1
|
Lee Y, Shin T, Tessier L, Javidan A, Jung J, Hong D, Strong AT, McKechnie T, Malone S, Jin D, Kroh M, Dang JT. Harnessing artificial intelligence in bariatric surgery: comparative analysis of ChatGPT-4, Bing, and Bard in generating clinician-level bariatric surgery recommendations. Surg Obes Relat Dis 2024; 20:603-608. [PMID: 38644078 DOI: 10.1016/j.soard.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 03/09/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND The formulation of clinical recommendations pertaining to bariatric surgery is essential in guiding healthcare professionals. However, the extensive and continuously evolving body of literature in bariatric surgery presents considerable challenge for staying abreast of latest developments and efficient information acquisition. Artificial intelligence (AI) has the potential to streamline access to the salient points of clinical recommendations in bariatric surgery. OBJECTIVES The study aims to appraise the quality and readability of AI-chat-generated answers to frequently asked clinical inquiries in the field of bariatric and metabolic surgery. SETTING Remote. METHODS Question prompts inputted into AI large language models (LLMs) and were created based on pre-existing clinical practice guidelines regarding bariatric and metabolic surgery. The prompts were queried into 3 LLMs: OpenAI ChatGPT-4, Microsoft Bing, and Google Bard. The responses from each LLM were entered into a spreadsheet for randomized and blinded duplicate review. Accredited bariatric surgeons in North America independently assessed appropriateness of each recommendation using a 5-point Likert scale. Scores of 4 and 5 were deemed appropriate, while scores of 1-3 indicated lack of appropriateness. A Flesch Reading Ease (FRE) score was calculated to assess the readability of responses generated by each LLMs. RESULTS There was a significant difference between the 3 LLMs in their 5-point Likert scores, with mean values of 4.46 (SD .82), 3.89 (.80), and 3.11 (.72) for ChatGPT-4, Bard, and Bing (P < .001). There was a significant difference between the 3 LLMs in the proportion of appropriate answers, with ChatGPT-4 at 85.7%, Bard at 74.3%, and Bing at 25.7% (P < .001). The mean FRE scores for ChatGPT-4, Bard, and Bing, were 21.68 (SD 2.78), 42.89 (4.03), and 14.64 (5.09), respectively, with higher scores representing easier readability. CONCLUSIONS LLM-based AI chat models can effectively generate appropriate responses to clinical questions related to bariatric surgery, though the performance of different models can vary greatly. Therefore, caution should be taken when interpreting clinical information provided by LLMs, and clinician oversight is necessary to ensure accuracy. Future investigation is warranted to explore how LLMs might enhance healthcare provision and clinical decision-making in bariatric surgery.
Collapse
Affiliation(s)
- Yung Lee
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada; Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Thomas Shin
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Léa Tessier
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Arshia Javidan
- Division of Vascular Surgery, University of Toronto, Toronto, Ontario, Canada
| | - James Jung
- Division of General Surgery, Duke University, Durham, North Carolina
| | - Dennis Hong
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Andrew T Strong
- Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | - Tyler McKechnie
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Sarah Malone
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
| | - David Jin
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Matthew Kroh
- Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jerry T Dang
- Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio.
| |
Collapse
|
2
|
Robinson TN, Armstrong SC. Treatment Interventions for Child and Adolescent Obesity: From Evidence to Recommendations to Action. JAMA 2024:2820247. [PMID: 38888897 DOI: 10.1001/jama.2024.11980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Affiliation(s)
- Thomas N Robinson
- Stanford Solutions Science Lab, Center for Healthy Weight, Division of General Pediatrics and Stanford Prevention Research Center, Departments of Pediatrics, Medicine, and Epidemiology and Population Health, Stanford University, Palo Alto, California
| | - Sarah C Armstrong
- Division of General Pediatrics and Adolescent Health, Duke Center for Childhood Obesity Research, Department of Pediatrics, Duke University, Chapel Hill, North Carolina
| |
Collapse
|
3
|
Lee Y, Hircock C, Dang J, Jung J, Zevin B, Elnahas A, Khamar J, Vergis A, Tahir U, Hardy K, Samarasinghe Y, Gill R, Gu J, McKechnie T, Pescarus R, Biertho L, Lam E, Neville A, Ellsmere J, Karmali S, Jackson T, Okrainec A, Doumouras A, Kroh M, Hong D. Assessment of guidelines for bariatric and metabolic surgery: a systematic review and evaluation using appraisal of guidelines for research and evaluation II (AGREE II). Int J Obes (Lond) 2024:10.1038/s41366-024-01559-7. [PMID: 38890403 DOI: 10.1038/s41366-024-01559-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 05/01/2024] [Accepted: 05/31/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND In recent years, multiple guidelines on bariatric and metabolic surgery were published, however, their quality remains unknown, leaving providers with uncertainty when using them to make perioperative decisions. This study aims to evaluate the quality of existing guidelines for perioperative bariatric surgery care. METHODS A comprehensive search of MEDLINE and EMBASE were conducted from January 2010 to October 2022 for bariatric clinical practice guidelines. Guideline evaluation was carried out using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) framework. RESULTS The initial search yielded 1483 citations, of which, 26 were included in final analysis. The overall median domain scores for guidelines were: (1) scope and purpose: 87.5% (IQR: 57-94%), (2) stakeholder involvement: 49% (IQR: 40-64%), (3) rigor of development: 42.5% (IQR: 22-68%), (4) clarity of presentation: 85% (IQR: 81-90%), (5) applicability: 6% (IQR: 3-16%), (6) editorial independence: 50% (IQR: 48-67%), (7) overall impressions: 48% (IQR: 33-67%). Only six guidelines achieved an overall score >70%. CONCLUSIONS Bariatric surgery guidelines effectively outlined their aim and presented recommendations. However, many did not adequately seek patient input, state search criteria, use evidence rating tools, and consider resource implications. Future guidelines should reference the AGREE II framework in study design.
Collapse
Affiliation(s)
- Yung Lee
- Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - Caroline Hircock
- Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - Jerry Dang
- Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - James Jung
- Division of General Surgery, University of Toronto, Toronto, ON, Canada
| | - Boris Zevin
- Department of Surgery, Queen's University, Kingston, ON, Canada
| | - Ahmad Elnahas
- Division of General Surgery, Western University, London, ON, Canada
| | - Jigish Khamar
- Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - Ashley Vergis
- Division of General Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Umair Tahir
- Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - Krista Hardy
- Division of General Surgery, University of Manitoba, Winnipeg, MB, Canada
| | | | - Richdeep Gill
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Jeffrey Gu
- Division of General Surgery, University of Saskatchewan, Saskatoon, SK, Canada
| | - Tyler McKechnie
- Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - Radu Pescarus
- Division of General Surgery, University of Montreal, Montreal, QC, Canada
| | - Laurent Biertho
- Department of Surgery, Laval University, Quebec City, QC, Canada
| | - Elaine Lam
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Amy Neville
- Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - James Ellsmere
- Division of General and Gastrointestinal Surgery, Dalhousie University, Halifax, NS, Canada
| | - Shahzeer Karmali
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Timothy Jackson
- Division of General Surgery, University of Toronto, Toronto, ON, Canada
| | - Allan Okrainec
- Division of General Surgery, University of Toronto, Toronto, ON, Canada
| | | | - Matthew Kroh
- Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Dennis Hong
- Division of General Surgery, McMaster University, Hamilton, ON, Canada.
| |
Collapse
|
4
|
Pramanik S, Mondal S, Palui R, Ray S. Type 2 diabetes in children and adolescents: Exploring the disease heterogeneity and research gaps to optimum management. World J Clin Pediatr 2024; 13:91587. [DOI: 10.5409/wjcp.v13.i2.91587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 04/07/2024] [Accepted: 04/18/2024] [Indexed: 06/07/2024] Open
Abstract
Over the past 20 years, the incidence and prevalence of type 2 diabetes mellitus (T2DM) in children and adolescents have increased, particularly in racial and ethnic minorities. Despite the rise in T2DM in children and adolescents, the pathophysiology and progression of disease in this population are not clearly understood. Youth-onset T2DM has a more adverse clinical course than is seen in those who develop T2DM in adulthood or those with T1DM. Furthermore, the available therapeutic options are more limited for children and adolescents with T2DM compared to adult patients, mostly due to the challenges of implementing clinical trials. A better understanding of the mechanisms underlying the de-velopment and aggressive disease phenotype of T2DM in youth is important to finding effective prevention and management strategies. This review highlights the key evidence about T2DM in children and adolescents and its current burden and challenges both in clinical care and research activities.
