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1.
Weight Loss and Food Intake 18 Months following Vertical Banded Gastroplasty or Gastric Bypass for Severe Obesity 总被引:2,自引:0,他引:2
Background: vertical banded gastroplasty (VBG) and gastric bypass Roux-en-Y (GBP) are adjunctive to lifelong commitment to
energy restricted diet in the attempt by the severely obese to lose weight and maintain weight loss. Methods: the outcome
of 48 subjects (36 VBG and 12 GBP) is presented. Results: 18 months nutritional counseling and follow-up indicated VBG and
GBP to be equally effective in maintaining appreciable weight loss. Achievement of ‘functional weight’, such as minimum 50%
loss of excess body weight for at least 12 months post-operatively occurred in the majority of patients. Excess weight loss
by GBP and VBG was 77% and 54% respectively during the first 6 months, with 7-15% additional loss during the next 12 months.
BMI decreased from an average 43 to 27 kg m−2 after 12 months. During the first 3 months, energy intake was approximately 2930 kJ, increasing to ∼4605 kJ at 6 months,
to ∼5860 kJ at 12 months and then stabilizing. Intake of ∼50% of the Recommended Daily Allowance (RDA) for most vitamins and
minerals was reached. Haemoglobin, iron, folic acid and thiamin values were in the normal range for the entire 18 months follow-up,
while serum vitamin B12 levels decreased to deficiency levels during the same period. The pre-operative moderately elevated triglycerides, cholesterol,
glucose and insulin levels returned to normal range, thereby alleviating the need for medication and reducing the risk of
obesity-related morbidity. Most subjects were quickly satiated with small amounts of solid foods and did not report hunger
feelings for the first 6 months post-operatively. The main significant changes in food preferences in the first 6 months were
the decrease in starch-based products and the increase in semi-solid milk products and eggs. Conclusion: taken together these
observations suggest that the subjects should be strongly advised to partake in structured counseling for an extended period
of time. 相似文献
2.
OBJECTIVE. The purpose of this study was to learn whether preoperative eating habits can be used to predict outcome after vertical banded gastroplasty (VBG) and Roux-en-Y gastric bypass (RYGB). BACKGROUND SUMMARY. Several independent randomized and sequential studies have reported significantly greater weight loss after RYGB in comparison with VBG. Although the mechanism responsible for weight loss after both procedures is restriction of intake rather than malabsorption, the relationships between calorie intake, food preferences, and postoperative weight loss are not well defined. METHODS. During the past 5 years, 138 patients were prospectively selected for either VBG or RYGB, based on their preoperative eating habits. All patients were screened by a dietitian who determined total calorie intake and diet composition before recommending VBG or RYGB. Thirty patients were selected for VBG; the remaining 108 patients were classified as "sweets eaters" or "snackers" and had RYGB. Detailed recall diet histories also were performed at each postoperative visit. RESULTS. Early morbidity rate was zero after VBG versus 3% after RYGB. There were no deaths. Mean follow-up was 39 +/- 11 months after VBG and 38 +/- 14 months after RYGB. Mean weight loss peaked at 74 +/- 23 lb at 12 months after VBG and 99 +/- 24 lb at 16 months after RYGB (p < or = 0.001). Twelve of 30 VBG patients lost > or = 50% of their excess weight versus 100 of 108 RYGB patients (p < or = 0.0001). Milk/ice cream intake was significantly greater postoperatively in patients who underwent VBG versus patients who underwent RYGB after 6 months (p < or = 0.003), whereas solid sweets intake was significantly greater after VBG during the first 18 months postoperatively (p < or = 0.004). Revision of VBG was performed in 6 of 30 patients (20%) for complications or poor weight loss, whereas only 2 of 108 patients who underwent RYGB required surgical revisions (p < or = 0.001). CONCLUSIONS. These data show that VBG adversely alters postoperative eating behavior toward soft, high-calorie foods, resulting in problematic postoperative weight loss. Conversely, RYGB patients had significantly greater weight loss despite inferior preoperative eating habits. The high rate of surgical revision in conjunction with inconsistent postoperative weight loss has led us to no longer recommend VBG as treatment for morbid obesity. 相似文献
3.
