不同代謝性手術對肥胖患者之身體組成與脂肪分布的影響

Influences of Different Metabolic Surgeries on Body Composition and Fat Distribution in Obese Individuals

10.3966/168232812014122404003

黃詩芸(Shih-Yun Huang)；李國鼎(Kuo-Ting Lee)；張秦松(Chin-Sung Chang)；陳秋盈(Chiu-Ying Chen)；郭素娥(Su-E Kuo)；石祐禎(Yu-Chen Shih)；吳至行(Chih-Hsing Wu)

肥胖 ； 代謝性手術 ； 生物電阻抗分析 ； bioelectric impedance analysis ； metabolic surgery ； obesity

台灣家庭醫學雜誌

24卷4期（2014 / 12 / 01）

173 - 186

繁體中文

背景：代謝性手術主要為限制型及吸收不良型兩類，雖都可減輕體重，但兩種類型手術對於身體組成變化的影響卻尚未明確探討。方法：蒐集自2008年至2013年於成大醫院接受代謝性手術個案共47人，其中限制型手術21人（男／女=9／12，平均年齡34.1±10.1歲，平均身體質量指數42.3±6.6 kg／m^2），吸收不良型手術26人（男／女=14／12，平均年齡36.8±10.5歲，平均BMI 41.7±7.0 kg／m^2）為研究對象。所有個案於術前及術後6個月均以生物電阻抗分析法（BC-418, Tanita Corp., Tokyo,Japan）測量脂肪及去脂肪質量。同時量取腰圍及臀圍，並計算腰臀圍比值表示脂肪分布狀態。結果：全體個案手術後6個月平均BMI平均下降22.6±7.5%，平均脂肪質量下降43.0±15.1%，平均體脂率下降27.1±14.2%，平均腰臀圍比值下降4.6±5.3%，均達顯著差異。於6個月時吸收不良型之脂肪質量與體脂率之下降幅度大於限制型手術（p 值分別為0.020及0.018），其餘身體組成與體脂分布的變化程度均未達統計顯著差異。於6個月時不同性別之身體組成與體脂分布的變化程度皆未達統計上顯著差異。結論：接受兩種不同代謝性手術術後6個月時其減重幅度相近且均超過術前體重之20%以上。吸收不良型手術對肥胖患者之脂肪質量與體脂率下降幅度大於限制型手術，其餘身體組成及脂肪分布的下降幅度於兩種手術類型之間並無顯著差異。

Background: Two major types of metabolic surgeries - restrictive and malabsorptive- are both effective in treating obesity. However, whether the type of metabolic surgery exerts different influences on body composition and fat distribution remains an understudied issue. Methods: During 2008 to 2013, a total of 47 subjects undergoing metabolic surgeries were enrolled, including 21 restrictive type (male/female=9/12, mean age=34.1±10.1 years-old, body mass index (BMI)=42.3±6.6 kg/m^2) and 26 malabsorptive type (male/female=14/12, mean age=36.8±10.5 years-old, BMI=41.7±7.0 kg/m^2). Body composition assessment was performed before and six months after the surgery using a bioelectric impedance analyzer (BC- 418, Tanita Corp., Tokyo, Japan) measuring fat mass (FM) and fat free mass (FFM). The waist circumference (WC) and hip circumference (HC) of each subject were also measured to obtain a waist-to-hip ratio (WHR) as the basis for estimating body fat distribution. Results: Six months after the surgery, statistically significant changes were observed in mean BMI (down by 22.6±7.5%), mean FM (down by 43.0±15.1%), mean percent body fat (PBF, down by 27.1±14.2%) and mean WHR (down by 4.6±5.3%). Compared to its restrictive type counterpart, malabsorptive metabolic surgery achieved significantly greater reduction in both FM (p=0.020) and PBF (p=0.018). Otherwise, there was no significant difference in other body composition indicators and fat distribution between the two types of metabolic surgeries or between subjects of different genders at six months after the surgery. Conclusions: Both types of metabolic surgeries produced similar results in weight loss as indicated by the over 20% reduction in weight at six months after the surgery. Except for the greater mean FM and PBF reduction in the malabsorptive type, there was no significant difference in the changes of body composition and fat distribution between two types of metabolic surgeries in obese people.