Collapse
Affiliation(s)
- Subhodip Pramanik
- Department of Endocrinology, Neotia Getwel Multi-specialty hospital, Siliguri 734010, West Bengal, India
| | - Sunetra Mondal
- Department of Endocrinology, NRS Medical College and Hospital, Kolkata 700014, West Bengal, India
| | - Rajan Palui
- Department of Endocrinology, The Mission Hospital, Durgapur 713212, West Bengal, India
| | - Sayantan Ray
- Department of Endocrinology, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar 751019, Odisha, India
| |
Collapse
|
5
|
Kermansaravi M, Shahmiri SS, Kow L, Gawdat K, Abbas SI, Aly A, Bashir A, Bhandari M, Haddad A, ElFawal MH, Inam A, Kasama K, Kim SH, Kular KS, Lakdawala M, Layani LA, Lee WJ, Pazouki A, Prasad A, Safadi B, Wang C, Yang W, Adib R, Jazi AHD, Shabbir A. Technical Variations and Considerations around OAGB in IFSO-APC and IFSO-MENAC Chapters, an Expert Survey. Obes Surg 2024; 34:2054-2065. [PMID: 38662251 DOI: 10.1007/s11695-024-07239-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE This study aimed to evaluate the technical variations of one-anastomosis gastric bypass (OAGB) among IFSO-APC and MENAC experts. BACKGROUND The multitude of technical variations and patient selection challenges among metabolic and bariatric surgeons worldwide necessitates a heightened awareness of these issues. Understanding different perspectives and viewpoints can empower surgeons performing OAGB to adapt their techniques, leading to improved outcomes and reduced complications. METHODS The scientific team of IFSO-APC, consisting of skilled bariatric and metabolic surgeons specializing in OAGB, conducted a confidential online survey. The survey aimed to assess technical variations and considerations related to OAGB within the IFSO-APC and IFSO-MENAC chapters. A total of 85 OAGB experts participated in the survey, providing their responses through a 35-question online format. The survey took place from January 1, 2024, to February 15, 2024. RESULTS Most experts do not perform OAGB for children and adolescents younger than 18 years. Most experts create the gastric pouch over a 36-40-F bougie and prefer to create a gastrojejunostomy, at the posterior wall of the gastric pouch. An anti-reflux suture during OAGB is performed in all patients by 51.8% of experts. Most experts set a common limb length of > 4 m in revisional and conversional OAGBs to prevent nutritional complications. CONCLUSION The ongoing debate among metabolic and bariatric surgeons regarding the technical variations and patient selection in OAGB remains a significant point of discussion. This survey demonstrated the variations in technical aspects and patient selection for OAGB among MBS surgeons in the IFSO-APC and IFSO-MENAC chapters. Standardizing the OAGB technique is crucial to ensure optimal safety and efficacy in this procedure.
Collapse
Affiliation(s)
- Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Hazrat‑E Fatemeh Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Shahab Shahabi Shahmiri
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Hazrat‑E Fatemeh Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Lilian Kow
- Adelaide Bariatric Centre, Flinders University of South Australia, Adelaide, Australia
| | - Khaled Gawdat
- Bariatric Surgery Unit, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Ahmad Aly
- Austin and Repatriation Medical Centre, Heidelberg, Victoria, Australia
- University of Melbourne, Melbourne, Australia
| | - Ahmad Bashir
- Minimally Invasive and Bariatric Surgery, Gastrointestinal Bariatric and Metabolic Center (GBMC), Jordan Hospital, Amman, Jordan
| | | | - Ashraf Haddad
- Minimally Invasive and Bariatric Surgery, Gastrointestinal Bariatric and Metabolic Center (GBMC), Jordan Hospital, Amman, Jordan
| | | | - Atif Inam
- Metabolic, Thoracic & General Surgery Unit III, Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Kazunori Kasama
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Sang Hyun Kim
- Department of Surgery, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | | | | | | | - Wei-Jei Lee
- Medical Weight Loss Center, China Medical University Hsinchu Hospital, Zhubei, Taiwan
| | - Abdolreza Pazouki
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Hazrat‑E Fatemeh Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Cunchuan Wang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Reza Adib
- The Wesley Hospital, Auchenflower, Queensland, Australia
| | - Amir Hossein Davarpanah Jazi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Hazrat‑E Fatemeh Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Asim Shabbir
- National University of Singapore, Singapore, Singapore
| |
Collapse
|
6
|
Karakso D. A systematic review and meta-analysis combing adolescent and adult data to evaluate weight loss and the effect of age following the laparoscopic sleeve gastrectomy. Obes Rev 2024:e13770. [PMID: 38804033 DOI: 10.1111/obr.13770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 03/05/2024] [Accepted: 04/14/2024] [Indexed: 05/29/2024]
Abstract
Obesity is a grave concern within the United States, resulting in lost productivity, increased medical costs, and comorbidities with lifelong repercussions. The laparoscopic sleeve gastrectomy is a treatment option for obesity. The following meta-analysis sought to combine adolescent and adult literature to determine the overall effect of the sleeve gastrectomy on weight loss, to evaluate the effect of age at the time of surgery on weight loss, and to describe and explore variation in weight loss by sample characteristics. Overall weight loss was assessed at proximal and distal points, a dichotomous moderator variable analysis was conducted with subjects ≤21 years of age and >21 years of age, and a meta-regression assessing % male, % female, and baseline BMI was conducted to assess moderator variables. The laparoscopic sleeve gastrectomy was effective at facilitating weight loss with effect sizes varying from 0.916 to2.816. Age, biological sex, and baseline BMI were not found to have an impact on weight loss. The clinical consequences of prolonged obesity are evident and earlier intervention may be justified to counter the long-term effects caused by obesity related comorbidities. Standardized reporting of comorbidities and the effect of bariatric surgery on comorbid conditions is essential to allow further analysis.
Collapse
Affiliation(s)
- Danielle Karakso
- University of Missouri, Columbia, Missouri, USA
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| |
Collapse
|
7
|
Liang NE, Herdes RE, Balili R, Pratt JSA, Bruzoni M. Sleeve gastrectomy for the treatment of adolescent obesity in children aged 13 and under: a retrospective study. Surg Obes Relat Dis 2024; 20:354-361. [PMID: 38195315 DOI: 10.1016/j.soard.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 11/28/2023] [Accepted: 12/06/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Sleeve gastrectomy (SG) induces weight reduction and improves metabolic co-morbidities in children with severe obesity but remains underutilized, especially for young adolescents and preadolescents. OBJECTIVE We hypothesized there would be no differences in weight loss or co-morbidity resolution at 1 year post-SG in children who underwent SG at 13 years or younger compared to children who underwent SG at 17-18 years old. SETTING Academic medical center, United States. METHODS Medical records of children who underwent laparoscopic SG at a quaternary academic center from September 2014 to October 2022 were reviewed. A cohort of 15 patients, ≤13 years of age, was compared to a matched cohort of 15 older adolescent patients. Preoperative characteristics and postoperative outcomes were collected. RESULTS Both cohorts had similar baseline characteristics. Median preoperative body mass index (BMI) was 51.8 kg/m2 for the ≤13 cohort compared to 50.9 kg/m2 in the older cohort (P = .87). Time to postoperative enteral feeds and length of stay were similar between both groups, and there were no 30-day readmissions or immediate postoperative complications. Median percentage excess BMI loss at 1 year postoperation was 54% (IQR, 25.5%-94.5%) for the ≤13 cohort compared with 44% (IQR, 34.0%-51.0%) for the older cohort (P = .34). Two of 11 patients were lost to follow-up in the younger group compared to 4 of 15 in the older group (P = .61). Both groups demonstrated significant improvement in metabolic syndrome co-morbidities after SG. CONCLUSION SG in younger children is associated with successful postsurgical outcomes compared with adolescents, with effective weight loss and improvement of obesity-related metabolic co-morbidities.
Collapse
Affiliation(s)
- Norah E Liang
- Department of Surgery, Division of Pediatric Surgery, Stanford University School of Medicine, Stanford, California.
| | - Rachel E Herdes
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University School of Medicine, Stanford, California
| | - Rachelle Balili
- Department of Surgery, Division of Pediatric Surgery, Stanford University School of Medicine, Stanford, California
| | - Janey S A Pratt
- Department of Surgery, Division of Pediatric Surgery, Stanford University School of Medicine, Stanford, California
| | - Matias Bruzoni
- Department of Surgery, Division of Pediatric Surgery, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
8
|
Irvine WFE, Spivack OKC, Ista E. Moving toward the Development and Effective Implementation of High-Quality Guidelines in Pediatric Surgery: A Review of the Literature. Eur J Pediatr Surg 2024; 34:115-127. [PMID: 38242151 DOI: 10.1055/s-0043-1778020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
Applying evidence-based guidelines can enhance the quality of patient care. While robust guideline development methodology ensures credibility and validity, methodological variations can impact guideline quality. Besides methodological rigor, effective implementation is crucial for achieving improved health outcomes. This review provides an overview of recent literature pertaining to the development and implementation of guidelines in pediatric surgery. Literature was reviewed to provide an overview of sound guideline development methodologies and approaches to promote effective guideline implementation. Challenges specific to pediatric surgery were highlighted. A search was performed to identify published guidelines relevant to pediatric surgery from 2018 to June 2023, and their quality was collectively appraised using the AGREE II instrument. High-quality guideline development can be promoted by using methodologically sound tools such as the Guidelines 2.0 checklist, the GRADE system, and the AGREE II instrument. While implementation can be promoted during guideline development and post-publication, its effectiveness may be influenced by various factors. Challenges pertinent to pediatric surgery, such as limited evidence and difficulties with outcome selection and heterogeneity, may impact guideline quality and effective implementation. Fifteen guidelines were identified and collectively appraised as suboptimal, with a mean overall AGREE II score of 58%, with applicability being the lowest scoring domain. There are identified challenges and barriers to the development and effective implementation of high-quality guidelines in pediatric surgery. It is valuable to prioritize the identification of adapted, innovative methodological strategies and the use of implementation science to understand and achieve effective guideline implementation.