M T Ott L Ott D Haack T A Colacchio J Lewis 《Archives of surgery (Chicago, Ill. : 1960)》1992,127(9):1089-1093
Thirteen morbidly obese individuals were studied prospectively for 1 year after vertical banded gastroplasty (VBG) to determine the relationships between energy balance equation parameters and excess weight loss. The measured energy expenditure (MEE), as determined by indirect calorimetry, was not correlated with weight loss. However, when this parameter was expressed as a ratio to the predicted energy expenditure (PEE), the ratio was significantly correlated with the postoperative excess weight loss at 2, 6, and 12 months. The mean daily energy intake after the VBG was 2715 +/- 865 kJ. The postoperative energy intake was not correlated with the excess weight loss. Diet-induced thermogenesis was studied in eight patients. The mean diet-induced thermogenesis was 10.31% +/- 13.92%. The diet-induced thermogenesis was not correlated with the postoperative excess weight loss. The preliminary findings of this trial suggest that the MEE/PEE ratio is useful in predicting excess weight loss after VBG. 相似文献
4.
Food intake and nutritional status after total gastrectomy: results of a nutritional follow-up 总被引:3,自引:0,他引:3
We studied dietary intake and nutritional status of 23 patients for 6 months after total gastrectomy with Roux-en-Y reconstruction. At discharge, patients were instructed to keep to recommended dietary allowances (RDA) and to record food intake on a specific form twice weekly. Nutritional follow-up was performed monthly and consisted of a computerized determination of food intake and of a nutritional assessment. The average daily energy intake was 6.10 MJ (1457.9 kcal) in the first postoperative month and 8.87 MJ (2118.4 kcal) in the sixth (P less than 0.0005). In the first monthly follow-up no patient reached RDA. By the sixth month mean daily calorie intake was greater than or equal to RDA in 14 patients (group A), while 9 patients (group B) did not reach RDA. A significant increase in body weight, serum albumin, total iron binding capacity and arm muscular circumference was observed in group A, while a significant decrease in body weight and arm muscular circumference was noted in group B. Moreover, of the seven patients who showed weight loss at 6 months only one was group A. These data indicate that malnutrition is not an inevitable consequence of total gastrectomy and can be prevented by an adequate calorie intake. A close relationship between dietary intake and postoperative nutritional parameters was observed. In gastrectomized patients a strict nutritional follow-up is very important to obtain an adequate dietary intake. 相似文献
5.
Background: Predicting successful outcomes after bariatric surgical procedures has been difficult, and the establishment of
specific selection criteria has been a subject of ongoing research. In an effort to choose the most appropriate surgical procedure
for each patient, we have established a specific set of selection criteria for each procedure based on degree of obesity,
preoperative dietary habits, eating behavior, and various metabolic features. Methods: From June 1994 to December 1998, 90
bariatric surgical procedures were performed at the authors' institution by a single surgeon (F.K.) based on specific selection
criteria. Vertical banded gastroplasty (VBG) was performed in 35 patients, standard Roux-en-Y gastric bypass (RYGB) in 38
patients, and distal RYGB in 17 patients. All patients were monitored postoperatively 1, 3, 6, and 12 months and once per
year thereafter, with an additional visit at 18 months in distal RYGB patients. Results: Early postoperative morbidity (<30
days) did not differ significantly between the three groups and averaged 9% of total patients. Long-term postoperative morbidity
(>30 days) included 9 incisional hernias (2 in the VBG group, 5 after RYGB, and 2 in the distal RYGB group). There were 6
cases of staple-line disruption, 4 after VBG and 2 after standard RYGB, 1 of which resulted in stomal ulcer. Early postoperative
mortality was 0%, and long-term mortality was 1.1%, which was due to pulmonary embolism in 1 standard RYGB patient on the
65th postoperative day. Average percentage of excess weight loss (%EWL) was 62% the first year, 61% the second year, and 50%
the third year in VBG patients, and 63.6%, 65%, and 63.3%, respectively, in standard RYGB patients. In distal RYGB patients,
where the patient number was significantly smaller, the %EWL at 1 and 2 years, respectively, was 51% and 53%. The most significant
metabolic/nutritional complication was the appearance of hypoproteinemia (hypoalbuminemia) in 1 distal RYGB patient 20 months
after surgery, which was corrected by total parenteral nutrition and subsequent increase in dietary protein intake. Significant
improvement or resolution of pre-existing comorbid conditions was observed in all patient groups. The postoperative quality
of eating, as evaluated by variety of food intake and frequency of vomiting, was significantly better in RYGB patients. Conclusions:
These results show that selection of the bariatric surgical procedure to be performed in each patient based on specific criteria
leads to acceptable weight loss, improvement in preexisting comorbid conditions, and a high degree of patient satisfaction
in most patients. On the basis of our own observations as well as those of others, our selection criteria have become more
strict over time and our selection of VBG as the operation of choice increasingly infrequent. 相似文献
6.