1. 簡義紋、吳岱穎、林光洋、吳逸帆、郭冠良、季瑋珠(2013)。肥胖的環境與生活型態因素。台灣衛誌，32，2。
   連結：
2. 衛生福利部：102年國人死因統計結果。台北：衛生福利部統計處
3. Ackerman, NB(1981).Observations on the improvements in carbohydrate metabolism in diabetic and other morbidly obese patients after jejunoileal bypass.Surg Gynecol Obstet,152,581-6.
4. Alhosaini, M,Leehey, D,Kramer, H(2014).Bariatric surgery: the solution to a big problem?.Am J Kidney Dis,64,332-4.
5. Allison, DB,Fontaine, K,Manson, J(1999).Annual deaths attributable to obesity in the United States.JAMA,282,1530-8.
6. Aniceto, B,Nieves, P,Carlos, S,Rafael, B,Marcelo, B,Fernando, B(2011).Weight loss reporting: predicted body mass index after bariatric surgery.Obes Surg,21,367-72.
7. Ashrafian, H,le Roux, CW(2009).Metabolic surgery and gut hormones: a review of bariatric entero-humoral modulation.Physiol Behav,97,620-31.
8. Bekheit, M,Katri, K,Ashour, MH(2014).Gender influence on long-term weight loss after three bariatric procedures: gastric banding is less effective in males in a retrospective analysis.Surg Endosc,28,2406-11.
9. Brunicardi, F(ed.),Andersen, DK(ed.),Billiar, TR(ed.)(2014).Schwartz's Principles of Surgery.New York:McGraw-Hill.
10. Brunicardi, F(ed.),Andersen, DK(ed.),Billiar, TR(ed.)(2010).Schwartz's Principles of Surgery.New York:McGraw-Hill.
11. Bruzzi, M,Rau, C,Voron, T,Guenzi, M,Berger, A,Chevallier, JM(2015).Single anastomosis or mini-gastricbypass: long-term results and quality of life after a 5-year follow-up.Surg Obes Relat Dis,11,321-6.
12. Buchwald, H,Braunwald, E,Avidor, Y(2004).Bariatric surgery: a systemic review and meta-analysis.JAMA,292,1724-37.
13. Cameron, JL(ed.),Cameron, AM(ed.)(2014).Current Surgical Therapy.Philadelphia:Saunders.
14. Carey, DG,Pliego, GJ,Raymond, RL,Skau, KB(2006).Body composition and metabolic changes following bariatric surgery: effects on fat mass, lean mass and basal metabolic rate.Obes Surg,16,469-77.
15. Cheng, IC,Wei, SC,Yeh, SL,Wang, W(2014).Comparison of weight loss and body composition changes in morbidly obese Taiwanese patients with different bariatric surgeries: a 1-year follow-up study.Obes Surg,24,572-7.
16. Chumlea, WC,Baumgartner, RN(1990).Bioelectric impedance methods for the estimation of body composition.Can J Sports Sci,10,205-17.
17. Deitel, M,Gawdat, K,Melissas, J(2007).Reporting weight loss 2007.Obes Surg,17,565-8.
18. Deurenberg-Yap, M,Schouten, FJ(2002).Validity of total and segmental impedance measurements for prediction of body composition across ethic population groups.Euro J Clin Nutr,56,214-20.
19. Douketis, J,Macie, C,Thabane, L,Williamson, DF(2005).Systematic review of long-term weight loss studies in obese adults: clinical significance and applicability to clinical practice.Int J Obes,29,1153-67.
20. Elizabeth, MW,Gladys, S,Wendy, CK(2014).Validity of bioelectrical impedance analysis for measuring changes in body water and percent fat after bariatric surgery.Obes Surg,24,847-54.
21. Feldman, MD(ed.),Christensen, JF(ed.)(2008).Behavioral Medicine: A Guide for Clinical Practice.New York:McGraw Hill.