Collapse
Affiliation(s)
- Willemijn F E Irvine
- Department of Evidence Based Medicine and Methodology, Qualicura Healthcare Support Agency, Breda, the Netherlands
- Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Olivia K C Spivack
- Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Erwin Ista
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
- Department of Internal Medicine, Division of Nursing Science, Erasmus Medical Center, Rotterdam, the Netherlands
| |
Collapse
|
9
|
Wasserman H, Jenkins T, Inge T, Ryder J, Michalsky M, Sisley S, Xie C, Kalkwarf HJ. Bone mineral density in young adults 5 to 11 years after adolescent metabolic and bariatric surgery for severe obesity compared to peers. Int J Obes (Lond) 2024; 48:575-583. [PMID: 38177697 DOI: 10.1038/s41366-023-01453-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/06/2023] [Accepted: 12/14/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE Metabolic and bariatric surgery (MBS) is associated with decreased bone mineral density (BMD) in adults. The long-term impact of MBS during adolescence on BMD is unknown. We report bone health status 5 to 11 years after Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) from the Teen-LABS study cohort. METHODS Between 2016 and 2022, BMD was measured by dual energy x-ray absorptiometry (DXA) in 106 young adults who had undergone MBS as adolescents. Volumetric BMD by peripheral quantitative computed tomography was measured on a subset. Ninety-one controls who had not undergone MBS were recruited for comparison. RESULTS In cases (RYGB: mean age 26.8 ± 1.9 years, mean BMI 42.1 ± 9.9 kg/m2, VSG: mean age 25.1 ± 2.1 years, mean BMI 37.1 ± 8.4 kg/m2), compared to controls (mean age 26.5 ± 2.7 years, mean BMI 40.2 ± 8.7 kg/m2) (age p < 0.001, BMI p = 0.02), adjusted mean DXA-BMD (g/cm2) of the RYGB (n = 58) and VSG (n = 48) groups were lower at the hip (-10.0% and -6.3%), femoral neck (-9.6% and -5.7%) and ultra-distal radius (-7.9% and -7.0%; all p < 0.001), respectively. DXA-BMD did not differ between RYGB and VSG groups. Trabecular volumetric BMD at the radius and tibia were lower in the RYGB (-30% and -26%) and VSG (-15% and -14%) groups compared to the control group (p < 0.001). Greater time since MBS was associated with lower BMD Z-scores at the hip (p = 0.05) and femoral neck (p = 0.045). Percent change in body mass index (BMI) from baseline or in the first year after MBS were not associated with bone measures at a median of 9.3 years post MBS. CONCLUSION BMD, especially of the hip and femoral neck, was lower in young adults who underwent MBS during adolescence compared to matched peers who had not undergone MBS. BMD Z-scores of the femoral neck were inversely associated with time since MBS but were not associated with BMI change.
Collapse
Affiliation(s)
- Halley Wasserman
- Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, OH, USA.
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Todd Jenkins
- Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, OH, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Thomas Inge
- Department of Surgery, Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Justin Ryder
- Department of Surgery, Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Marc Michalsky
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
- The Ohio State University, College of Medicine, Columbus, OH, USA
| | - Stephanie Sisley
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- ARS/USDA Children's Nutrition Research Center, Houston, TX, USA
| | - Changchun Xie
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Heidi J Kalkwarf
- Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, OH, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| |
Collapse
|
10
|
Kang E, Hong YH, Kim J, Chung S, Kim KK, Haam JH, Kim BT, Kim EM, Park JH, Rhee SY, Kang JH, Rhie YJ. Obesity in Children and Adolescents: 2022 Update of Clinical Practice Guidelines for Obesity by the Korean Society for the Study of Obesity. J Obes Metab Syndr 2024; 33:11-19. [PMID: 38193204 PMCID: PMC11000513 DOI: 10.7570/jomes23060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/12/2023] [Accepted: 11/28/2023] [Indexed: 01/10/2024] Open
Abstract
The prevalence of obesity in children and adolescents has been gradually increasing in recent years and has become a major health problem. Childhood obesity can readily progress to adult obesity. It is associated with obesity-related comorbidities, such as type 2 diabetes mellitus, hypertension, obstructive sleep apnea, non-alcoholic fatty liver disease, and the risk factor for cardiovascular disease. It is important to make an accurate assessment of overweight and obesity in children and adolescents with consideration of growth and development. Childhood obesity can then be prevented and treated using an appropriate treatment goal and safe and effective treatment strategies. This article summarizes the clinical practice guidelines for obesity in children and adolescents that are included in the 8th edition of the Clinical Practice Guidelines for Obesity of the Korean Society for the Study of Obesity.
Collapse
Affiliation(s)
- Eungu Kang
- Department of Pediatrics, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Yong Hee Hong
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jaehyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sochung Chung
- Department of Pediatrics, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Kyoung-Kon Kim
- Department of Family Medicine, Gachon University College of Medicine, Incheon, Korea
| | - Ji-Hee Haam
- Deptartment of Family Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Bom Taeck Kim
- Department of Family Practice & Community Health, Ajou University School of Medicine, Suwon, Korea
| | - Eun Mi Kim
- Department of Dietetics, Kangbuk Samsung Hospital, Seoul, Korea
| | - Jung Hwan Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sang Youl Rhee
- Department of Endocrinology and Metabolism, College of Medicine, Kyung Hee University, Seoul, Korea
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Seoul, Korea
| | - Jee-Hyun Kang
- Department of Family Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Young-Jun Rhie
- Department of Pediatrics, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| |
Collapse
|
11
|
Tish S, Corcelles R. The Art of Sleeve Gastrectomy. J Clin Med 2024; 13:1954. [PMID: 38610719 PMCID: PMC11012326 DOI: 10.3390/jcm13071954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Sleeve gastrectomy (SG) has historically evolved from gastroplasty and anti-reflux procedures into one of the most commonly performed primary metabolic surgeries in the United States and worldwide. Initially initiated in the 1980s as part of the duodenal switch procedure, its standalone effectiveness and simplicity have led to increasing popularity globally. The rise in obesity rates transcends age boundaries, alarmingly affecting not only adults but also the younger demographic. This escalating trend is concerning, as it predisposes these populations to numerous future health complications, as well as highlighting the critical necessity for a safe and potent weight loss strategy. Although sleeve gastrectomy carries a higher risk for gastroesophageal reflux disease (GERD) compared to other bariatric procedures, it stands out as a reliable, safe and effective surgical solution for obesity. It is particularly beneficial for adolescents and patients with complex medical comorbidities, including, but not limited to, heart failure and immunocompromisation. It has also served as a bridge for transplants in morbidly obese patients with end-stage heart, liver and kidney disease due to its favorable safety profile.
Collapse
Affiliation(s)
- Shahed Tish
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH 44195, USA;
| | | |
Collapse
|
12
|
Schmoke N, Nemeh C, Gennell T, Schapiro D, Hiep-Catarino A, Alexander M, Chalphin AV, Crum RW, Holynskyj L, Kubacki T, Schechter WS, Zitsman J. Enhanced recovery after surgery improves clinical outcomes in adolescent bariatric surgery. Surg Obes Relat Dis 2024:S1550-7289(24)00123-0. [PMID: 38653653 DOI: 10.1016/j.soard.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/10/2024] [Accepted: 03/09/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) protocols are evidence-based, multimodal approaches to optimize patient recovery and minimize complications. OBJECTIVES Our team evaluated clinical outcomes following the implementation of an ERAS protocol for adolescents undergoing metabolic and bariatric surgery. SETTING Academic hospital, New York, NY, USA. METHODS We performed a single-institution longitudinal assessment of adolescents who underwent laparoscopic vertical sleeve gastrectomy (VSG) between August 2021 and November 2022. Unpaired t-tests and Fisher's exact test were used to compare means between groups and categorical factors. RESULTS Forty-three patients were included in the study, 21 who participated in the ERAS protocol and 22 control patients. ERAS cohort was 52% females, with a median age of 17.5 years and a median body mass index (BMI) of 46.3 kg/m2. The non-ERAS cohort was 59% females, with a median age of 16.7 years and a median BMI of 44.0 kg/m2. There were no significant differences between baseline characteristics. Patients in the ERAS group had a shorter time to oral intake (10.7 hours versus 21.5 hours, P < .01), lower morphine milligram equivalents (18.2 versus 97.0, P < .01), and shorter length of stay (1.5 days versus 2.0 days, P = .01). There were no significant differences between return visits to the emergency department (ED) within 30 days (3 versus 2, P = .66) or readmissions (0 versus 1, P = 1.0). CONCLUSIONS The described ERAS protocol is safe and effective in adolescents undergoing laparoscopic VSG and is associated with shorter time to oral intake, reduced opioid requirements, and shorter hospital lengths of stay with no increase in return ED visits or readmissions.