Ortega J Escudero MD Mora F Sala C Flor B Martinez-Valls J Sanchiz V Martinez-Alzamora N Benages A Lledo S 《Obesity surgery》2004,14(8):1086-1094
Background: One of the co-morbidities frequently associated with morbid obesity is gastro-esophageal reflux disease (GERD),
present in >50 % of morbidly obese individuals. We compared the anti-reflux effect of vertical banded gastroplasty (VBG) and
Roux-en-Y gastric bypass (RYGBP), and their effect on esophageal function. Methods: 10 patients underwent VBG and 40 patients
underwent RYGBP. Anthropometric parameters, symptomatology of GERD, esophageal manometry (EM), isotopic esophageal emptying
(IEE) and 24hr esophageal pH monitoring were recorded in all patients preoperatively, and at 3 months and 1 year postoperatively.
Results: Preoperatively, there was a high prevalence of GERD, symptomatic and pH-metric in both groups (57% and 80% respectively).
The preoperative values of EM and IEE parameters were within the normal range in most patients. After surgery, there was an
improvement at 3 months postoperatively in both groups. 1 year after surgery, the VBG group presented symptomatic GERD in
30% and pH-metric reflux in 60% of patients while the RYGBP group presented symptomatic GERD and pH-metric reflux in 12.5%
and 15% of patients, respectively. There was an increase in postoperative sensation of dysphagia in both groups (70% VBG,
30% RYGBP) one year after operation. After surgery, differences in all EM parameters were minimal, and never reached statistical
significance for any group (VBG and RYGBP). The IEE showed a significantly higher percentage of esophageal retention after
surgery, but this retention was always within the normal range. Both groups had an improvement in anthropometric parameters,
but 1 year after surgery the results were significantly better in RYGBP patients (70% excess weight loss) than in VBG patients
(46% excess weight loss). Conclusion: >50% of morbidly obese individuals suffer from GERD. We did not find changes in esophageal
function of morbidly obese patients to explain their gastroesophageal reflux preoperatively and postoperatively. EM and IEE
studies are not indicated as standard preoperative tests, except in patients with significant symptoms of gastroesophageal
reflux. RYGBP is significantly better than VBG as an anti-reflux procedure, and had better weight loss. 相似文献
7.
M. Lötborn L.-E. Bratteby G. Samuelson S. Ljunghall L. Sjöström 《Osteoporosis international》1999,9(2):106-114
Bone mineral area (BA), total bone mineral content (TBMC) and total bone mineral density (TBMD) were assessed by dual-energy
X-ray absorptiometry (DXA) in 396 randomly selected, healthy 15-year-old Swedish boys and girls. The influence of body size,
pubertal development, physical activity level (PAL), total energy expenditure (TEE), dietary intake of energy, calcium and
vitamin D, and alcohol and smoking habits on TBMC and TBMD were examined in bi- and multivariate analyses. In bivariate analyses
BA, TBMC and TBMD showed strong correlations with weight, height and TEE in both sexes. In boys but not in girls these bone
variables were significantly correlated with dietary intakes of energy, calcium and vitamin D. No significant correlations
were found between PAL and the three bone variables. In multivariate analyses with TBMC as dependent variable BA, height,
weight and Tanner stages explained 88% and 87% of the variance in boys and girls respectively. In similar analyses with TBMD
as dependent variable the corresponding figures were 50% and 54%. The major part of the variance in all these models was explained
by BA, and only a few percent by all the other independent variables. No significant reduction was found when TEE or daily
intakes of calcium or vitamin D were introduced into the models. These results illustrate the importance of including BA,
weight and height as independent variables in regression models of TBMC to avoid spurious associations with other variables
in the analyses. The results may also indicate that in normal Swedish adolescents environmental factors such as dietary intake
of nutrients play a minor role as determinants of bone mineralization. High levels of physical activity and bone mineral measures
possibly explain the lack of significant correlations between these variables and do not imply a lack of association.
