Comparison of the Performance of Common Measures of Weight Regain After Bariatric Surgery for Association With Clinical Outcomes.
Comparison of the Performance of Common Measures of Weight Regain After Bariatric Surgery for Association With Clinical Outcomes.
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DOI：
10.1001/jama.2018.14433
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发表时间：
2018-10-16
期刊：
影响因子：
--
通讯作者：
Courcoulas AP
中科院分区：
文献类型：
--
作者：
King WC;Hinerman AS;Belle SH;Wahed AS;Courcoulas AP
减肥手术后体重恢复的估计差异很大。描述Roux-en-Y胃旁路术后（RYGB）体重最低点后的体重恢复，并比较常见的体重恢复指标与临床结局的相关性。美国六个城市的10家医院：波特兰，OR，西雅图，WA，法戈，ND，匹兹堡，PA，纽约，NY和Greenville，NC。接受减肥手术的成人在2006年2月至2009年2月（N=2458）之间进入了一项前瞻性队列研究，并完成了术前、6个月和年度评估，持续至2015年1月。纳入了接受RYGB并随访≥5年且体重测量≥5次的受试者（83%; 1703例中的1406例，不包括死亡/逆转）。基于统计学显著性、相关性程度和模型拟合，比较了通过5个连续测量（kg、体重指数[BMI; kg/m2]、术前体重%、最低体重%和最大体重减轻%）和8个二分测量（根据既定阈值）评估的体重恢复与临床结局的关系。糖尿病、高脂血症和高血压的进展，以及身心健康相关生活质量和手术满意度的下降。报告中位数（25 - 75倍）。术前年龄为47岁（38-55岁），BMI为46.3（42.3-51.8）。大多数参与者是女性（80.3%）和白色（84.9%）。随访6.6（5.9-7.0）年。最大体重减轻为手术前体重的37.4%（31.6%-43.3%），发生在手术后2.0（1.0-3.2）年。体重恢复率在体重最低点后的第一年最高，但在随访期间体重恢复持续，范围从最大体重减轻的9.5%（4.7%-17.2%）到26.8%（16.7%-41.5%），最低点后1到5年。体重恢复的参与者百分比取决于阈值（例如，最低点后5年，43.6%的患者体重恢复≥5个BMI点，50.2%的患者体重恢复≥最低点体重的15%，67.3%的患者体重恢复≥最大体重减轻的20%）。最大体重减轻百分比与其他持续体重恢复指标相比，与所有结局的相关性最强，模型拟合最佳，但高脂血症除外，高脂血症与BMI恢复的相关性略强。在二分指标中，除高脂血症和满意度外，最大体重减轻≥20%在所有结局中表现最佳（≥10 kg和最大体重减轻≥25%分别为优上级）。在接受RYGB的大型成人队列中，体重恢复量化为最大体重减轻的百分比，与大多数临床结局的相关性优于所检查的替代品。这些发现可能为减肥手术研究中体重恢复的标准化测量提供信息。
Estimates of weight regain following bariatric surgery vary widely. Describe weight regain following post-Roux-en-Y gastric bypass (RYGB) weight nadir, and compare common weight regain measures for association with clinical outcomes. Ten hospitals in six US cities: Portland, OR, Seattle, WA, Fargo, ND, Pittsburgh, PA, New York, NY and Greenville, NC. Adults undergoing bariatric surgical procedures entered a prospective cohort study between February 2006-February 2009 (N=2458) and completed pre-surgery, six month and annual assessments for up to seven years through January 2015. Participants who underwent RYGB and were followed ≥5 years with ≥5 weight measurements were included (83%; 1406 of 1703, excluding deceased/reversals). Weight regain assessed by five continuous measures (kg, body mass index [BMI; kg/m2], % pre-surgery weight, % nadir weight and % maximum weight loss) and eight dichotomous measures (per established thresholds) were compared in relation to clinical outcomes based on statistical significance, magnitude of association and model fit. Progression of diabetes, hyperlipidemia, and hypertension, and declines in physical and mental health-related quality of life, and satisfaction with surgery. Medians (25th–75thpercentiles) are reported. Pre-surgery age was 47 years (38–55) and BMI was 46.3 (42.3–51.8). Most participants were female (80.3%) and white (84.9%). Follow-up was 6.6 (5.9–7.0) years. Maximum weight loss was 37.4% (31.6%−43.3%) of pre-surgery weight, occurring 2.0 (1.0–3.2) years post-surgery. The rate of weight regain was highest in the first year following weight nadir, but regain continued across follow-up, ranging from 9.5% (4.7%−17.2%) to 26.8% (16.7%−41.5%) of maximum weight lost, one to five years post-nadir. The % participants who regained weight depended on threshold (e.g., five years post-nadir, 43.6% regained ≥5 BMI points, 50.2% regained ≥15% of nadir weight and 67.3% regained ≥20% of maximum weight lost). Percentage of maximum weight lost vs. other continuous weight regain measures, had the strongest associations with, and best model fits for, all outcomes except hyperlipidemia, which had a slightly stronger association with regain in BMI. Of dichotomous measures, ≥20% of maximum weight lost performed best with all outcomes except hyperlipidemia and satisfaction (≥10 kg and ≥25% of maximum weight lost were superior, respectively). Among a large cohort of adults who underwent RYGB, weight regain quantified as percentage of maximum weight lost performed better for association with most clinical outcomes than the alternatives examined. These findings may inform standardizing measurement of weight regain in studies of bariatric surgery.
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