Collapse
Affiliation(s)
- Nicholas Schmoke
- Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons/New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York
| | - Christopher Nemeh
- Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons/New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York
| | - Tania Gennell
- Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons/New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York
| | - Dana Schapiro
- Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons/New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York
| | - Ashley Hiep-Catarino
- Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons/New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York
| | - Matthew Alexander
- Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons/New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York
| | - Alexander V Chalphin
- Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons/New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York
| | - Robert W Crum
- Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons/New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York
| | - Leign Holynskyj
- Deparment of Nursing/New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York
| | - Tatiana Kubacki
- Division of Pediatric Anesthesia, Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons/New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York
| | - William S Schechter
- Division of Pediatric Anesthesia, Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons/New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York; Division of Pediatric Pain Medicine and Advanced Care Medicine, Columbia University Vagelos College of Physicians and Surgeons/New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York; Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons/New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York
| | - Jeffrey Zitsman
- Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons/New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York.
| |
Collapse
|
13
|
Zhang L, Wang P, Huang J, Xing Y, Wong FS, Suo J, Wen L. Gut microbiota and therapy for obesity and type 2 diabetes. Front Endocrinol (Lausanne) 2024; 15:1333778. [PMID: 38596222 PMCID: PMC11002083 DOI: 10.3389/fendo.2024.1333778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/06/2024] [Indexed: 04/11/2024] Open
Abstract
There has been a major increase in Type 2 diabetes and obesity in many countries, and this will lead to a global public health crisis, which not only impacts on the quality of life of individuals well but also places a substantial burden on healthcare systems and economies. Obesity is linked to not only to type 2 diabetes but also cardiovascular diseases, musculoskeletal disorders, and certain cancers, also resulting in increased medical costs and diminished quality of life. A number of studies have linked changes in gut in obesity development. Dysbiosis, a deleterious change in gut microbiota composition, leads to altered intestinal permeability, associated with obesity and Type 2 diabetes. Many factors affect the homeostasis of gut microbiota, including diet, genetics, circadian rhythms, medication, probiotics, and antibiotics. In addition, bariatric surgery induces changes in gut microbiota that contributes to the metabolic benefits observed post-surgery. Current obesity management strategies encompass dietary interventions, exercise, pharmacotherapy, and bariatric surgery, with emerging treatments including microbiota-altering approaches showing promising efficacy. While pharmacotherapy has demonstrated significant advancements in recent years, bariatric surgery remains one of the most effective treatments for sustainable weight loss. However, access to this is generally limited to those living with severe obesity. This underscores the need for non-surgical interventions, particularly for adolescents and mildly obese patients. In this comprehensive review, we assess longitudinal alterations in gut microbiota composition and functionality resulting from the two currently most effective anti-obesity treatments: pharmacotherapy and bariatric surgery. Additionally, we highlight the functions of gut microbiota, focusing on specific bacteria, their metabolites, and strategies for modulating gut microbiota to prevent and treat obesity. This review aims to provide insights into the evolving landscape of obesity management and the potential of microbiota-based approaches in addressing this pressing global health challenge.
Collapse
Affiliation(s)
- Luyao Zhang
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, Jilin, China
- Section of Endocrinology, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, United States
| | - Pai Wang
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, Jilin, China
- Section of Endocrinology, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, United States
| | - Juan Huang
- Section of Endocrinology, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, United States
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology, Central South University, Ministry of Education, Changsha, Hunan, China
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yanpeng Xing
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, Jilin, China
- Section of Endocrinology, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, United States
| | - F. Susan Wong
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Jian Suo
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Li Wen
- Section of Endocrinology, Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, United States
| |
Collapse
|
14
|
Beck RH, Afrooz I, Suhail Masalawala M, Watad R, Al Shaban T, Deeb A. Characteristics of adolescents referred for bariatric surgery in Abu Dhabi, United Arab Emirates. Front Pediatr 2024; 12:1297251. [PMID: 38523841 PMCID: PMC10957758 DOI: 10.3389/fped.2024.1297251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/26/2024] [Indexed: 03/26/2024] Open
Abstract
About a third of children and adolescents are overweight or obese in the United Arab Emirates, and referrals for metabolic and bariatric surgery (MBS) are now common. Despite excellent evidence that MBS should be considered in adolescents with severe obesity, it remains a management approach of last resort in many cases. Baseline, real-world data on adolescent patients living with obesity referred for surgery, their characteristics, and how these relate to current and future referral policy are important to ensure best practice. Here we examined the demographic, anthropometric, and clinical characteristics of adolescents referred for MBS over a three-year period to Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, UAE. Ninety-two adolescents living with obesity were recruited: 54.3% were female, the average age was 16.3 ± 2.4 years, and 88.0% of patients had a first-degree relative with a history of obesity and 62% a family history of bariatric surgery. The average BMI was 47.7 ± 10.5, and the average percentage of the 95th percentile BMI was 169.5 ± 38.8%. Complications of obesity (hypertension, type 2 diabetes and prediabetes, dyslipidemia, and liver function abnormalities) were common. Our analysis highlights that there exists a mismatch between the profiles of patients referred for MBS, local guidelines, and international best practice in decision-making for referral to MBS services. While many adolescents in the UAE seem to enjoy family support and experience in the surgical management of obesity, local guidelines need updating to reflect changes in the definitions of obesity, thresholds for referral, and to remove unnecessary developmental stage barriers to increase the window for personalized surgical management.
Collapse
Affiliation(s)
- Reem Hassan Beck
- Clinical Trial Unit, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Imrana Afrooz
- Clinical Trial Unit, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | | | - Rama Watad
- Paediatric Endocrine Division, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Talat Al Shaban
- Department of Surgery, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Asma Deeb
- Paediatric Endocrine Division, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| |
Collapse
|
15
|
Cromwell P, McCarthy T, Fearon N, Heneghan H. Adolescent bariatric surgery-a survey of referring practitioners. Ir J Med Sci 2024:10.1007/s11845-024-03624-6. [PMID: 38459246 DOI: 10.1007/s11845-024-03624-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/29/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Recent guidelines, supported by large, well-designed studies, suggest that bariatric surgery is a safe and effective treatment for adolescents living with severe obesity to improve health and psychosocial functioning. The aim of this study was to assess the opinions and referral practices of general practitioners (GPs) and paediatricians in Ireland. METHODS A cross-sectional survey was circulated online to practising paediatricians and GPs. The survey consisted of a short introduction about childhood obesity and 12 questions on adolescent bariatric surgery and obesity medications. RESULTS There were 45 unique responses to the survey from 22 GPs (48%), 8 paediatricians (17%), and 15 others. Most GPs (72%) would not consider referring an adolescent for bariatric surgery. Paediatricians were significantly more likely to refer (72% vs. 28%, p = 0.034). A minimum BMI of 40 kg/m2 was the most common response, which GPs (45%) and paediatricians (37.5%) suggested should be a pre-requisite for surgery. There was strong support for family psychological assessment and a reported deficit in the community support needed to manage obesity. GPs were more likely than paediatricians to respond that anti-obesity medications should be made available to adolescents, specifically liraglutide (45% vs. 25%), semaglutide (45% vs. 37.5%), and orlistat (22% vs. 0%). DISCUSSION There is a reluctance among GPs to refer adolescents with severe obesity for consideration of bariatric surgery. Concerns regarding the different obesity treatments held by medical professionals should be addressed through education and engagement and should be fundamental to the development of child and adolescent obesity services.
Collapse
Affiliation(s)
- Paul Cromwell
- Department of Surgery, St. Vincent's University Hospital, Dublin, Ireland.
| | - Therese McCarthy
- Department of Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Naomi Fearon
- Department of Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Helen Heneghan
- Department of Surgery, St. Vincent's University Hospital, Dublin, Ireland
| |
Collapse
|
16
|
Michalsky MP, Pratt J. Addressing Disparities and Underutilization of Adolescent Metabolic and Bariatric Surgery. Pediatrics 2024; 153:e2023064375. [PMID: 38410852 DOI: 10.1542/peds.2023-064375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 02/28/2024] Open
Affiliation(s)
- Marc P Michalsky
- Department of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Janey Pratt
- Division of Pediatric Surgery, Stanford University, School of Medicine, Lucile Packard Children's Hospital, Palo Alto, California
| |
Collapse
|
17
|
Cuda S. Special considerations for the adolescent with obesity: An obesity medicine association (OMA) clinical practice statement (CPS) 2024. OBESITY PILLARS (ONLINE) 2024; 9:100096. [PMID: 38186667 PMCID: PMC10770754 DOI: 10.1016/j.obpill.2023.100096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 01/09/2024]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) details special considerations for the management of the adolescent with obesity. The information in this CPS is based on scientific evidence, supported by medical literature, and derived from the clinical experiences of members of the OMA. Methods The scientific information and clinical guidance in this CPS are based on scientific evidence, supported by the medical literature, and derived from the clinical perspectives of the authors. Results This OMA Clinical Practice Statement addresses special considerations in the management and treatment of adolescents with overweight and obesity. Conclusions This OMA Clinical Practice Statement on the adolescent with obesity is an overview of current recommendations. These recommendations provide a roadmap to the improvement of the health of adolescents with obesity, especially those with metabolic, physiological, and psychological complications. This CPS also addresses treatment recommendations and is designed to help the provider with clinical decision making.
