Obesity-related cardiovascular risk factors after weight loss: a clinical trial comparing gastric bypass surgery and intensive lifestyle intervention.
Obesity-related cardiovascular risk factors after weight loss: a clinical trial comparing gastric bypass surgery and intensive lifestyle intervention.
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DOI：
10.1530/eje-10-0514
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发表时间：
2010-11
影响因子：
5.8
通讯作者：
Hjelmesaeth J
中科院分区：
文献类型：
--
作者：
Hofsø D;Nordstrand N;Johnson LK;Karlsen TI;Hager H;Jenssen T;Bollerslev J;Godang K;Sandbu R;Røislien J;Hjelmesaeth J
减肥可以改善几种与肥胖相关的健康状况。我们的目的是比较减肥手术和综合生活方式干预对2型糖尿病和肥胖相关心血管危险因素的影响。为期一年的对照临床试验（ClinicalTrials.gov标识符NCT00273104）。病态肥胖患者（19-66岁，平均（s.d）体重指数45.1 kg/m2(5.6)， 103名女性）接受Roux-en-Y胃旁路手术（n=80）或康复中心强化生活方式干预（n=66）。两组的辍学率均为5%。在手术组的76名完成者和生活方式组的63名完成者中，平均(s.d。1年减重分别为30%（8例）和8%（9例）。两组均对糖代谢、血压、血脂和低度炎症有有益影响。2型糖尿病和高血压的缓解率手术组明显高于生活方式干预组；70 vs 33%， P=0.027, 49 vs 23%， P=0.016。血糖控制和血压的改善是通过减轻体重来调节的。与生活方式组相比，手术组在代谢综合征、蛋白尿和心电图左心室肥厚的患病率显著降低。胃旁路手术后胃肠道症状和餐后低血糖的发生率高于生活方式干预后。没有人员死亡。两种治疗策略后，2型糖尿病和肥胖相关的心血管危险因素均得到改善。然而，在接受胃旁路手术的患者中，改善最大。
Weight reduction improves several obesity-related health conditions. We aimed to compare the effect of bariatric surgery and comprehensive lifestyle intervention on type 2 diabetes and obesity-related cardiovascular risk factors. One-year controlled clinical trial (ClinicalTrials.gov identifier NCT00273104). Morbidly obese subjects (19–66 years, mean (s.d.) body mass index 45.1 kg/m2 (5.6), 103 women) were treated with either Roux-en-Y gastric bypass surgery (n=80) or intensive lifestyle intervention at a rehabilitation centre (n=66). The dropout rate within both groups was 5%. Among the 76 completers in the surgery group and the 63 completers in the lifestyle group, mean (s.d.) 1-year weight loss was 30% (8) and 8% (9) respectively. Beneficial effects on glucose metabolism, blood pressure, lipids and low-grade inflammation were observed in both groups. Remission rates of type 2 diabetes and hypertension were significantly higher in the surgery group than the lifestyle intervention group; 70 vs 33%, P=0.027, and 49 vs 23%, P=0.016. The improvements in glycaemic control and blood pressure were mediated by weight reduction. The surgery group experienced a significantly greater reduction in the prevalence of metabolic syndrome, albuminuria and electrocardiographic left ventricular hypertrophy than the lifestyle group. Gastrointestinal symptoms and symptomatic postprandial hypoglycaemia developed more frequently after gastric bypass surgery than after lifestyle intervention. There were no deaths. Type 2 diabetes and obesity-related cardiovascular risk factors were improved after both treatment strategies. However, the improvements were greatest in those patients treated with gastric bypass surgery.