22. Frige', F,Laneri, M,Veronelli, A(2009).Bariatric surgery in obesity: changes of glucose and lipid metabolism correlate with changes of fat mass.Nutr Metab Cardiovasc Dis,19,198-204.
23. Galanakis, C,Daskalakis, M,Manios, A,Xyda, A,Karantanas, A,Melissas, J(2015).Computed tomography-based assessment of abdominal adiposity changes and their impact on metabolic alterations following bariatric surgery.World J Surg,39,417-23.
24. Gallagher, D,Visser, M,Sepúlveda, D,Pierson, R,Harris, T,Heymsfield, S(1996).How useful is body mass index for comparison of body fatness across age, sex, and ethnic groups.Am J Epidemiol,143,228-39.
25. Guo, X、Yin, K、Zhuo, GZ、Chang, XS、Ding, D、Zheng, CZ(2012)。Efficacy comparison between 2 methods of laparoscopic gastric bypass surgery in the treatment of type 2 diabetes mellitus。J Gastrointest Surg，15，1125-8。
26. Huxley, R,Mendis, S,Zheleznyakov, E,Reddy, S,Chan, J(2010).Body mass index, waist circumference and waist: hip ratio as predictors of cardiovascular risk - a review of the literature.Eur J Clin Nutr,64,16-22.
27. Ionut, V,Burch, M,Youdim, A,Bergman, R(2013).Gastrointestinal hormones and bariatric surgery-induced weight loss.Obesity,21,1093-103.
28. Jaffrin, MY(2009).Body composition determination by bioimpedance: an update.Curr Opin Clin Nutr,12,482-6.
29. Kushner, RF,Schoeller, D(1986).Estimation of total body water by bioelectrical impedance analysis.Am J Clin Nutr,44,417-23.
30. Lear, SA,James, P,Ko, GT,Kumanyika, S(2010).Appropriateness of wait circumference and waist-to-hip cut-offs for different ethnic groups.Eur J Clin Nutr,64,42-61.
31. Lee, WJ,Almulaifi, A(2015).Recent advances in bariatric/metabolic surgery: appraisal of clinical evidence.J Biomed Res,29,98-104.
32. Lee, WJ,Chong, K,Ser, KH(2011).Gastric bypass vs sleeve gastrectomy for type 2 diabetes mellitus: a randomized controlled trial.Arch Surg,146,143-8.
33. Lee, WJ,Yu, PJ,Wang, W,Chen, TC,Wei, PL,Huang, MT(2005).Laparoscopic roux-en-y versus mini-gastric bypass for the treatment of morbid obesity.Ann Surg,242,20-8.
34. Lee, YC,Lee, WJ,Liew, PL(2013).Predictors of remission of type 2 diabetes mellitus in obese patients after gastrointestinal surgery.Obes Res Clin Pract,7,494-500.
35. Longo, DL(ed.),Fauci, AS(ed.),Kasper, DL(ed.)(2012).Harrison's Principles of Internal Medicine.McGraw-Hill:McGraw-Hill.
36. Lonnqvist, F,Thorne, A,Large, V,Arner, P(1997).Sex differences in visceral fat lipolysis and metabolic complications of obesity.Arterioscler Thromb Vasc Biol,17,1472-80.
37. Maggard, MA,Shugarman, LR,Suttorp, M(2005).Meta-analysis: surgical treatment of obesity.Ann Int Med,142,547-59.
38. Markle, WH(ed.),Fisher, MA(ed.),Smego, RA, Jr(ed.)(2013).Understanding Global Health.New York:McGraw-Hill Education.
39. Miras, AD,le Roux, CW(2010).Bariatric surgery and taste: novel mechanisms of weight loss.Curr Opin Gastroenterol,26,140-5.