Received: 16 December 1997 / Accepted: 19 May 1998 相似文献
8.
Avsar FM Ozel H Topaloglu S Yuksel BC Berkem H Delibasi T Hengirmen S 《Obesity surgery》2004,14(2):265-270
Background: Vertical banded gastroplasty (VBG) has been found to reduce BMI significantly during the first postoperative year.
However, the same trend in weight loss has not been established thereafter.The purpose of this study was to evaluate the effects
of our dietary program on morbidly obese patients treated with VBG. Methods: A prospective evaluation of 40 obese patients
(25 female, 15 male) undergoing VBG over a 3-year period was undertaken. Results: The age range was 24-57 (median 38) years,
mean weight 133±2 SD kg, and mean BMI 45±6.4 SD kg/m2. After VBG, a special follow-up program was applied to patients. All
patients (100%) were available for follow-up. Operative mortality was zero. 4 patients developed an early postoperative complication,
and 1 patient was re-operated because of staple-line disruption 8 months after VBG. BMI decreased to 34±3.2 after 12 months,
27±1.3 after 24 months, and 28±1.4 after 36 months. All patients showed weight loss after VBG, and the weight loss continued
with the strict follow-up program during a 3-year period, except in 1 patient who regained the weight lost despite an intact
staple-line and stoma. Conclusion: Our policy for patients after VBG appears to be effective. 相似文献
9.
Serum iron, folate, B12 and total iron binding capacity (TIBC) were obtained preoperatively and at 6-month intervals in 40 morbidly obese patients who underwent VGB. Deficiencies of hemic micronutrients rarely occurred following VBG. Hemoglobin and hematocrit levels were within normal limits at all times. Some patients experienced transitory depression of nutrients at six months postoperatively, during the period of most rapid weight loss and lowest dietary intake. These levels return to normal by one year in almost all cases. Low B12 levels were observed in four patients at 1 year. All had been above 120 per cent overweight and had lost in excess of 100 pounds in the first postoperative year. These data indicate that hemic micronutrients remain at normal levels following VBG. B12 levels should be followed to determine possible need for supplementation other than that provided by usual daily multivitamin preparations in patients above 120 per cent ideal weight loss exceeding 100 lbs in the first postoperative year. 相似文献
10.
Background: Gastric restrictive surgery in a large non-university teaching hospital has been combined with preoperative weight
loss by diet. The aims of preoperative dieting were to test patient motivation, to reduce perioperative morbidity, to accustom
patients to the restriction of food intake after surgery, and to increase total weight loss. This study was performed to investigate
the long-term results of this approach. Methods: 200 morbidly obese persons were operated on between 1978 and 1986 after they
had lost more than 50% of their excess weight by diet. 100 Roux-en-Y gastric bypasses (RYGB) and, after 1983, 100 vertical
banded gastroplasties (VBG) were performed. Data from medical records and data concerning present weight, complaints, food
intolerance, nutritional deficiencies, and medical follow-up visits were obtained by questionnaire. Results: The lowest body
weight was obtained 1 year after operation with an average excess weight loss (EWL) of 78% after RYGB and 75% after VBG. Body
weight gradually increased, and 7 years after surgery the average EWL was 67% after RYGB and 63% after VBG. Ten patients had
died (three postoperatively after RYGB). Preoperative dieting did not decrease perioperative morbidity and mortality in comparison
with other reports. Conclusions: After combined preoperative dieting and VBG, weight loss is greater than after surgery alone.
No additional weight loss after preoperative dieting was observed in RYGB patients. Most patients who underwent bariatric
surgery still experience nutritional, physical, and cosmetic problems 7 years after surgery. 相似文献
11.
