| Summary: | 博士 === 臺灣大學 === 職業醫學與工業衛生研究所 === 98 === Objective: The aims of our study are to (1) compare the health-related quality of life (HRQOL) between patients with morbid obesity and the healthy population in Taiwan (2) evaluate the effects of bariatric surgery on the dynamic changes of HRQOL during one year follow-up (3) translate the Moorehead-Ardelt Quality of Life Questionnaire II (MA II) into Chinese and validate it (4) use QOL measurement to investigate the impact of long-term rotating shift work.
Background: The prevalence of obesity has increased markedly in the past several decades, and is now a major public health issue. In Taiwan, the prevalence of obesity were 19.2% and 13.4% for man and woman, respectively. Many obesity-related co-morbidities have been documented and account for the use of considerable medical resources worldwide. In particular, obesity is closely related to metabolic syndrome, which has been emphasized by rotating shift work (RSW) in occupational medicine recently. Morbid obesity could also significantly affect quality of life. Bariatric surgery could reduce body weight and improve HRQOL effectively, but no study has shown detailed profiles of HRQOL changes along with time. The MA II is a obesity specific questionnaire and it has been applied in many studies. The impact of RSW on QOL is unclear.
Material and Methods: Patients were enrolled for bariatric surgery by a modified recommendation of the Asia-Pacific consensus. WHOQOL-BREF was administered 1 month before the operation, 1, 3, 6, and 12 months after surgery. BMI, co-morbidities and operation related complications was also measured simultaneously. A healthy reference group was randomly sampled from the database of National Health Interview Survey in Taiwan. Mixed-effect model was constructed to analyze the repeated measurements and determine the relationship among the BMI, WHOQOL scores, and other covariates. MA II was translated into Taiwan version in Chinese fist. Cross-validation of MA-II with WHOQOL and SF-36 were performed. WHOQOL-BREF was applied for the steel workers in annual health check up. Multiple linear regression models were conducted for the analysis of QOL and its determinants in all steel workers.
Results: A total of 114 consecutive patients with obesity coming for bariatric surgery at E-Da hospital were enrolled. Obese subjects had poorer WHOQOL-BREF scores than those of the healthy referents in physical, psychological and social domains but not in environment domain. Patients with BMI >32 kg/m2 had consistently poorer scores in various facets after adjusting for other risk factors. The mixed effect model showed that the physical, psychological and social domains improved after bariatric surgery with simultaneous reduction in weight and improvement in co-morbidities. There was a dip in scores in physical and psychological domains three to six months after surgery, significantly related to complications. All patients gradually improved between six and 12 months after surgery reaching levels similar to those of healthy subjects. Good test-retest reliability was shown by intra-class correlations ranging from 0.73 to 0.91. The total sum of MA II scores was significantly correlated with all 4 domains of the WHOQOL-BREF and 2 major components of SF-36. Totally 471 steel workers were enrolled for QOL measurement and 35.5% of them had RSW. Morbid obesity decreased the QOL scores of psychological domain. The facet of sleep and rest did not showed negative impact by long-term RSW.
Conclusion: The higher the BMI level the poorer the HRQOL. Our findings seem to support the recommendations of Asia-Pacific consensus based on HRQOL considerations. HRQOL improved dramatically after bariatric surgery, dipped slightly between three and six months and improved again up to the end of the first year. The MA II Taiwan version is an obesity-specific questionnaire for QOL evaluation with satisfactory reliability and validity. The steel workers in Taiwan with long-term RSW seem to accommodate the circadian rhythm without disturbance of sleep and rest, whose sores of WHOQOL-BREF were better in various associating facets of physical and social domains.
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