Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials

作者：Viktoria Gloy, Matthias Briel, Deepak L. Bhatt, Sangeeta Rao Kashyap, Philip R. Schauer, Geltrude Mingrone, Heiner C. Bucher, A. J. Nordmann · 发表于：BMJ · 年份：2013 · DOI：10.1136/bmj.f5934 · 被引用次数：1361 · 研究领域：Bariatric Surgery and Outcomes、Cardiovascular Disease and Adiposity、Cardiovascular Function and Risk Factors

OBJECTIVE: To quantify the overall effects of bariatric surgery compared with non-surgical treatment for obesity. DESIGN: Systematic review and meta-analysis based on a random effects model. DATA SOURCES: Searches of Medline, Embase, and the Cochrane Library from their inception to December 2012 regardless of language or publication status. ELIGIBILITY CRITERIA: Eligible studies were randomised controlled trials with ≥ 6 months of follow-up that included individuals with a body mass index ≥ 30, compared current bariatric surgery techniques with non-surgical treatment, and reported on body weight, cardiovascular risk factors, quality of life, or adverse events. RESULTS: The meta-analysis included 11 studies with 796 individuals (range of mean body mass index at baseline 30-52). Individuals allocated to bariatric surgery lost more body weight (mean difference -26 kg (95% confidence interval -31 to -21)) compared with non-surgical treatment, had a higher remission rate of type 2 diabetes (relative risk 22.1 (3.2 to 154.3) in a complete case analysis; 5.3 (1.8 to 15.8) in a conservative analysis assuming diabetes remission in all non-surgically treated individuals with missing data) and metabolic syndrome (relative risk 2.4 (1.6 to 3.6) in complete case analysis; 1.5 (0.9 to 2.3) in conservative analysis), greater improvements in quality of life and reductions in medicine use (no pooled data). Plasma triglyceride concentrations decreased more (mean difference -0.7 mmol/L (-1.0 to...