Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery
Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery
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DOI：
10.1056/nejmoa035622
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发表时间：
2004-12-23
影响因子：
158.5
通讯作者：
Wedel, H
中科院分区：
文献类型：
--
作者：
Sjöström, L;Lindroos, AK;Wedel, H
背景减肥与短期改善和预防代谢和心血管风险相关，但这些益处是否会随着时间的推移持续存在尚不清楚。方法前瞻性对照瑞典肥胖受试者研究涉及接受胃手术的肥胖受试者和同期匹配的常规治疗肥胖对照受试者。我们现在报告在分析（2004 年 1 月 1 日）之前已入组至少 2 年（4047 名受试者）或 10 年（1703 名受试者）的受试者（平均年龄，48 岁；平均体重指数，41）的随访数据。实验室检查随访率2年86.6%，10年74.5%。结果两年后，对照组体重增加0.1%，手术组体重减少23.4%（P<0.001）。 10年后，体重分别增加了1.6%和减少了16.1%（P<0.001）。在整个观察期间，手术组的能量摄入量低于对照组，体力活动受试者的比例高于对照组。手术组的糖尿病、高甘油三酯血症、低水平高密度脂蛋白胆固醇、高血压和高尿酸血症的两年和十年恢复率优于对照组，而高胆固醇血症的恢复率在各组之间没有差异。手术组2年和10年糖尿病、高甘油三酯血症和高尿酸血症的发病率低于对照组；各组之间高胆固醇血症和高血压发生率的差异无法检测到。结论与传统疗法相比，减肥手术似乎是治疗严重肥胖的可行选择，可实现长期体重减轻、改善生活方式，并且除高胆固醇血症外，还可改善基线时升高的危险因素。
BACKGROUNDWeight loss is associated with short-term amelioration and prevention of metabolic and cardiovascular risk, but whether these benefits persist over time is unknown.METHODSThe prospective, controlled Swedish Obese Subjects Study involved obese subjects who underwent gastric surgery and contemporaneously matched, conventionally treated obese control subjects. We now report follow-up data for subjects ( mean age, 48 years; mean body-mass index, 41) who had been enrolled for at least 2 years ( 4047 subjects) or 10 years ( 1703 subjects) before the analysis ( January 1, 2004). The follow-up rate for laboratory examinations was 86.6 percent at 2 years and 74.5 percent at 10 years.RESULTSAfter two years, the weight had increased by 0.1 percent in the control group and had decreased by 23.4 percent in the surgery group (P< 0.001). After 10 years, the weight had increased by 1.6 percent and decreased by 16.1 percent, respectively ( P< 0.001). Energy intake was lower and the proportion of physically active subjects higher in the surgery group than in the control group throughout the observation period. Two- and 10-year rates of recovery from diabetes, hypertriglyceridemia, low levels of high-density lipoprotein cholesterol, hypertension, and hyperuricemia were more favorable in the surgery group than in the control group, whereas recovery from hypercholesterolemia did not differ between the groups. The surgery group had lower 2- and 10-year incidence rates of diabetes, hypertriglyceridemia, and hyperuricemia than the control group; differences between the groups in the incidence of hypercholesterolemia and hypertension were undetectable.CONCLUSIONSAs compared with conventional therapy, bariatric surgery appears to be a viable option for the treatment of severe obesity, resulting in long-term weight loss, improved lifestyle, and, except for hypercholesterolemia, amelioration in risk factors that were elevated at baseline.