Seven-Year Weight Trajectories and Health Outcomes in the Longitudinal Assessment of Bariatric Surgery (LABS) Study
Seven-Year Weight Trajectories and Health Outcomes in the Longitudinal Assessment of Bariatric Surgery (LABS) Study
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DOI：
10.1001/jamasurg.2017.5025
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发表时间：
2018-05-01
期刊：
影响因子：
16.9
通讯作者：
Yanovski, Susan Z.
中科院分区：
文献类型：
--
作者：
Courcoulas, Anita P.;King, Wendy C.;Yanovski, Susan Z.
需要更多关于减肥手术后减肥的持久性和健康改善的信息。目的观察Roux-en-Y胃旁路术（RYGB）和腹腔镜可调节胃束带术（LAGB）术后的长期体重变化和健康状况。减肥手术的纵向评估（实验室）研究是一项多中心观察队列研究，在美国10家医院的6个地理位置不同的临床中心进行。招募了2006年至2009年期间接受减肥外科手术作为临床护理一部分的成年人，并随访至2015年1月31日。参与者完成了长达7年的手术、6个月和年度研究评估。主要结局和测量指标体重从基线、糖尿病、血脂异常和高血压变化的百分比，由物理测量、实验室检测和药物使用确定。结果在2348名参与者中，1738人接受RYGB(74%)， 610人接受LAGB（26%）。对于RYBG，中位年龄为45岁（范围19-75岁），中位体重指数（以体重公斤除以身高米的平方计算）为47（范围34-81），1389名参与者（80%）是女性，257名参与者（15%）是非白人。对于LAGB，中位年龄为48岁（范围18-78），体重指数为44（范围33-87），465名参与者（76%）是女性，63名参与者（10%）是非白人。在1569例（83%）符合7年随访条件的患者中，获得了1300例的随访权重。RYGB后7年，平均体重减轻38.2 kg (95% CI, 36.9-39.5)，或基线体重的28.4% (95% CI, 27.6-29.2)；第3年至第7年的平均体重恢复为基线体重的3.9% （95% CI, 3.4-4.4）。LAGB后7年，平均体重减轻18.8 kg （95% CI, 16.3-21.3）或14.9% (95% CI, 13.1-16.7)，恢复1.4% （95% CI, 0.4-2.4）。确定了RYGB的6种不同体重变化轨迹模式和LAGB的7种不同体重变化轨迹模式。大多数参与者遵循的轨迹是，3到7年的体重反弹相对于第3年的体重下降较小，但模式是可变的。与基线相比，两种手术后7年的血脂异常患病率较低；仅RYGB组糖尿病和高血压患病率较低。在基线时患有糖尿病的患者中（1723例RYGB患者中有488例[28%]；604例LAGB患者中有175例[29%]），RYGB患者在1、3、5和7年时的缓解比例分别为71.2% （95% CI, 67.0-75.4）、69.4% （95% CI, 65.0-73.8）、64.6% （95% Cl. 60.0-69.2）和60.2% (95% CI, 54.7-65.6)，而LAGB患者分别为30.7% （95% CI, 22.8-38.7）、29.3% （95% CI, 21.6-37.1）、29.2% （95% CI, 21.0-37.4）和20.3% （95% CI, 9.7-30.9）。RYGB组的糖尿病发病率在所有随访评估中均低于1.5%。14名RYGB参与者和160名LAGB参与者发生了肥胖再手术。结论和相关性减肥手术后，观察到不同的体重减轻模式，但大多数参与者在长期内保持了不同的体重波动。随着时间的推移，糖尿病的缓解有所下降，但RYGB后新病例的发生率很低。
IMPORTANCE More information is needed about the durability of weight loss and health improvements after bariatric surgical procedures.OBJECTIVE To examine long-term weight change and health status following Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB).DESIGN, SETTING, AND PARTICIPANTS The Longitudinal Assessment of Bariatric Surgery (LABS) study is a multicenter observational cohort study at 10 US hospitals in 6 geographically diverse clinical centers. Adults undergoing bariatric surgical procedures as part of clinical care between 2006 and 2009 were recruited and followed up until January 31, 2015. Participants completed presurgery, 6-month, and annual research assessments for up to 7 years.MAIN OUTCOME AND MEASURES Percentage of weight change from baseline, diabetes, dyslipidemia, and hypertension, determined by physical measures, laboratory testing, and medication use.RESULTS Of 2348 participants, 1738 underwent RYGB (74%) and 610 underwent LAGB (26%). For RYBG, the median age was 45 years (range, 19-75 years), the median body mass index (calculated as weight in kilograms divided by height in meters squared) was 47 (range, 34-81), 1389 participants (80%) were women, and 257 participants (15%) were nonwhite. For LAGB, the median age was 48 years (range, 18-78), the body mass index was 44 (range, 33-87), 465 participants (76%) were women, and 63 participants (10%) were nonwhite. Follow-up weights were obtained in 1300 of 1569 (83%) eligible for a year-7 visit. Seven years following RYGB, mean weight loss was 38.2 kg (95% CI, 36.9-39.5), or 28.4% (95% CI, 27.6-29.2) of baseline weight; between years 3 and 7 mean weight regain was 3.9% (95% CI, 3.4-4.4) of baseline weight. Seven years after LAGB, mean weight loss was 18.8 kg (95% CI, 16.3-21.3) or 14.9% (95% CI, 13.1-16.7), with 1.4% (95% CI, 0.4-2.4) regain. Six distinct weight change trajectory patterns for RYGB and 7 for LAGB were identified. Most participants followed trajectories in which weight regain from 3 to 7 years was small relative to year-3 weight loss, but patterns were variable. Compared with baseline, dyslipidemia prevalence was lower 7 years following both procedures; diabetes and hypertension prevalence were lower following RYGB only. Among those with diabetes at baseline (488 of 1723 with RYGB [28%]; 175 of 604 with LAGB [29%]), the proportion in remission at 1, 3, 5, and 7 years were 71.2% (95% CI, 67.0-75.4), 69.4% (95% CI, 65.0-73.8), 64.6% (95% Cl. 60.0-69.2), and 60.2% (95% CI, 54.7-65.6), respectively, for RYGB and 30.7% (95% CI, 22.8-38.7), 29.3% (95% CI, 21.6-37.1), 29.2% (95% CI, 21.0-37.4), and 20.3% (95% CI, 9.7-30.9) for LAGB. The incidence of diabetes at all follow-up assessments was less than 1.5% for RYGB. Bariatric reoperations occurred in 14 RYGB and 160 LAGB participants.CONCLUSIONS AND RELEVANCE Following bariatric surgery, different weight loss patterns were observed, but most participants maintained much of their weight loss with variable fluctuations over the long term. There was some decline in diabetes remission over time, but the incidence of new cases is low following RYGB.