Feasibility of a Supervised Inpatient Low-Calorie Diet Program for Massive Weight Loss Prior to RYGB in Superobese Patients
Feasibility of a Supervised Inpatient Low-Calorie Diet Program for Massive Weight Loss Prior to RYGB in Superobese Patients
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DOI：
10.1007/s11695-009-0001-x
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发表时间：
2010-02-01
期刊：
影响因子：
2.9
通讯作者：
Livingston, Edward H.
中科院分区：
文献类型：
--
作者：
Huerta, Sergio;Li, Zhaoping;Livingston, Edward H.
这项研究是为了确定一项住院低卡路里计划的可行性，以大幅减轻超重肥胖症患者的术前体重(体重指数为10分)。5名患者平均住院11周，并被安排低卡路里流质饮食(<；900千卡/天)和锻炼计划。体重指数下降10分后，他们接受了Roux-en-Y胃分流术(RYGB)。在饮食开始时、手术前和最后一次随访时获得血红蛋白A1c和血脂谱。我们的结果与国家外科质量改进计划(NSQIP)数据库进行了比较，该数据库包括1999年10月至2007年8月在退伍军人管理局中心进行的1046例减肥手术。所有5名患者都是重度肥胖男性(体重指数=64.3+/-2.1 kg/m(2)；54.7+/-2.6岁；4/5是白人)，合并多种疾病，这使他们接受减肥手术的风险大大增加。在四名糖尿病患者中，有两名是胰岛素依赖型患者。在术前饮食期间(11周)，BMI平均下降12.7分(85.8+/-6.0磅)。所有患者均接受RYGB治疗，无并发症发生。手术治疗后，这组患者的BMI进一步降低了10.6点(88.4+/-29.4磅)。平均随访10.6个月，术前术后超重总减重率为89%。胃旁路手术后睡眠呼吸暂停得到缓解，但在术前减重期间并未改善。手术干预后，高血压、骨关节炎和血脂异常均有所改善。在饮食诱导的体重减轻期间，血红蛋白A1c下降了1.9%，手术后没有发现进一步的改善。这两名胰岛素依赖型糖尿病患者在手术后停止了胰岛素治疗。NSQIP数据库包含77名患者，他们的特征与我们的患者队列相似。这组患者的30天死亡率为3.9%，并发症发生率为33.8%。在超重肥胖症患者中，大量的术前体重减轻可以通过液体蛋白饮食来实现，这极大地促进了高危患者群体的胃旁路手术。
This study was undertaken to determine the feasibility of an inpatient low-calorie program for a substantial decrease of preoperative weight (> 10 points in BMI) in superobese patients.Five patients were hospitalized for an average of 11 weeks and were placed on a low-calorie liquid diet (< 900 kcal/day) and an exercise program. Following a drop of ten points in BMI, they underwent a Roux-en-Y gastric bypass (RYGB). Hemoglobin A1c and lipid profiles were obtained at the beginning of the diet, prior to surgery and at the last follow-up appointment. Our results were compared to the National Surgical Quality Improvement Program (NSQIP) database, which included 1,046 bariatric operations performed at VA centers between October 1999 and August 2007.All five patients were massively obese men (body mass index (BMI) = 64.3 +/- 2.1 kg/m(2); 54.7 +/- 2.6 years old; four of five were white) with multiple comorbid conditions, which placed them in a substantially higher risk for bariatric surgery. Of the four diabetic patients, two were insulin dependent. There was an average decrease in BMI by 12.7 points (85.8 +/- 6.0 lb) during the preoperative diet period (11 weeks). All patients underwent RYGB without complications. This cohort of patients further decreased their BMI by 10.6 points (88.4 +/- 29.4 lb) following surgical intervention. The total combined preoperative and postoperative excess body weight loss was 89% (10.6-month average follow-up). Sleep apnea resolved following gastric bypass but did not improve during the preoperative weight loss period. Hypertension, osteoarthritis, and dyslipidemia all improved following surgical intervention. Hemoglobin A1c decreased by 1.9% during diet-induced weight loss with no further improvement being noted after surgery. The two insulin-dependent diabetic patients discontinued insulin therapy following surgery. The NSQIP database contained 77 patients with similar characteristics to our cohort of patients. The 30-day mortality for this cohort of patients was 3.9% with a complication rate of 33.8%.Massive preoperative weight loss is possible to achieve with a liquid protein diet in superobese patients greatly facilitating gastric bypass surgery in an otherwise high-risk patient population.