40. Mizrahi, I,Beglaibter, N,Simanovsky, N(2014).Ultrasound evaluation of visceral and subcutaneous fat reduction in morbidly obese subjects undergoing laparoscopic gastric banding, sleeve gastrectomy, and roux-en-y gastric bypass: a prospective comparison study.Obes Surg,25,959-66.
41. Musella, M,Milone, M,Gaudioso, D(2014).A decade of bariatric surgery: what have we learned? outcome in 520 patients from a single institution.Int J Surg,12,183-8.
42. Must, A,Spadano, J,Coakley, E(1999).The disease burden associated with overweight and obesity.JAMA,282,1523-9.
43. NIH Conference(1991).Gastrointestinal surgery for severe obesity.Ann Int Med,115,959-61.
44. Nishida, C,Ko, GT,Kumanyika, S(2010).Body fat distribution and noncommunicable diseases in populations: overview of the 2008 WHO expert consultation on waist circumference and waist-hip ratio.Eur J Clin Nutr,64,2-5.
45. Ostlund, RE, Jr,Staten, M,Kohrt, WM,Schultz, J,Malley, M(1990).The ratio of waist-tohip circumference, plasma insulin level, and glucose intolerance as independent predictors of the HDL2 cholesterol level in older adults.N Engl J Med,322,229-34.
46. Paul, NM,Dimitrios, S,James, N,Keith, G,Timothy, K(2011).Reported excess weight loss after bariatric surgery could vary significantly depending on calculation method: a plea for standardization.Surg Obes Relat Dis,7,531-5.
47. Pedersen, SB,Kristensen, K,Hermann, PA,Katzenellenbogen, JA,Richelsen, B(2004).Estrogen controls lipolysis by up-regulating alpha2A-adrenergic receptors directly in human adipose tissue through the estrogen receptor alpha. Implications for the female fat distribution.J Clin Endocrinol Metab,89,1869-78.
48. Pietrobelli, A,Rubiano, F,St-Onge, MP,Heymsfield, S(2004).New bioimpedance analysis system: improved phenotyping with wholebody analysis.Eur J Clin Nutr,58,1479-84.
49. Puzziferri, N,Roshek, TB(2014).Long-term followup after bariatric surgery: a systematic review.JAMA,312,934-42.
50. Seidell, JC,Cigolini, M,Charzewska, J,Ellsinger, BM,Di, BG(1990).Fat distribution in European women: a comparison of anthropometric measurements in relation to cardiovascular risk factors.Int J Epidemiol,19,303-8.
51. Valve, R,Sivenius, K,Miettinen, R(1999).Two polymorphisms in the peroxisome proliferator-activated receptor- gamma gene are associated with severe overweight among obese women.J Clin Endocrinol Metab,84,3708-12.
52. Wajchenberg, BL(2000).Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome.Endocr Rev,21,697-738.
53. Williams, CM(2004).Lipid metabolism in women.Proc Nutr Soc,63,153-60.
54. World Health Organization=WHO(2008).Waist circumference and waist-hip ratio: Report of a WHO expert consultation.Geneva:
55. Yeh, CJ,Chang, HY,Pan, WH(2011).Time trend of obesity, the metabolic syndrome and related dietary pattern in Taiwan: from NAHSIT 1993-1996 to NAHSIT 2005-2008.Asia Pac J Clin Nutr,20,292-300.
56. 王自勉(2000)。人體組成學：歷史、現況和未來。生理科學進展，31，185-92。
57. 楊宜青編(2008)。肥胖症—原因、病理生理及治療。台北:台灣肥胖醫學會。

1. 劉冠伶、黃詩芸、曾暐翔、陳淑慧、郭素娥、張秦松、李國鼎、呂忻瑾、吳至行(2018)。不同代謝性手術對身體組成之影響。臺灣家庭醫學雜誌，28(4)，193-207。