Daily nutrient intake represents a modifiable determinant of nutritional status in chronic haemodialysis patients. 总被引:2,自引:0,他引:2
Vincenzo Bellizzi Biagio R Di Iorio Vincenzo Terracciano Roberto Minutolo Carmela Iodice Luca De Nicola Giuseppe Conte 《Nephrology, dialysis, transplantation》2003,18(9):1874-1881
BACKGROUND: In maintenance haemodialysis patients, daily food intake is changeable; however, its relationship with nutritional status is unexplored. This study aimed to evaluate the isolated, long-term effect of daily nutrient intake on nutritional status in haemodialysis patients. METHODS: We performed a prospective 1-year controlled study in 27 chronic haemodialysis patients, without recognized risk factors for malnutrition. Each day for 1 week, four times in the year, we measured protein nitrogen appearance, and assessed dietary protein (DPI) and energy (DEI) intake from dietary diaries. We compared the nutritional outcome of patients spontaneously reducing nutrient intake below the threshold of 0.8 g/kg body weight/day for DPI and 25 kcal/kg body weight/day for DEI during the week (LOW, n = 8), with controls at adequate nutrient intake (CON, n = 19). An interventional 6-month study was then carried out in LOW to verify the cause-effect relationship. RESULTS: All patients showed a day-by-day reduction of whole nutrient intake during interdialytic period, which was mostly relevant in the third interdialytic day (L3). During the 1-year study, even in the presence of adequate dialysis dose and normal inflammatory indexes, body weight (68.0 +/- 5.5 to 65.8 +/- 5.9 kg), serum albumin (3.96 +/- 0.07 to 3.66 +/- 0.06 g/dl) and creatinine (9.2 +/- 1.1 to 8.1 +/- 0.7 mg/dl) significantly decreased in LOW but not in CON. Diaries evidenced in LOW a reduced number of meals at L3 that was explained by the fear of excessive interdialytic weight gain. During the interventional study, daily DPI and DEI increased at L3; this was associated with a significant increment of body weight, and serum albumin and creatinine levels. CONCLUSIONS: In maintenance haemodialysis patients the persistent, marked reduction of daily nutrient intake, even if limited to a single day of the week, is an independent determinant of reversible impairment of nutritional status. 相似文献
12.
A Prospective Comparison of Vertical Banded Gastroplasty and Roux-en-Y Gastric Bypass in a Non-Superobese Population 总被引:4,自引:4,他引:0
Background: In the non-superobese population, consensus is currently unavailable in bariatric surgery. We report the results
of a prospective comparison of vertical banded gastroplasty (VBG) and Roux-en-Y gastric bypass (RYGBP) in a non-superobese
population. Methods: From 1994 to 2000, 179 patients with clinically severe obesity underwent various surgical procedures
in our department. During this time a prospective study was undertaken in order to compare VBG with RYGBP in morbidly obese
patients with a BMI <50 kg/m2. Based on specific criteria including eating behavior, 68 patients were selected to undergo RYGBP and 35 VBG. All patients
have undergone complete follow-up evaluation at 1, 3, 6, and 12 months postoperatively and every year thereafter. Results:
All patients have now completed their 5th postoperative year. Mean follow-up period to date is 96.5±12.2 months for VBG and
67.6±11.3 months for RYGBP. 3 patients (8.6%) in the VBG group and 9 patients (13.2%) in the RYGBP group are lost to follow-up.
Mean excess weight loss (EWL) was always better in the RYGBP group (P=0.0013). The percentage of failure, defined as EWL <25%, was not significantly different between the two procedures. No statistically
significant differences were observed between the 2 groups in the total number of non-metabolic complications, and the only
statistically significant difference observed in metabolic complications was vitamin B12 deficiency after RYGBP. Frequency of vomiting was significantly less and quality of eating significantly better in RYGBP
than in VBG patients. Conclusion: This prospective long-term study, with nearly complete follow-up, suggests that in the non-superobese
population, preoperative eating habits may play a role in choosing the most appropriate bariatric operation for each patient.