Collapse
Affiliation(s)
- Suzanne Cuda
- Alamo City Healthy Kids and Families, 1919 Oakwell Farms Parkway, Ste 145, San Antonio, TX, 78218, USA
| |
Collapse
|
18
|
Leanza S, Coco D, Viola MG. Sleeve Gastrectomy: Literature Results. MAEDICA 2024; 19:137-146. [PMID: 38736914 PMCID: PMC11079741 DOI: 10.26574/maedica.2021.19.1.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Sleeve gastrectomy (SG) is the most frequently performed bariatric procedure globally. However, data regarding short- and long-term results remain insufficient. This study aimed to evaluate the short- and longterm effects of SG. We performed a thorough PubMed search for references that mentioned sleeve gastrectomy was carried out. In terms of weight loss and resolution of comorbid disorders, the immediate results have been encouraging. Although long-term results are still being obtained, a large number of individuals have experienced persistent weight loss. Eight short-term studies were extracted for the present review. Each study clarified that SG was utilized as a management technique for a high-risk patient population or as a component of a stepwise therapeutic procedure. The laparoscopic SG method was examined in all studies. The percentage of patients who were followed up for 30 days or longer after LSG was reported. Significant weight loss has been observed in studies that evaluated short-term results. An excess weight loss of 67.3% and a significant decrease in body mass index (BMI) were observed in a systematic evaluation of 5,218 patients. In long-term studies, SG was administered to 2713 patients, of whom 1626 completed the five-year follow-up period. Among all patients, 71.3% were women and 28.7% men. The mean BMI before surgery was 46.9 kg/m². The follow-up durations ranged from 5 to 11 years. The mean five-year follow-up rate was 66% (range 57-100%). At 5, 6, 7, 8 and 11 years, the mean percentage excess weight decreases were 58.4%, 59.5%, 56.6% and 62.5%, respectively. Five years after SG, resolution of type 2 diabetes resolved in 77.8% of patients, and arterial hypertension, dyslipidemia, obstructive sleep apnea, gastroesophageal reflux disease and degenerative joint diseases improved or resolved in 68.0%, 65.9%, 75.8%, 30.6% and 55.7% of patients, respectively. Laparoscopic SG is more technically straightforward and has fewer surgical complications than other more complex surgical techniques. Laparoscopic SG is an effective treatment option for bariatric surgery. It is relatively easy to perform, well tolerated by patients and effective for longterm excessive weight loss and resolution of comorbidities.
Collapse
Affiliation(s)
- Silvana Leanza
- Department of General Surgery, Giglio Hospital Foundation, Cefalù (PA), Italy
| | - Danilo Coco
- Department of General Surgery, Giglio Hospital Foundation, Cefalù (PA), Italy
| | | |
Collapse
|
19
|
Kokkinos A, Tsilingiris D, Simati S, Stefanakis K, Angelidi AM, Tentolouris N, Anastasiou IA, Connelly MA, Alexandrou A, Mantzoros CS. Bariatric surgery, through beneficial effects on underlying mechanisms, improves cardiorenal and liver metabolic risk over an average of ten years of observation: A longitudinal and a case-control study. Metabolism 2024; 152:155773. [PMID: 38181882 PMCID: PMC10872266 DOI: 10.1016/j.metabol.2023.155773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 12/13/2023] [Accepted: 12/27/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Bariatric surgery has long-term beneficial effects on body weight and metabolic status, but there is an apparent lack of comprehensive cardiometabolic, renal, liver, and metabolomic/lipidomic panels, whereas the underlying mechanisms driving the observed postoperative ameliorations are still poorly investigated. We aimed to study the long-term effects of bariatric surgery on metabolic profile, cardiorenal and liver outcomes in association with underlying postoperative gut hormone adaptations. METHODS 28 individuals who underwent bariatric surgery [17 sleeve gastrectomy (SG), 11 Roux-en-Y gastric bypass (RYGB)] were followed up 3, 6 and 12 and at 10 years following surgery. Participants at 10 years were cross-sectionally compared with an age-, sex- and adiposity-matched group of non-operated individuals (n = 9) and an age-matched pilot group of normal-weight individuals (n = 4). RESULTS There were durable effects of surgery on body weight and composition, with an increase of lean mass percentage persisting despite some weight regain 10 years postoperatively. The improvements in metabolic and lipoprotein profiles, cardiometabolic risk markers, echocardiographic and cardiorenal outcomes persisted over the ten-year observation period. The robust improvements in insulin resistance, adipokines, activin/follistatin components and postprandial gastrointestinal peptide levels persisted 10 years postoperatively. These effects were largely independent of surgery type, except for a lasting reduction of ghrelin in the SG subgroup, and more pronounced increases in proglucagon products, mainly glicentin and oxyntomodulin, and in the cardiovascular risk marker Trimethylamine-N-oxide (TMAO) within the RYGB subgroup. Despite similar demographic and clinical features, participants 10 years after surgery showed a more favorable metabolic profile compared with the control group, in conjunction with a dramatic increase of postprandial proglucagon product secretion. CONCLUSIONS We demonstrate that cardiorenal and metabolic benefits of bariatric surgery remain robust and largely unchanged ten years postoperatively and are associated with durable effects on gastrointestinal- muscle- and adipose tissue-secreted hormones. TRIAL REGISTRATION ClinicalTrials.gov: NCT04170010.
Collapse
Affiliation(s)
- Alexander Kokkinos
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Dimitrios Tsilingiris
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Stamatia Simati
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Konstantinos Stefanakis
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece; Department of Internal Medicine, Boston VA Healthcare System, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Angeliki M Angelidi
- Department of Internal Medicine, Boston VA Healthcare System, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Nikolaos Tentolouris
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Ioanna A Anastasiou
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | | | - Andreas Alexandrou
- First Department of Surgery, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Christos S Mantzoros
- Department of Internal Medicine, Boston VA Healthcare System, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
| |
Collapse
|
20
|
Shah SA, Khan NA, Qureshi FG. Metabolic and Bariatric Surgery in Children: Current Practices and Outcomes. Curr Obes Rep 2024; 13:77-86. [PMID: 38172474 DOI: 10.1007/s13679-023-00540-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW This review will examine the most current evidence for Metabolic and Bariatric Surgery (MBS) in the pediatric population, specifically in terms of weight loss outcomes and improvement in comorbid conditions and complications. Additionally, we compare surgical and non-surgical interventions, review current guidelines, and propose a stepwise evidence-based approach to the management of obesity in children. RECENT FINDINGS MBS is a safe option for appropriately selected pediatric patients which leads to significant and sustained weight loss. This weight loss is associated with improvement of related comorbid conditions. Laparoscopic sleeve gastrectomy (LSG) has emerged as the procedure of choice with a better safety profile. Despite the evidence, very few adolescents undergo MBS. New pharmacologic agents specifically the GLP-1/GIP agents have shown early promise especially in patients under body mass index 40, but the long-term effects are unknown. MBS is an effective tool in the management of pediatric obesity, and its use has been recommended by professional societies. Early referral to a multidisciplinary obesity team can help identify appropriate patients.
Collapse
Affiliation(s)
| | - Noor A Khan
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, UPMC Mercy Hospital, Pittsburgh, PA, USA
| | - Faisal G Qureshi
- Division of Pediatric Surgery, Department of Surgery, University of Texas Southwestern Medical Center and, Children's Medical Center Dallas, 1935 Medical District Drive, D2000, Dallas, TX, 75235, USA.
| |
Collapse
|
21
|
Liang NE, Perez NP, Singhal V, Pratt JSA, Zitsman J, Griggs CL. Regional Variations in Pediatric Metabolic and Bariatric Surgeon Availability: A Call for Action. J Surg Res 2024; 295:522-529. [PMID: 38086252 DOI: 10.1016/j.jss.2023.11.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 09/19/2023] [Accepted: 11/12/2023] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Obesity is a significant public health concern in children. The American Academy of Pediatrics recommends the use of metabolic and bariatric surgery (MBS) in children with severe obesity, however; MBS remains underutilized in part due to lack of access. This study aims to characterize the prevalence of pediatric obesity and compare this to regional pediatric MBS provider availability. METHODS State-specific prevalence rates of childhood obesity in children aged 10-17 were obtained from the National Survey of Children's Health. The member directory provided by the American Society for Metabolic and Bariatric Surgeons was used to identify all pediatric MBS providers and used to calculate the prevalence of MBS providers by state. RESULTS The five states with the highest prevalence rates of childhood obesity were Kentucky, Mississippi, Louisiana, West Virginia, and Alabama. The five states with the highest prevalence (per 100,000 children with obesity) of MBS providers doing pediatric cases were North Dakota, New Jersey, Kansas, New York, and Utah. Notably, there was a negative correlation between the states with the lowest prevalence of pediatric MBS providers and states with the highest prevalence of childhood obesity (r -0.40, ∗P = 0.002). CONCLUSIONS Our study demonstrates significant state-to-state variation in the prevalence of pediatric obesity and MBS provider availability by state as a proxy for access to surgical care for pediatric obesity. Further work to establish accessible multidisciplinary pediatric weight loss centers is needed to ensure that children and adolescents with obesity receive thorough evaluation and have access to MBS.
Collapse
Affiliation(s)
- Norah E Liang
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Numa P Perez
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Vibha Singhal
- Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Janey S A Pratt
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Jeffrey Zitsman
- Department of Surgery, Columbia University Medical Center, New York, New York
| | - Cornelia L Griggs
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
22
|
Lawton RI, Stanford FC. The Role of Racism in Childhood Obesity. Curr Obes Rep 2024; 13:98-106. [PMID: 38172479 PMCID: PMC10939728 DOI: 10.1007/s13679-023-00538-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW Obesity rates continue to rise among children and have shown persistent racial disparities. Racism plays a potentially essential and actionable role in these disparities. This report reviews some mechanisms through which racism may shape childhood obesity. RECENT FINDINGS From the youngest ages, disparities in childhood obesity prevalence are already present. Racism may shape intergenerational and prenatal factors that affect obesity and various stressors and environments where children grow up. The relationships between clinicians and patients may also be shaped by everyday racism and legacies of past racism, which may affect obesity prevalence and treatment efficacy. Comprehensive data on the extent to which racism shapes childhood obesity is limited. However, compelling evidence suggests many ways through which racism ultimately does affect childhood obesity. Interventions to address racism at multiple points where it shapes childhood obesity, including intergenerational and prenatal mechanisms, may help to close disparities.
