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Abstract-Little is known about the relationship between lower-limb amputation (LLA) and subsequent changes in body weight. We conducted a retrospective cohort study using clinical and administrative databases to identify and follow weight changes in 759 males with amputation (partial foot amputation [PFA], n = 396; transtibial amputation [TTA], n = 267; and transfemoral amputation [TFA], n = 96) and 3,790 men without amputation frequency-matched (5:1) on age, body mass index, diabetes, and calendar year from eight Department of Veterans Affairs medical care facilities in the Pacific Northwest. We estimated and compared longitudinal percent weight change from baseline up to 39 mo of follow-up in men with and without amputation. Weight gain in the 2 yr after amputation was significantly more in men with an amputation than without, and in men with a TTA or TFA (8%-9% increase) than in men with a PFA (3%-6% increase). Generally, percent weight gain peaked at 2 yr and was followed by some weight loss in the third year. These findings indicate that LLA is often followed by clinically important weight gain. Future studies are needed to better understand the reasons for weight gain and to identify intervention strategies to prevent excess weight gain and the deleterious consequences that may ensue.
Key words: adult, lower-limb amputation, men, obesity, partial foot amputation, toe amputation, transfemoral amputation, transtibial amputation, Veterans, weight change.
Abbreviations: BMI = body mass index, DCG = diagnostic cost group, ICD-9 = International Classification of Diseases-9th edition, LLA = lower-limb amputation, PFA = partial foot amputation, SCD = service-connected disability, TFA = transfemoral amputation, TTA = transtibial amputation, VA = Department of Veterans Affairs, VISN = Veterans Integrated Service Network.
INTRODUCTION
An estimated 185,000 amputations are performed each year in the United States [1-3]. Excess body weight is a major concern for people with a lower-limb amputation (LLA) because it can have numerous deleterious consequences, including an increased risk of musculoskeletal pain, osteoarthritis, cardiovascular disease, falls and other injuries, impaired functional capacity, reduced prosthesis fit and function, and a diminished quality of life [4-8]. These consequences can in turn result in reduced activity levels and a cascade of events such as increased wheelchair use, a more sedentary lifestyle, greater healthcare utilization and costs, reduced ability to live independently,...