Background Metabolic and bariatric surgery (MBS) is the most effective treatment for severe obesity, but long-term success is often limited by recurrent weight gain (RWG). This study evaluates the association between metabolic adaptation (MA) and long-term RWG. Methods Body composition (via bioimpedance) and resting energy expenditure (REE) via indirect calorimetry were assessed at baseline (n = 95), 2 (n = 29), and 12 months (n = 46) after gastric bypass (GBP, n = 68) or sleeve gastrectomy (SG, n = 27). Body weight was measured throughout the subsequent 4 years of follow-up. RWG was defined as the difference between maximum weight in years 3–5 and nadir in years 1–2. Results On average, MA (kcal/day) was − 130 (95% CI: −205 to − 56, p = 0.001) at 2 months and − 115 (CI: −167 to − 64, p < 0.001) at 12 months. The extent of MA at 12 months was greater (p < 0.001) after SG (− 259 ± 111 kcal/day, 95% CI: −327 to − 191, n = 12) compared to GBP (− 63 ± 161 kcal/day, 95% CI: −120 to − 6, n = 33). Weight loss at nadir within the 2-year postoperative period was − 44 ± 13 kg (mean ± SD), while RWG was 9.2 ± 8.6 kg over the subsequent 3 years. In exploratory analyses of the smaller SG subgroup, greater individual MA at 12 months was associated with greater RWG in the SG group (r = − 0.71, 95% CI for r: −0.90 to − 0.26, p = 0.01), but not in the GBP group (p = 0.59), such that a relative reduction of 100 kcal/day in REE was associated with a mean RWG of 7.6 kg (CI: 2.3 to 13 kg). Conclusions Our data show that MA occurs within the first year after MBS. The magnitude of MA was greater in SG patients than in GBP patients in this cohort. Exploratory analyses in the smaller SG subgroup (n = 12) suggested an association between greater MA and RWG over three years, whereas no association was observed in GBP (n = 33); these hypothesis-generating, procedure-specific observations warrant prospective validation in larger contemporary cohorts with adequate statistical power.
Post-operative Metabolic Adaptation and its Influence on Long-Term Recurrent Weight Gain After Metabolic and Bariatric Surgery
Piaggi, Paolo;
In corso di stampa
Abstract
Background Metabolic and bariatric surgery (MBS) is the most effective treatment for severe obesity, but long-term success is often limited by recurrent weight gain (RWG). This study evaluates the association between metabolic adaptation (MA) and long-term RWG. Methods Body composition (via bioimpedance) and resting energy expenditure (REE) via indirect calorimetry were assessed at baseline (n = 95), 2 (n = 29), and 12 months (n = 46) after gastric bypass (GBP, n = 68) or sleeve gastrectomy (SG, n = 27). Body weight was measured throughout the subsequent 4 years of follow-up. RWG was defined as the difference between maximum weight in years 3–5 and nadir in years 1–2. Results On average, MA (kcal/day) was − 130 (95% CI: −205 to − 56, p = 0.001) at 2 months and − 115 (CI: −167 to − 64, p < 0.001) at 12 months. The extent of MA at 12 months was greater (p < 0.001) after SG (− 259 ± 111 kcal/day, 95% CI: −327 to − 191, n = 12) compared to GBP (− 63 ± 161 kcal/day, 95% CI: −120 to − 6, n = 33). Weight loss at nadir within the 2-year postoperative period was − 44 ± 13 kg (mean ± SD), while RWG was 9.2 ± 8.6 kg over the subsequent 3 years. In exploratory analyses of the smaller SG subgroup, greater individual MA at 12 months was associated with greater RWG in the SG group (r = − 0.71, 95% CI for r: −0.90 to − 0.26, p = 0.01), but not in the GBP group (p = 0.59), such that a relative reduction of 100 kcal/day in REE was associated with a mean RWG of 7.6 kg (CI: 2.3 to 13 kg). Conclusions Our data show that MA occurs within the first year after MBS. The magnitude of MA was greater in SG patients than in GBP patients in this cohort. Exploratory analyses in the smaller SG subgroup (n = 12) suggested an association between greater MA and RWG over three years, whereas no association was observed in GBP (n = 33); these hypothesis-generating, procedure-specific observations warrant prospective validation in larger contemporary cohorts with adequate statistical power.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