Although RYGBP is associated with better mean weight loss outcomes, the percentage of patients who achieved and maintained
≥50% EWL after VBG in this pre-selected patient population was not significantly different. Each type of operation has advantages
and disadvantages, and, if properly chosen, a purely restrictive procedure can be successful for some patients. Therefore,
it can be said that the decision regarding which bariatric procedure to perform in non-superobese patients must be based on
in-depth preoperative evaluation as well as the patients' own preferences and outcome expectations. 相似文献
13.
Background Roux-en-Y gastric bypass (RYGBP) has been found to be the most efficient way to lose weight and maintain the weight loss in
morbid obesity. However, with the formation of a new stomach and the modification of intestinal anatomy, there are significant
changes on physiological properties of these organs that lead to nutrient deficiency, including calcium. The objectives of
this study were to evaluate calcium intake, bone metabolism, and prevalence of metabolic bone disease in women subjected to
RYGBP after 8 years.
Methods Food frequency questionnaire and 3-day dietary recall, laboratory tests of bone metabolism and bone mineral density were accessed.
Results Calcium intake was below the recommendation in all women. Serum PTH and alkaline phosphatase were elevated, whereas vitamin
D and urinary calcium were significantly lower. Also, a higher prevalence of metabolic bone disease than the one expected
for the normal population at the same age was noted.
Conclusion These data suggest that metabolic bone disease could be a complication of this type of surgery. 相似文献
14.
Comparative Analysis of Vertical Banded Gastroplasty and Duodenal Switch at Five Years Follow-Up 总被引:2,自引:2,他引:0
Background: Bariatric surgery is the only effective long-term treatment for morbid obesity. We compared long-term results
of the vertical banded gastroplasty (VBG) and biliopancreatic diversion with duodenal switch (DS). Quality of life (QoL),
weight loss (WL), and reoperation were evaluated. Methods: This is a retrospective study of 85 of 129 patients with VBG and
49 of 743 patients with DS, with follow-up >5 years. Mean preoperative BMI of the VBG patients was 48.8 kg/m2 and for the DS patients was 50.3 kg/m2. Results: Percent excess weight loss (%EWL) at 5 years for VBG patients was 56.4% and for DS patients 70.6% (P<0.0001). 8 VBG patients (9.4%) and 1 DS patient (2.0%) required re-operation due to failure of the technique. None of the
VBG patients could eat a normal diet, while 80% of the DS had no restriction in the quality of their intake. Conclusions:
At 60 months follow-up, only the DS patients fullfilled the ASBS requirements of %EWL >50 in over 75% of the patients. 相似文献
15.
Psychological Condition and Quality of Life in Patients with Morbid Obesity Before and After Surgical Weight Loss 总被引:6,自引:6,他引:0
Mamplekou E Komesidou V Bissias Ch Papakonstantinou A Melissas J 《Obesity surgery》2005,15(8):1177-1184
Background: Bariatric surgery results in significant weight loss, improvement or cure of accompanying illnesses, and may lead
to important changes in psychological conditions. The aim of this paper is to study the changes in the psychological and emotional
lives of patients as well as quality of life during the first 2 years after vertical banded gastroplasty (VBG). Methods: The
study population comprised 59 patients, 45 women (76.3%) and 14 men, between 18 and 64 years old. Patients were asked to complete
an SCL-90R questionnaire before VBG. 2 years after VBG, patients were again asked to complete an SCL-90R as well as a BAROS
questionnaire. Comparisons were made between loss of weight, alteration in the psychological condition and quality of life
postoperatively, within the parameters of sex, age, marital status, level of education, duration of obesity and family history
of obesity. Results: Women had a greater degree of depression from obesity than their male counterparts before the procedure
(P=0.001), while their postoperative emotional improvement was more marked (P=0.008). The General Mental Health Index was higher in female than male patients (P=0.008). At 2 years after VBG, BMI was significantly reduced (P<0.001). Oversensitivity in personal relationships and anxiety affected patients more both pre- and postoperatively. The averages
of all the indexes of the subgroups of the SCL-90R, which relates to psychological condition of patients, showed a statistically
significant reduction at 2 years following VBG, indicative of the improvement of the patients' psychosomatic condition. The
more weight patients lost, the more their quality of life improved, as evaluated by the BAROS (P<0.001). Conclusions: The bariatric surgery most satisfactorily improved the patients' psychosomatic condition, as well as
their quality of life, during the first 2 years after VBG. 相似文献
16.
