目的:本指南(GL)旨在为超重或肥胖与代谢并发症相关且对生活方式改变有抵抗力的成年患者的管理提供临床实践参考。
方法:外科医生,内分泌学家,胃肠病学家,心理学家,药理学家,全科医生,营养学家,一名护士和一名患者代表充当多学科小组。本总账是根据建议评估等级制定的,开发和评估(等级)方法。由一个方法学组进行系统评价和网络荟萃分析。对于每个问题,小组确定了潜在的相关结果,然后对它们对治疗选择的影响进行评级。在对证据的系统评价中,仅考虑了分类为“关键”和“重要”的结果。那些被归类为“关键”的被认为是临床实践建议。通过多数票达成了关于建议的方向(赞成或反对)和强度(有力或有条件)的共识。
结果:本GL为BMI>27kg/m2和<40kg/m2与体重相关的代谢合并症相关的成年患者人群的临床管理提供了药物和手术治疗的建议。抵制生活方式的改变。小组:建议及时实施治疗干预措施,除了饮食和体力活动;建议使用semaglutide2.4毫克/周,并建议利拉鲁肽3毫克/天的肥胖或超重患者也受糖尿病或糖尿病前期影响;建议semaglutide2.4毫克/周的肥胖或超重患者也受非酒精性脂肪肝影响;建议semagluttide2.4毫克/周作为超重或超重患者的高甘油三酯降低的患者的一剂情绪化饮食;建议手术干预(袖状胃切除术,Roux-en-Y胃旁路术,对于BMI≥35kg/m2的患者,适合进行代谢手术的患者,或代谢性胃旁路术/单次吻合胃旁路术/胃微型旁路术;并建议尽可能进行胃束带术,虽然效果较差,手术替代方案。
结论:当前的GL针对所有在医院工作的肥胖患者的医生,领土服务或私人执业-以及全科医生和患者。建议还应考虑患者的偏好以及可用的资源和专业知识。
OBJECTIVE: This
guideline (GL) is aimed at providing a clinical practice reference for the management of adult patients with overweight or obesity associated with metabolic complications who are resistant to lifestyle modification.
METHODS: Surgeons, endocrinologists, gastroenterologists, psychologists, pharmacologists, a general practitioner, a nutritionist, a nurse and a patients\' representative acted as multi-disciplinary panel. This GL has been developed following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. A systematic review and network meta-analysis was performed by a methodologic group. For each question, the panel identified potentially relevant outcomes, which were then rated for their impact on therapeutic choices. Only outcomes classified as \"critical\" and \"important\" were considered in the systematic review of evidence. Those classified as \"critical\" were considered for clinical practice recommendations.
Consensus on the direction (for or against) and strength (strong or conditional) of recommendations was reached through a majority vote.
RESULTS: The present GL provides recommendations about the role of both pharmacological and surgical treatment for the clinical management of the adult patient population with BMI > 27 kg/m2 and < 40 kg/m2 associated with weight-related metabolic comorbidities, resistant to lifestyle changes. The panel: suggests the timely implementation of therapeutic interventions in addition to diet and physical activity; recommends the use of semaglutide 2.4 mg/week and suggests liraglutide 3 mg/day in patients with obesity or overweight also affected by diabetes or pre-diabetes; recommends semaglutide 2.4 mg/week in patients with obesity or overweight also affected by non-alcoholic fatty liver disease; recommends semaglutide 2.4 mg/week as first-line drug in patients with obesity or overweight that require a larger weight loss to reduce comorbidities; suggests the use of orlistat in patients with obesity or overweight also affected by hypertriglyceridemia that assume high-calorie and high-fat diet; suggests the use of naltrexone/bupropion combination in patients with obesity or overweight, with emotional eating; recommends surgical intervention (sleeve gastrectomy, Roux-en-Y gastric bypass, or metabolic gastric bypass/gastric bypass with single anastomosis/gastric mini bypass in patients with BMI ≥ 35 kg/m2 who are suitable for metabolic surgery; and suggests gastric banding as a possible, though less effective, surgical alternative.
CONCLUSIONS: The present GL is directed to all physicians addressing people with obesity-working in hospitals, territorial services or private practice-and to general practitioners and patients. The recommendations should also consider the patient\'s preferences and the available resources and expertise.