Changes in measured resting energy expenditure after Roux-en-Y gastric bypass for clinically severe obesity
Changes in measured resting energy expenditure after Roux-en-Y gastric bypass for clinically severe obesity
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DOI：
10.1016/s0039-6060(97)90336-6
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发表时间：
1997-11-01
期刊：
影响因子：
3.8
通讯作者：
Burge, JC
中科院分区：
文献类型：
--
作者：
Flancbaum, L;Choban, PS;Burge, JC
背景资料。Roux-en-Y胃分流术(RYGB)可持续减轻体重，改善临床严重肥胖症患者的合并症。RYGB治疗后体重减轻的机制尚不清楚。本研究的目的是记录RYGB治疗后临床重度肥胖症患者静息能量消耗(MREE)随时间的变化。我们前瞻性地研究了70名接受RYGB治疗的患者(11名男性，59名女性；体重指数[BMI]，40至80 kg/m(2))的MREE。分别于术前、术后6周、术后3、6、22、18、24个月用间接量热法测定MREE。将患者分为低代谢组([HM]MREE低于Harris-Benedict[HE]预测值的85%；n=22)或正常代谢率([NM]MREE+/-15%HE预测值；n=48)，平均BMI分别为Hill，53.4+/-11.0 kg/m(2)；NM，51.4+/-9.8 kg/m(2)；在每个时间点测定MREE、体重下降、超重体重下降百分比(EWL)和能量摄入量。总体而言，MREE显著低于术前Hb预测的REE(90+/-28%)，但在6周后上升到与Hb预测的REE相等(96+/-15%)，并保持不变。当按初始代谢率分层时，HM患者的MREE在6周后显著增加，从1329+/-604kcal/天(预测的Hb的55%)增加到1882+/-398kcal/天(预测的Hb的88%)(p<；0.001)，而MREE保持正常(2332+/-484kcal/天到2029+/-410kcal/天)。两组在每个时间段的EWL百分比相似。术后3个月、6个月、12个月、18个月、24个月的能量摄入量分别降至815+/-196、969+/-241、1095+/-307、1259+/-466、第1373+/-620大卡/天，差异无统计学意义。Hb预测的REE百分比在手术后显著增加，尽管能量摄入显著减少。RYGB与MREE随时间的显著变化有关。在NM患者中，随着体重的减轻，MREE随着时间的推移而下降，但仍保持正常，而低代谢患者的MREE呈上升趋势，接近正常。尽管与VERI低卡路里饮食相比，能量摄入减少了，但MREE仍发生了这些变化。这种对MREE的矛盾效应可能有助于RYGB相关的体重减轻增强。
Background. Roux-en-Y gastric bypass (RYGB) results in sustained weight loss and amelioration of comorbid conditions in patients with clinically severe obesity. The mechanism of weight loss after RYGB is not well defined. The objective of this study was to document the changes in measured resting energy expenditure (MREE) over time in patients with clinically severe obesity after RYGB.Methods. We prospectively studied MREE in 70 patients (11 male, 59 female; body mass index [BMI], 40 to 80 kg/m(2)) treated by RYGB. MREE was measured by indirect calorimetry before operation and at 6 weeks and 3, 6, 22, 18, and 24 months after operation. Patients were stratified to hypometabolic ([HM] MREE less than 85% of Harris-Benedict [HE] predicted; n = 22) or normal metabolic rate ([NM] MREE +/- 15 % HE predicted; n = 48) before operation; mean BMIs were Hill, 53.4 +/- 11.0 kg/m(2); NM, 51.4 +/- 9.8 kg/m(2); p = not significant. MREE, weight loss, percent excess body weight loss (EWL), and energy intake were determined at each time point.Results. Overall, MREE was significantly less than HB-predicted REE before operation (90 +/- 28%), but rose to become equal to the HB-predicted REE by 6 weeks (96 +/- 15%) and remained so. When stratified by initial metabolic rate, MREE increased significantly in the HM patients by 6 weeks, from 1329 +/- 604 kcal/day (55 % of HB predicted) to 1882 +/- 398 kcal/day (88 % of HB predicted) (p < 0.001), and MREE remained normal (2332 +/- 484 kcal/day to 2029 +/- 410 kcal/day) in the NM patients. Percent EWL was similar in both groups at each time. Energy intake was 2603 +/- 982 kcal/day before operation and fell to 815 +/- 196 kcal/day at 3 months, 969 +/- 241 kcal/day at 6 months, 1095 +/- 307 kcal/day at 12 months, 1259 +/- 466 kcal/day at 18 months, and 1373 +/- 620 kcal/day at 24 months, and was similar between the groups at each time point. Percent HB-predicted REE increased significantly after operation despite a significant decrease in energy intake.Conclusions. RYGB is associated with significant changes in MREE over time. In NM patients MREE fell over time consistent with weight loss but remained normal, whereas patients who were hypometabolic exhibited increases in MREE toward normal. These changes in MREE occurred despite reduced energy intake comparable to a veri low calorie diet. This paradoxical effect on MREE may contribute to the enhanced weight loss associated with RYGB.