Collapse
Affiliation(s)
| | - Fatima Cody Stanford
- Harvard Medical School, Boston, MA, USA.
- MGH Weight Center, Department of Medicine-Division of Endocrinology-Neuroendocrine, Massachusetts General Hospital, Weight Center, 50 Staniford Street, 4th Floor, Boston, MA, 02114, USA.
- Department of Pediatrics-Division of Endocrinology, Nutrition Obesity Research Center at Harvard (NORCH), Weight Center, 50 Staniford Street, 4th Floor, Boston, MA, USA.
| |
Collapse
|
23
|
Misserian M, Wheelington A, King R, Francis J, Mathew MS, Allicock MA, Cartwright BR, Adewunmi A, Chandrasekhar A, Polavarapu D, Qureshi FG, Barlow SE, Messiah SE. Adaptation of a standardized lifestyle intervention to maximize health outcomes in adolescent metabolic and bariatric surgery patients. J Transl Med 2024; 22:197. [PMID: 38395836 PMCID: PMC10893696 DOI: 10.1186/s12967-024-04953-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 02/03/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Metabolic and bariatric surgery (MBS) is safe and efficacious in treating adolescents with severe obesity. Behavioral/lifestyle programs can support successful preparation for surgery and post-MBS weight loss, but no standardized lifestyle intervention exists for adolescents. Here we describe the process of developing and adapting the Diabetes Prevention Program Group Lifestyle Balance (DPP/GLB) curriculum to support adolescents pre- and post-MBS. METHODS We collected both qualitative and quantitative data from a diverse group of adolescents (N = 19, mean age 15.2 years, range 13-17, 76% female, 42% non-Hispanic Black, 41% Hispanic, 17% other). Additionally, we included data from 13 parents, all of whom were mothers. These participants were recruited from an adolescent MBS program at Children's Health System of Texas. In an online survey, we asked participants to rank their preferences and interests in DPP/GLB content topics. We complemented these results with in-depth interviews from a subset of 10 participants. This qualitative data triangulation informed the development of the TeenLYFT lifestyle intervention program, designed to support adolescents who were completing MBS and described here. This program was adapted from adolescent and parent DPP/GLB content preferences, incorporating the social cognitive model (SCM) and the socioecological model (SEM) constructs to better cater to the needs of adolescent MBS patients. RESULTS Adolescents' top 3 ranked areas of content were: (1) steps to adopt better eating habits and healthier foods; (2) healthy ways to cope with stress; and (3) steps to stay motivated and manage self-defeating thoughts. Nearly all adolescent participants preferred online delivery of content (versus in-person). Mothers chose similar topics with the addition of information on eating healthy outside the home. Key themes from the adolescent qualitative interviews included familial support, body image and self-confidence, and comorbidities as key motivating factors in moving forward with MBS. CONCLUSIONS The feedback provided by both adolescents and parents informed the development of TeenLYFT, an online support intervention for adolescent MBS candidates. The adapted program may reinforce healthy behaviors and by involving parents, help create a supportive environment, increasing the likelihood of sustained behavior change. Understanding adolescent/parent needs to support weight management may also help healthcare providers improve long-term health outcomes for this patient population.
Collapse
Affiliation(s)
- Maral Misserian
- School of Health Professions, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Rashon King
- Center for Pediatric Population Health, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, 2777 North Stemmons Freeway, Suite 8400, Dallas, TX, 75390, USA
- UTHealth School of Public Health at Houston, Dallas Campus, Dallas, TX, USA
| | - Jackson Francis
- Center for Pediatric Population Health, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, 2777 North Stemmons Freeway, Suite 8400, Dallas, TX, 75390, USA
- UTHealth School of Public Health at Houston, Dallas Campus, Dallas, TX, USA
| | - M Sunil Mathew
- Center for Pediatric Population Health, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, 2777 North Stemmons Freeway, Suite 8400, Dallas, TX, 75390, USA
- UTHealth School of Public Health at Houston, Dallas Campus, Dallas, TX, USA
| | - Marlyn A Allicock
- UTHealth School of Public Health at Houston, Dallas Campus, Dallas, TX, USA
| | - Bethany R Cartwright
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Touchstone Diabetes Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Adejumoke Adewunmi
- Center for Pediatric Population Health, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, 2777 North Stemmons Freeway, Suite 8400, Dallas, TX, 75390, USA
- UTHealth School of Public Health at Houston, Dallas Campus, Dallas, TX, USA
| | - Aparajita Chandrasekhar
- Center for Pediatric Population Health, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, 2777 North Stemmons Freeway, Suite 8400, Dallas, TX, 75390, USA
- UTHealth School of Public Health at Houston, Dallas Campus, Dallas, TX, USA
| | - Dhatri Polavarapu
- Center for Pediatric Population Health, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, 2777 North Stemmons Freeway, Suite 8400, Dallas, TX, 75390, USA
- UTHealth School of Public Health at Houston, Dallas Campus, Dallas, TX, USA
| | - Faisal G Qureshi
- Children's Health System of Texas, Dallas, TX, USA
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sarah E Barlow
- Children's Health System of Texas, Dallas, TX, USA
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sarah E Messiah
- Center for Pediatric Population Health, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, 2777 North Stemmons Freeway, Suite 8400, Dallas, TX, 75390, USA.
- UTHealth School of Public Health at Houston, Dallas Campus, Dallas, TX, USA.
- Department of Pediatrics, UTHealth McGovern Medical School, Houston, TX, USA.
| |
Collapse
|
24
|
Ibrahim T, El Ansari W, Abusabeib A, Yousaf Z, Elhag W. Infrequent but serious? Beriberi And Thiamine deficiency among adolescents and young adults after bariatric surgery. Surg Obes Relat Dis 2024; 20:115-126. [PMID: 37620168 DOI: 10.1016/j.soard.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/19/2023] [Accepted: 06/23/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Thiamine deficiency (TD) among adolescents following metabolic and bariatric surgery (MBS) has not been assessed. OBJECTIVE We assessed TD among adolescents following MBS. SETTING University Hospital. METHODS A retrospective chart review was conducted for all adolescents and young adults (aged 10-25 years) who had MBS and subsequently presented with TD at our institution (n = 30). Diagnosis used clinical, laboratory, brain imaging, and neurophysiology criteria. Of 1575 patients, 7 subsequently had TD. Another 23 adolescents had MBS at private hospitals or overseas and presented at our institution with TD. RESULTS Based on MBS undertaken at our institution, TD prevalence was .45 cases per 100 MBS. The mean age of patients was 19.5 ± 3.23 years, 53.3% were male, 96.7% had sleeve gastrectomy, and time from MBS to admission averaged 4.97 ± 11.94 months. Mean weight loss from surgery to admission was 33.68 ± 10.90 kg. Associated factors included poor oral intake (90%), nausea and vomiting (80%), and noncompliance with multivitamins (71%). Signs and symptoms included generalized weakness, nystagmus, numbness, and paraparesis (83.3%-80%). Seven patients had Wernicke encephalopathy full triad; 16 displayed a mixed picture of Wernicke encephalopathy and dry beriberi; and there were no cases of wet beriberi. Half the patients achieved complete resolution of symptoms, whereas 47% and 40% had residual weakness or persistent sensory symptoms, respectively. There was no mortality. Most common concurrent nutritional deficiencies were of vitamins K, D, and A. CONCLUSIONS This is the first in-depth study of TD among adolescents after MBS. Although TD is uncommon among adolescents after MBS, it is serious, requiring diligent suspicion and prompt treatment. Bariatric teams should emphasize compliance with multivitamin regimens and follow it up.
Collapse
Affiliation(s)
- Tawheeda Ibrahim
- Department of Bariatric Surgery/Bariatric Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Walid El Ansari
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar; College of Medicine, Qatar University, Doha, Qatar; Weill Cornell Medicine - Qatar, Doha, Qatar.