Vivian Gahtan MD Sarah E Goode RN Helen Z Kurto RN Douglas D Schocken MD Pauline Powers MD Alexander S Rosemurgy MD 《Obesity surgery》1997,7(3):184-188
Background: Little is known about the composition and source of weight loss after bariatric surgery for morbid obesity. Purpose:
This study was undertaken to determine changes in weight, body mass index (BMI), lean body weight (LBW), fat weight (FW) and
left ventricular cardiac mass (LVM) following vertical banded gastroplasty (VBG). Methods: After VBG for morbid obesity, 26
women and four men (mean age = 39.1 years) were weighed and had body composition analysis undertaken at intervals. Thirteen
patients underwent echocardiography preoperatively and 1 year postoperatively to determine change in LVM and LVM index. Results:
Over 12 months there was significant weight loss for all weight parameters examined (p < 0.05). Fat weight loss was most significant; total weight loss and reduction of BMI were significant but less so than fat
loss (Wilcoxon's signed ranks test). LBW loss had the smallest contribution to weight loss (p < 0.0001). There was a significant loss of LVM and posterior cardiac wall thickness (p < 0.05). Conclusions: VBG can lead to loss of lean body weight and left ventricular mass, and more dramatically, fat weight,
body weight, and BMI. Cardiac mass and lean body mass are preferentially conserved relative to body fat with weight loss after
VBG. 相似文献
17.
Wim G van Gemert MD Jan Willem M Greve MD PhD Peter B Soeters MD PhD 《Obesity surgery》1997,7(2):128-135
Background: The VBG was originally performed with a Marlex band and characterized by a satisfactory weight loss and low morbidity.
The effect of the material used for the banding procedure (Marlex vs Dacron) in vertical banded gastroplasty (VBG) is evaluated.
Methods: In 49 consecutive obese patients treated with a VBG, a Marlex band was used in 17 patients and a Dacron band in 32
patients. Data were analyzed retrospectively with regard to the type of band, weight loss and complications. Results: A significant
difference was found in the percentage excess weight 5 years postoperatively in favor of the Dacron group (59.2% vs 39.2%;
p < 0.05) because of more band-related complications in the Marlex group. The difference in percentage excess weight disappeared
8 years postoperatively (43.3% vs 46.8%), due to the renewed weight loss of the Marlex group following reoperation. Conclusion:
The Dacron band is superior to the Marlex band in VBG because sustained weight loss is satisfactory and morbidity is low. 相似文献
18.
Calorie Intake and Meal Patterns up to 4 Years after Roux-en-Y Gastric Bypass Surgery 总被引:1,自引:1,他引:0
Background: Roux-en-Y gastric bypass (RYGBP) is the most popular surgical treatment for morbid obesity in the U.S.A., producing
significant and durable weight loss with improvement in co-morbidities. Although a greater number of patients are undergoing
surgical treatment for obesity, little data are available regarding their food intake after surgery. This study was undertaken
to evaluate the caloric amount, nutrient composition and meal patterns of patients 18 months to 4 years after RYGBP. Ethnic
differences in food intake were also investigated. Methods: Questionnaires were mailed to 360 patients who had undergone RYGBP
at least 18 months prior to the onset of the study. Results: Data were available from 69 patients, 52% Caucasian, 25% African-American,
23% Hispanic. 30 months after surgery, the average daily calorie intake was 1733 ± 630 kcal (n=68, range 624-3486 kcal), with
44% of calories from carbohydrates, 22% from protein and 33% from fat. Sugar-sweetened beverages represented 7% of total caloric
intake. Patients consumed 3 meals and 3 snacks per day on average. Food intake from dinner and an evening snack represented
40% of the daily caloric intake. Snacks accounted for 37% of the daily intake. Percent excess weight loss (%EWL) was 58 ±
17% and was not different among ethnic groups. However, Hispanics reported consuming fewer snacks and fewer calories. %EWL
correlated with the total daily caloric intake (r= .446, P <0.001). Follow-up attendance was 54% at 1 year after surgery but fell to 10% at 3 years. Only 77% of patients were taking
vitamin supplements. Conclusion: RYGBP resulted in significant weight loss. Caloric intake was quite variable. Long-term follow-up
remained low, putting patients at risk for metabolic and vitamin deficiencies. The relationship between caloric intake and
long-term weight changes remains to be studied. 相似文献
19.
