队列研究中，饮食紊乱和不规范的饮食行为与减肥没有显示出显著的前瞻性关联。然而，阈值以下暴饮暴食障碍和饮食失控与较低的HRQOL有显著的前瞻性关联。结果表明，阈值以下暴饮暴食障碍和失控饮食与肥胖症手术后的长期HRQOL结果具有前瞻性相关性；术后监测可能确定哪些患者需要有针对性的预防或心理治疗。这项针对接受肥胖症手术的患者的队列研究检查了手术前和手术后不规范的饮食行为和饮食紊乱与长期结果的关系。接受肥胖手术(OS)的重度肥胖者经常表现出不规范的饮食行为(NEB)和饮食紊乱(ED)，但与减肥和健康相关生活质量(HRQOL)的长期病程和前瞻性关联尚不清楚。根据《精神疾病诊断和统计手册》第五版，通过临床访谈诊断，检查手术前和手术后NEBs和EDs的患病率和预期相关性，以评估OS后长达6年的体重减轻和HRQOL。在这项前瞻性的多中心心理社会肥胖手术登记队列研究中，在德国的6个OS中心招募了寻求OS的患者，并在手术前、术后6个月和1至6年进行基线评估。从2012年3月1日至2020年12月31日连续抽样调查1040名有计划OS的志愿者，共748人(71.92%)纳入本研究。在整个随访过程中，748名患者中有93名(12.43%)退出。对2021年4月至11月的数据进行了分析。腹腔镜Roux-en-Y胃分流术或袖状胃切除术。NEBs和EDs都是通过饮食障碍检查访谈确定的。主要结果是总体重下降百分比(%TBWL)和HRQOL(体重对生活质量的影响-Lite；范围0-100，0表示最差，100表示最好)。在748例接受OS治疗的患者中(平均年龄46.26[11.44]岁；平均[SD]体重指数[体重除以身高的平方]，48.38[8.09]；513[68.58%]女性)，平均(SD)%TBWL为26.70%(9.61%)，平均(SD)HRQOL改善35.41(20.63)个百分点。NEBs和EDs在手术前都很常见，术后有不同程度的改善。虽然NEBs和EDS并未显示出与%总体重有显著的前瞻性关联，但在随访时饮食失控与较低的总体重同时存在关联(估计，−为0.09；95%CI，−为0.14至−为0.04)。随访时饮食失控(估计，−0.10；95%CI，−0.17~−0.03个百分点)和低频率和/或有限持续时间的暴食障碍(估计，−6.51；95%CI，−12.69~−0.34个百分点)与较低的高危生活质量有显著的前瞻性关联。这项队列研究发现，低频率和/或持续时间有限的失控进食和暴饮暴食障碍与OS后长期HRQOL降低具有前瞻性相关性。这些发现强调了在手术后长期监测NEBs，特别是失控进食，以及EDs，以确定需要有针对性的预防或心理治疗的患者的重要性。
Are eating disorders and nonnormative eating behaviors prospectively associated with weight loss and health-related quality of life (HRQOL) up to 6 years following obesity surgery? In a multicenter cohort study of 748 patients who presented for obesity surgery, eating disorders and nonnormative eating behaviors did not show significant prospective associations with weight loss. However, subthreshold binge-eating disorder and loss-of-control eating were significantly prospectively associated with lower HRQOL. The results demonstrate prospective relevance of subthreshold binge-eating disorder and loss-of-control eating for long-term HRQOL outcomes following obesity surgery; postsurgical monitoring may identify patients who need targeted prevention or psychotherapy. This cohort study of patients who presented for obesity surgery examines the association of presurgical and postsurgical nonnormative eating behaviors and eating disorders with long-term outcomes. Individuals with severe obesity presenting for obesity surgery (OS) frequently show nonnormative eating behaviors (NEBs) and eating disorders (EDs), but the long-term course and prospective associations with weight loss and health-related quality of life (HRQOL) remain unclear. To examine the prevalence and prospective relevance of presurgical and postsurgical NEBs and EDs according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnosed through clinical interview, for weight loss and HRQOL up to 6 years following OS. In the prospective, multicenter Psychosocial Registry for Obesity Surgery cohort study, patients seeking OS were recruited at 6 OS centers in Germany and assessed at baseline before surgery and at 6 months and 1 to 6 years after surgery. From a consecutive sample of 1040 volunteers with planned OS from March 1, 2012, to December 31, 2020, a total of 748 (71.92%) were included in this study. Across follow-up, 93 of the 748 patients (12.43%) dropped out. Data were analyzed from April to November 2021. Laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy. Both NEBs and EDs were identified using the Eating Disorder Examination interview. Main outcomes were the percentage of total body weight loss (%TBWL) and HRQOL (Impact of Weight on Quality of Life-Lite; range, 0-100, with 0 indicating worst and 100 indicating best). In 748 patients undergoing OS (mean [SD] age, 46.26 [11.44] years; mean [SD] body mass index [calculated as weight in kilograms divided by height in meters squared], 48.38 [8.09]; 513 [68.58%] female), the mean (SD) %TBWL was 26.70% (9.61%), and the mean (SD) HRQOL improvement was 35.41 (20.63) percentage points across follow-up. Both NEBs and EDs were common before surgery, with postsurgical improvements of varying degrees. Whereas NEBs and EDs did not reveal significant prospective associations with %TBWL, loss-of-control eating at follow-up was concurrently associated with lower %TBWL (estimate, −0.09; 95% CI, −0.14 to −0.04). Loss-of-control eating (estimate, −0.10; 95% CI, −0.17 to −0.03 percentage points) and binge-eating disorder of low frequency and/or limited duration (estimate, −6.51; 95% CI, −12.69 to −0.34 percentage points) at follow-up showed significant prospective associations with lower HRQOL. This cohort study found prospective relevance of loss-of-control eating and binge-eating disorder of low frequency and/or limited duration for reduced long-term HRQOL following OS. These findings underline the importance of monitoring both NEBs, especially loss-of-control eating, and EDs in the long term postsurgically to identify patients in need of targeted prevention or psychotherapy.
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影响因子：
5.4
作者：
Bryant, E. J.;Malik, M. S.;Waters, G. M.
通讯作者：
Waters, G. M.
影响因子：
16.9
作者：
Courcoulas, Anita P.;King, Wendy C.;Yanovski, Susan Z.
通讯作者：
Yanovski, Susan Z.
影响因子：
3.1
作者：
Baldofski, Sabrina;Tigges, Wolfgang;Hilbert, Anja
通讯作者：
Hilbert, Anja
影响因子：
3.1
作者：
de Zwaan, Martina;Hilbert, Anja;Mitchell, James E.
通讯作者：
Mitchell, James E.
DOI：
10.1056/nejmoa1700459
发表时间：
2017-09-21
期刊：
The New England journal of medicine
影响因子：
--
作者：
Adams TD;Davidson LE;Litwin SE;Kim J;Kolotkin RL;Nanjee MN;Gutierrez JM;Frogley SJ;Ibele AR;Brinton EA;Hopkins PN;McKinlay R;Simper SC;Hunt SC
通讯作者：
Hunt SC