| | - Alyaa Abusabeib
- Department of Bariatric Surgery/Bariatric Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Zohaib Yousaf
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Wahiba Elhag
- Department of Bariatric Surgery/Bariatric Medicine, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medicine - Qatar, Doha, Qatar
| |
Collapse
|
25
|
Bruze G, Järvholm K, Norrbäck M, Ottosson J, Näslund I, Söderling J, Reutfors J, Olbers T, Neovius M. Mental health from 5 years before to 10 years after bariatric surgery in adolescents with severe obesity: a Swedish nationwide cohort study with matched population controls. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:135-146. [PMID: 38159575 DOI: 10.1016/s2352-4642(23)00311-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/27/2023] [Accepted: 11/07/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND The long-term effects of bariatric surgery on the mental health of adolescents with severe obesity remain uncertain. We aimed to describe the prevalence of psychiatric health-care visits and filled prescription psychiatric drugs among adolescents with severe obesity undergoing bariatric surgery in the 5 years preceding surgery and throughout the first 10 years after surgery, and to draw comparisons with matched adolescents in the general population. METHODS Adolescents with severe obesity and who underwent bariatric surgery were identified through the Scandinavian Obesity Surgery Registry. We included adolescents who had bariatric surgery between 2007 and 2017 and were younger than 21 years at time of surgery. Each adolescent patient was matched with ten adolescents from the general population by age, sex, and county of residence. Specialist psychiatric care and filled psychiatric prescriptions were retrieved from nationwide data registers. FINDINGS 1554 adolescents (<21 years) with severe obesity underwent bariatric surgery between 2007 and 2017, 1169 (75%) of whom were female. At time of surgery, the mean age was 19·0 years [SD 1·0], and the mean BMI was 43·7 kg/m2 (SD 5·5). 15 540 adolescents from the general population were matched with adolescents in the surgery group. 5 years before the matched index date, 95 (6·2%) of 1535 surgery patients and 370 (2·5%) of 14 643 matched adolescents had a psychiatric health-care visit (prevalence difference 3·7%; 95% CI 2·4-4·9), whereas 127 (9·8%) of 1295 surgery patients and 445 (3·6%) of 12 211 matched adolescents filled a psychiatric drug prescription (prevalence difference 6·2%; 95% CI 4·5-7·8). The year before the matched index date, 208 (13·4%) of 1551 surgery patients and 844 (5·5%) of 15 308 matched adolescents had a psychiatric health-care visit (prevalence difference 7·9%; 95% CI 6·2-9·6), whereas 319 (20·6%) of 1551 surgery patients and 1306 (8·5%) of 15 308 matched adolescents filled a psychiatric drug prescription (prevalence difference 12·0%; 10·0-14·1). The prevalence difference in psychiatric health-care visits peaked 9 years after the matched index date (12·0%; 95% CI 9·0-14·9), when 119 (17·6%) of 675 surgery patients and 377 (5·7%) of 6669 matched adolescents had a psychiatric health-care visit. The prevalence difference in filled psychiatric drug prescription was highest 10 years after the matched index date (20·4%; 15·9-24·9), when 171 (36·5%) of 469 surgery patients and 739 (16·0%) of 4607 matched adolescents filled a psychiatric drug prescription. The year before the matched index date, 19 (1·2%) of 1551 surgery patients and 155 (1·0%) of 15304 matched adolescents had a health-care visit associated with a substance use disorder diagnosis (mean difference 0·2%, 95% CI -0·4 to 0·8). 10 years after the matched index date, the prevalence difference had increased to 4·3% (95% CI 2·3-6·4), when 24 (5·1%) of 467 surgery patients and 37 (0·8%) of 4582 matched adolescents had a health-care visit associated with a substance use disorder diagnosis. INTERPRETATION Psychiatric diagnoses and psychiatric drug prescriptions were more common among adolescents with severe obesity who would later undergo bariatric surgery than among matched adolescents from the general population. Both groups showed an increase in prevalence in psychiatric diagnoses and psychiatric drug prescriptions leading up to the time of surgery, but the rate of increase in the prevalence was higher among adolescents with severe obesity than among matched adolescents. With the exception of health-care visits for substance use disorders, these prevalence trajectories continued in the 10 years of follow-up. Realistic expectations regarding mental health outcomes should be set preoperatively. FUNDING Swedish Research Council, Swedish Research Council for Health, Working Life and Welfare.
Collapse
Affiliation(s)
- Gustaf Bruze
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Kajsa Järvholm
- Department of Psychology, Lund University, Lund, Sweden; Childhood Obesity Unit, Skåne University Hospital, Malmö, Sweden.
| | - Mattias Norrbäck
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Johan Ottosson
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ingmar Näslund
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jonas Söderling
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Johan Reutfors
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Torsten Olbers
- Department of Biomedical and Clinical Sciences and Wallenberg Centre for Molecular Medicine, Linköping University, Linköping, Sweden
| | - Martin Neovius
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
26
|
Mitchell DM, Singhal V, Nimmala S, Lauze M, Bouxsein ML, Misra M, Bredella MA. Risk of wrist fracture, estimated by the load-to-strength ratio, declines following sleeve gastrectomy in adolescents and young adults. Osteoporos Int 2024; 35:285-291. [PMID: 37864596 DOI: 10.1007/s00198-023-06941-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/04/2023] [Indexed: 10/23/2023]
Abstract
To understand whether the bone loss which occurs after vertical sleeve gastrectomy increases the risk of fracture, we used an engineering model to estimate risk in participants before and after surgery. We found that estimated risk decreased 1 year after surgery and remained lower, though had rebounded, at year 2. PURPOSE Vertical sleeve gastrectomy (VSG) improves metabolic health in young people with obesity but is accompanied by substantial loss of bone mass and estimated bone strength. We thus estimated fracture risk following VSG using the load-to-strength ratio (LSR), which integrates bone strength estimates with the predicted force of a fall. METHODS Prospective 2-year study of youth ages 13-24 years with obesity undergoing VSG (n = 24) or lifestyle therapy (n = 34). We performed high-resolution peripheral quantitative computed tomography of the distal radius and microfinite element analysis to estimate bone strength and calculated LSR. RESULTS VSG participants lost 26.4 ± 8.1% weight at year 1 (p < 0.001), which was sustained at year 2, while control participants gained weight at year 2 (4.5 ± 8.3%, p = 0.009). The predicted impact force decreased at years 1 and 2 following VSG (p < 0.001) but increased at year 2 among controls (p = 0.011). Estimated bone strength was unchanged at year 1 but decreased (p < 0.001) at year 2 following VSG, while bone strength did not change in controls. At year 1, the LSR decreased among VSG participants (p < 0.001), implying a lower risk of fracture. At year 2, the LSR was lower than baseline (p < 0.001), but higher compared to year 1 (p = 0.001). LSR did not change in the control group. CONCLUSIONS Short-term estimated fracture risk at the radius following VSG decreases. However, ongoing bone loss despite stable weight between years 1 and 2 leads to a concerning rise in estimated fracture risk. Longer follow-up will be critical to evaluate the trajectory of fracture risk. (ClinicalTrials.gov NCT02557438, registered 9/23/2015).
Collapse
Affiliation(s)
- Deborah M Mitchell
- Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Vibha Singhal
- Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Supritha Nimmala
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Meghan Lauze
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Mary L Bouxsein
- Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Madhusmita Misra
- Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Miriam A Bredella
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
27
|
Wilson RB. Comment on: Infrequent but serious? Thiamine deficiency among adolescents and young adults after bariatric surgery. Surg Obes Relat Dis 2024; 20:126-127. [PMID: 37620169 DOI: 10.1016/j.soard.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 07/15/2023] [Indexed: 08/26/2023]
Affiliation(s)
- Robert Beaumont Wilson
- Department of Upper Gastrointestinal Surgery, University of New South Wales, Liverpool Hospital, Liverpool, New South Wales, Australia
| |
Collapse
|
28
|
Concepción-Zavaleta MJ, Quiroz-Aldave JE, Durand-Vásquez MDC, Gamarra-Osorio ER, Valencia de la Cruz JDC, Barrueto-Callirgos CM, Puelles-León SL, Alvarado-León EDJ, Leiva-Cabrera F, Zavaleta-Gutiérrez FE, Concepción-Urteaga LA, Paz-Ibarra J. A comprehensive review of genetic causes of obesity. World J Pediatr 2024; 20:26-39. [PMID: 37725322 DOI: 10.1007/s12519-023-00757-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/16/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Obesity is a multifactorial chronic disease with a high, increasing worldwide prevalence. Genetic causes account for 7% of the cases in children with extreme obesity. DATA SOURCES This narrative review was conducted by searching for papers published in the PubMed/MEDLINE, Embase and SciELO databases and included 161 articles. The search used the following search terms: "obesity", "obesity and genetics", "leptin", "Prader-Willi syndrome", and "melanocortins". The types of studies included were systematic reviews, clinical trials, prospective cohort studies, cross-sectional and prospective studies, narrative reviews, and case reports. RESULTS The leptin-melanocortin pathway is primarily responsible for the regulation of appetite and body weight. However, several important aspects of the pathophysiology of obesity remain unknown. Genetic causes of obesity can be grouped into syndromic, monogenic, and polygenic causes and should be assessed in children with extreme obesity before the age of 5 years, hyperphagia, or a family history of extreme obesity. A microarray study, an analysis of the melanocortin type 4 receptor gene mutations and leptin levels should be performed for this purpose. There are three therapeutic levels: lifestyle modifications, pharmacological treatment, and bariatric surgery. CONCLUSIONS Genetic study technologies are in constant development; however, we are still far from having a personalized approach to genetic causes of obesity. A significant proportion of the affected individuals are associated with genetic causes; however, there are still barriers to its approach, as it continues to be underdiagnosed. Video Abstract (MP4 1041807 KB).
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - José Paz-Ibarra
- Department of Medicine, School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| |
Collapse
|
29
|
Gray EW, Smith WA, Burton ET, Hale D, Odulana A, Weatherall YZ. Insurance Approval for Laparoscopic Sleeve Gastrectomy in Adolescents in the Midsouth. Child Obes 2024; 20:35-40. [PMID: 36749140 DOI: 10.1089/chi.2022.0175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: Metabolic and bariatric surgery (MBS) has been shown to be safe and effective for the treatment of adolescent obesity, yet many providers express hesitance to refer adolescents for surgery due to concerns for insufficient insurance coverage. Methods: The Healthy Lifestyle Clinic, a pediatric weight management clinic, was established in 2014, and an adolescent MBS program was added in 2017. Patients 15 years or older who meet the selection criteria are eligible for the surgery track. A retrospective chart review was conducted to describe our experience obtaining insurance approval for laparoscopic sleeve gastrectomy (LSG) for our adolescent patients. Results: Almost all patients who were interested in and eligible for LSG ultimately received insurance approval. Most patients had public insurance (70%). Sixty-four percent of patients were approved after the initial application, 23% were approved after a peer-to-peer review, and 11% required an appeal for approval. There was no difference in the time from insurance application to insurance approval based on age, race/ethnicity, or type of insurance. Conclusions: Age <18 years and having public health insurance have not been demonstrated as barriers to insurance approval for LSG in our cohort. Providers should not delay referral for MBS for eligible adolescents based on concern for insufficient insurance coverage. Adolescent MBS programs would benefit from a patient advocate to help families navigate the insurance approval process and reduce barriers to surgery.
