Background

Weight regain (WR) post bariatric surgery affects almost 20% of patients. It has been theorized that a complex interplay between physiologic adaptations and epigenetic mechanisms promotes WR in obesity, however, reliable predictors have not been identified. Our study examines the relationship between early postoperative weight loss (WL), nadir weight (NW), and WR following laparoscopic Roux-en-Y gastric bypass (LRYGB) and sleeve gastrectomy (LSG).

Methods

A retrospective review of prospectively collected data was conducted for LRYGB or LSG patients from 2012 to 2016. Demographics, preoperative BMI, procedure type, and postoperative weight at 6, 12, 24, 36, and 48 months were recorded. WR was defined as > 20% increase from NW. Univariate and multivariate linear and logistic regression models were used to determine the association between early postoperative WL with NW and WR at 4 years.

Results

Thousand twenty-six adults were included (76.8% female, mean age 44.9 ± 11.9 years, preoperative BMI 46.1 ± 8); 74.6% had LRYGB and 25.3% had LSG. Multivariable linear regression models showed that greater WL was associated with lower NW at 6 months (Coef − 2.16; 95% CI − 2.51, − 1.81), 1 year (Coef − 2.33; 95% CI − 2.58, − 2.08), 2 years (Coef − 2.04; 95% CI − 2.25, − 1.83), 3 years (Coef − 1.95; 95% CI − 2.14, − 1.76), and 4 years (Coef − 1.89; 95% CI − 2.10, − 1.68), p ≤ 0.001. WR was independently associated with increased WL between 6 months and 1 year (Coef 1.59; 95% CI 1.05,2.14; p ≤ 0.001) and at 1 year (Coef 1.24; 95% CI 0.84,1.63;p ≤ 0.001) postoperatively. The multivariable logistic regression model showed significantly increased risk of WR at 4 years for patients with greater WL at 6 months (OR 1.20, 95% CI 1.08,1.33; p = 0.001) and 1 year (OR 1.14; 95% CI 1.06,1.23; p ≤ 0.001).

Conclusion

Our findings demonstrate that higher WL at 6 and 12 months post bariatric surgery may be risk factors for WR at 4 years. Surgeons may need to follow patients with high early weight loss more closely and provide additional treatment options to maximize their long-term success.

中文翻译：

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腹腔镜袖状胃切除术和 Roux-en-Y 胃旁路术后早期术后体重减轻预测最低体重和体重恢复

背景

减肥手术后的体重恢复 (WR) 影响了近 20% 的患者。据推测，生理适应和表观遗传机制之间复杂的相互作用促进了肥胖的 WR，但是，尚未确定可靠的预测因子。我们的研究检查了腹腔镜 Roux-en-Y 胃旁路术 (LRYGB) 和袖状胃切除术 (LSG) 后早期术后体重减轻 (WL)、最低体重 (NW) 和 WR 之间的关系。

方法

对 2012 年至 2016 年 LRYGB 或 LSG 患者的前瞻性收集数据进行了回顾性分析。记录了 6、12、24、36 和 48 个月时的人口统计学、术前 BMI、手术类型和术后体重。WR 被定义为从 NW 增加 > 20%。使用单变量和多变量线性和逻辑回归模型来确定术后早期 WL 与 NW 和 4 年 WR 之间的关联。

结果

包括 26 名成年人（76.8% 为女性，平均年龄 44.9 ± 11.9 岁，术前 BMI 46.1 ± 8）；74.6% 有 LRYGB，25.3% 有 LSG。多变量线性回归模型表明，较大的 WL 与较低的 NW 在 6 个月时相关（Coef − 2.16；95% CI − 2.51，− 1.81），1 年（Coef − 2.33；95% CI − 2.58，− 2.08），2 年(Coef - 2.04; 95% CI - 2.25, - 1.83), 3 年 (Coef - 1.95; 95% CI - 2.14, - 1.76), 和 4 年 (Coef - 1.89; 95% CI - 2.10, - 1.68), p≤0.001  。WR 与 6 个月至 1 年（Coef 1.59；95% CI 1.05,2.14；p  ≤ 0.001）和 1 年（Coef 1.24；95% CI 0.84,1.63；p ≤ 0.001) 术后。多变量逻辑回归模型显示，对于 6 个月（OR 1.20，95% CI 1.08,1.33；p = 0.001）和 1 年（OR 1.14；95% CI 1.06,1.23）更大 WL 的患者，4 年时 WR 的风险显着增加；p≤0.001 ）。

结论

我们的研究结果表明，减肥手术后 6 个月和 12 个月较高的 WL 可能是 4 年 WR 的危险因素。外科医生可能需要更密切地跟踪早期体重减轻率高的患者，并提供额外的治疗选择，以最大限度地提高他们的长期成功率。