Kanoupakis E Michaloudis D Fraidakis O Parthenakis F Vardas P Melissas J 《Obesity surgery》2001,11(5):552-558
Background: It is well established that morbid obesity affects the respiratory system and the diastolic function of the heart.
During exercise, cardiopulmonary reserve is exhausted because of augmented requirements, leading to a significant intolerance.
A study was undertaken to investigate the influence of body weight loss on the characteristics of the left ventricle (LV)
and on exercise capacity in obese patients before and 6 months following vertical banded gastroplasty (VBG). Methods: 16 morbidly
obese individuals (BMI >40 kg/m2) scheduled for VBG were studied. A symptomlimited cardiopulmonary exercise test and a complete transthoracic echocardiogram
were performed 1 day before operation and 6 months postoperatively (after the patients achieved a body weight loss of ≥ 20%
of their pre-operative values). Results: Exercise duration increased significantly 6 months following surgery.The mean O2 consumption at peak exercise (peak VO2) and at the anaerobic threshold (VO2AT) was significantly higher after weight loss. 6 months after VBG the LV thickness decreased significantly. Regarding the diastolic
indices, isovolumic relaxation time (IVRT) and early/late (E/A) velocity ratio, there was a significant improvement after
weight loss. Simple linear regression analysis revealed that peak VO2 and VO2AT were significantly correlated with IVRT and E/A velocity ratio. Conclusions: Weight loss after VBG improves the cardiac diastolic
function and this is associated with an improvement in cardiopulmonary exercise performance. Left ventricular filling variables
could be considered among the most important determinants of exercise intolerance in obese individuals. 相似文献
20.
C. V. Harinarayan 《Osteoporosis international》2005,16(4):397-402
Aim: To evaluate the dietary calcium and vitamin D status in south Indian postmenopausal women. Methods: Postmenopausal women (n=164) were evaluated for their daily dietary calcium intake, phytate to calcium ratio, and bone mineral parameters. Their serum leutinizing hormone (LH), follicle-stimulating hormone (FSH), 25-hydroxyvitamin D (25[OH]D), and parathyroid hormone levels (PTH) were measured. Results: Their age and BMI were 59.5 ± 8 years and 27 ± 5 kg/m2, respectively. Their daily dietary intake of calcium was 323 ± 66 mg/day; phytate to calcium ratio, 0.56±0.1; LH, 26 ± 13.5 µIU/l; and FSH, 62.6 ± 30 µIU/l. Their dietary intake of calcium was low compared with the recommended daily/dietary allowance (RDA) of the Indian Council of Medical Research (ICMR) for the Indian population. Of the 164 patients studied, based on population-based reference values, 126 (77%) had normal 25(OH)D levels (9–37.6 ng/ml), and 38 (23%) had 25(OH)D deficiency. Using functional health-based reference values, 30 (18%) patients had normal 25(OH)D levels (>20 ng/ml), 85 (52%) had 25(OH)D insufficiency (10–20 ng/ml), and 49(30%) had 25(OH)D deficiency (<10 ng/ml). PTH and serum alkaline phosphatase (SAP) was significantly high in patients with 25(OH)D deficiency (p<0.05) compared with those with normal 25(OH)D levels. There was a negative correlation between 25(OH)D and PTH (r=–0.2; p<0.007) and SAP (r=–0.2; p<0.001). Dietary calcium correlated positively with dietary phosphates (r=0.8; p<0.001) and phytate to calcium ratio (r=0.75; p<0.001). Conclusions: Population-based reference values underdiagnosed vitamin D insufficiency and overdiagnosed normal vitamin D status. The diet was insufficient in calcium and high in phytate. About 82% of the study group had varying degrees of low 25-hydroxyvitamin D levels. The quality of diet has to be improved with enrichment/supplementation of calcium and vitamin D to suppress secondary hyperparathyroidism-induced bone loss and risk of fractures. 相似文献