Construction of a Prediction Model for Inadequate Weight Loss After Sleeve Gastrectomy Based on Preoperative Indicators.

INTRODUCTION

Inadequate weight loss (IWL) after sleeve gastrectomy may lead to persistent obesity-related comorbidities and adversely affect long-term health outcomes. Evidence suggests that preoperative metabolic status and body fat distribution are closely associated with postoperative weight loss outcomes. This study aimed to identify preoperative predictors of IWL 1 year after laparoscopic sleeve gastrectomy (LSG) and to develop a clinically applicable nomogram for risk stratification.

METHODS

A total of 1,111 patients were initially included. Due to unavailable follow-up data, 989 patients were included in the final analysis. Patients were randomly allocated into training (70%) and validation (30%) sets. Predictor selection used least absolute shrinkage and selection operator (LASSO) regression, followed by multivariable logistic regression. The nomogram was evaluated via discrimination (area under the receiver operating characteristic (AUC) curve) and calibration plots.

RESULTS

Four independent predictors of IWL were identified: fasting plasma glucose (FPG) [odds ratio (OR) = 1.09, P = 0.02], visceral fat area (VFA) (OR = 1.01, P < 0.001), fatty liver index (FLI) (OR = 1.02, P < 0.001), and body roundness index (BRI) (OR = 1.28, P = 0.04). The nomogram demonstrated moderate discriminative ability, with an AUC of 0.79 in the training set and 0.77 in the validation set and calibration was excellent (Hosmer-Lemeshow test P > 0.05).

CONCLUSION

FPG, VFA, FLI, and BRI were identified as key predictors of IWL after LSG. The developed nomogram may serve as a preliminary tool for preoperative risk stratification of patients with obesity at risk for IWL, although further external validation is required before clinical implementation, enabling personalized intervention strategies.