Collapse
Affiliation(s)
- Emily W Gray
- Healthy Lifestyle Clinic, Le Bonheur Children's Hospital, Memphis, TN, USA
- Department of Health Promotion and Disease Prevention, College of Nursing, Department of Surgery, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Webb A Smith
- Healthy Lifestyle Clinic, Le Bonheur Children's Hospital, Memphis, TN, USA
- Pediatric Obesity Program, Department of Surgery, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
- Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - E Thomaseo Burton
- Healthy Lifestyle Clinic, Le Bonheur Children's Hospital, Memphis, TN, USA
- Pediatric Obesity Program, Department of Surgery, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
- Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Darla Hale
- Healthy Lifestyle Clinic, Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Adebowale Odulana
- Healthy Lifestyle Clinic, Le Bonheur Children's Hospital, Memphis, TN, USA
- Department of Pediatrics, Department of Surgery, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Preventive Medicine, and Department of Surgery, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ying Z Weatherall
- Healthy Lifestyle Clinic, Le Bonheur Children's Hospital, Memphis, TN, USA
- Division of Pediatric Surgery, Department of Surgery, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| |
Collapse
|
30
|
Shah A, Liang NE, Bruzoni M, Pratt JSA, Zitsman J, Nadler EP. Outcomes after metabolic and bariatric surgery in preteens versus teens using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database and center-specific data. Obesity (Silver Spring) 2024; 32:150-155. [PMID: 37800184 DOI: 10.1002/oby.23908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/12/2023] [Accepted: 08/12/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE The American Academy of Pediatrics (AAP) recently released clinical guidelines for the treatment of childhood obesity, including surgery being appropriate for children 13 years of age and older. The use of this age cut-off was due to a lack of data for children younger than 13. To address this knowledge gap, the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database was queried to compare outcomes in preteens to teens after bariatric surgery hypothesizing that there would be no difference in outcomes between the two groups. METHODS Patients from the MSAQIP database (2016-2021) were identified and divided into groups <13 years and 13-18 years and were matched using propensity scores based on race, sex, and preoperative BMI. Outcomes were compared including change in BMI, complication rates, 30-day readmission or reoperation, and mortality. Additionally, the centers responsible for the bulk of the preteen patient entries queried their center-specific databases to evaluate weight loss over time. RESULTS A total of 4755 patients were identified, 47 of whom were <13 years of age. Preteens had similar sex distribution (66% vs. 75% female), were more likely to be Black (27.7% vs. 18.3%) or Hispanic (21.3% vs. 7.6%) race, and weighed less (274 ± 58 vs. 293 ± 85 lb, p = 0.01), but they had similar BMI (46.9 ± 7 vs. 47 ± 13 kg/m2 ) as their teen counterparts. Preteens were more likely to suffer from sleep apnea (34% vs. 19%, p < 0.01) and insulin-dependent type 2 diabetes (10.6% vs. 1.8%, p < 0.01). There were no complications in the preteens compared to teens (0% vs. 0.5%), and they did not undergo any unplanned readmissions (0% vs. 2.9%) or reoperations (0% vs. 0.8%) within 30 days of surgery. There were also no mortalities reported in preteens (0% vs. 0.1%). The risk-adjusted decrease in BMI between preteens and teens was also comparable at 30 days (4.2 [95% CI: 3.0-5.4] vs. 4.6 [95% CI: 4.4-4.7], p = 0.6). Decrease in BMI in preteens was 7 ± 3 kg/m2 at 3 months and 9 ± 4 kg/m2 at 12 months after surgery, which represented a percentage BMI change of 16 ± 7 and 20 ± 8, respectively. CONCLUSIONS This study demonstrates that bariatric surgery in preteens is safe and efficacious when performed at specialized centers, and that age criteria may not be required. The AAP and others are encouraged to include age cut-offs in their guidelines for children with obesity and bariatric surgery only when data are available to support their inclusion.
Collapse
Affiliation(s)
- Adil Shah
- Children's National Hospital, Washington, DC, USA
| | - Norah E Liang
- Lucile Packard Children's at Stanford, Palo Alto, California, USA
| | - Matias Bruzoni
- Lucile Packard Children's at Stanford, Palo Alto, California, USA
| | - Janey S A Pratt
- Lucile Packard Children's at Stanford, Palo Alto, California, USA
| | - Jeffrey Zitsman
- Morgan Stanley Children's Hospital of New York Presbyterian, New York, New York, USA
| | | |
Collapse
|
31
|
Hitt TA, Hannon TS, Magge SN. Approach to the Patient: Youth-Onset Type 2 Diabetes. J Clin Endocrinol Metab 2023; 109:245-255. [PMID: 37584397 DOI: 10.1210/clinem/dgad482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/17/2023]
Abstract
Youth-onset type 2 diabetes is a growing epidemic with a rising incidence worldwide. Although the pathogenesis and diagnosis of youth-onset type 2 diabetes are similar to adult-onset type 2 diabetes, youth-onset type 2 diabetes is unique, with greater insulin resistance, insulin hypersecretion, and faster progression of pancreatic beta cell function decline. Individuals with youth-onset type 2 diabetes also develop complications at higher rates within short periods of time compared to adults with type 2 diabetes or youth with type 1 diabetes. The highest prevalence and incidence of youth-onset type 2 diabetes in the United States is among youth from minoritized racial and ethnic groups. Risk factors include obesity, family history of type 2 diabetes, comorbid conditions and use of medications associated with insulin resistance and rapid weight gain, socioeconomic and environmental stressors, and birth history of small-for-gestational-age or pregnancy associated with gestational or pregestational diabetes. Patients with youth-onset type 2 diabetes should be treated using a multidisciplinary model with frequent clinic visits and emphasis on addressing of social and psychological barriers to care and glycemic control, as well as close monitoring for comorbidities and complications. Intensive health behavior therapy is an important component of treatment, in addition to medical management, both of which should be initiated at the diagnosis of type 2 diabetes. There are limited but growing pharmacologic treatment options, including metformin, insulin, glucagon-like peptide 1 receptor agonists, and sodium-glucose cotransporter 2 inhibitors. Although long-term outcomes are not fully known, metabolic/bariatric surgery in youth with type 2 diabetes has led to improved cardiometabolic outcomes.
Collapse
Affiliation(s)
- Talia A Hitt
- Division of Endocrinology and Diabetes, Department of Pediatrics, Johns Hopkins University School of Medicine, 200 N. Wolfe Street, Room 3114, Baltimore, MD 21287, USA
| | - Tamara S Hannon
- Division of Endocrinology and Diabetology, Department of Pediatrics, Indiana University School of Medicine, 705 Riley Hospital Drive, Indianapolis, IN 46202, USA
| | - Sheela N Magge
- Division of Endocrinology and Diabetes, Department of Pediatrics, Johns Hopkins University School of Medicine, 200 N. Wolfe Street, Room 3114, Baltimore, MD 21287, USA
| |
Collapse
|
32
|
Wang YN, Heidl AJ, Angeles PM, Farnesi BC, Alberga AS, Cohen TR. Assessment of electronic patient education materials for adolescent bariatric surgery candidates: An environment scan. PEC INNOVATION 2023; 2:100143. [PMID: 37214509 PMCID: PMC10194287 DOI: 10.1016/j.pecinn.2023.100143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 05/24/2023]
Abstract
Objective Adolescents who opt for metabolic and bariatric surgery (MBS) will use the internet to learn about the procedure. The objective of this study is to assess the suitability of electronic patient education materials (ePEM) of North American centers that perform adolescent bariatric surgery. Methods Canadian and American bariatric centers that perform adolescent MBS were identified from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program and Google web-based searches. Suitability of ePEM for the adolescent readership was evaluated using the Suitability Assessment of Materials (SAM). Results Sixty-five centers were evaluated from June to July 2020 with 41% citing adolescent specific material. Six percent of the ePEM were evaluated as 'not suitable', 69% were evaluated as 'adequate', and 25% were evaluated as 'superior'. Conclusion Adequate ePEM scoring was obtained, but centers had little resources tailored to adolescent patients. Further research is needed to evaluate all the resources provided to adolescents (i.e., resources provided by the health team) to ensure the tools are appropriate for the adolescent readership. Innovation This environmental scan provided insights to ePEM available for adolescents considering MBS.
Collapse
Affiliation(s)
- Yolanda N. Wang
- Faculty of Land and Food Systems, Food Nutrition and Health, The University of British Columbia, 2205 East Mall, Vancouver, BC, Canada
| | - Alexandra J. Heidl
- School of Human Nutrition, McGill University, 21111 Lakeshore Road, Ste-Anne-de-Bellevue, QC, Canada
| | - Patricia M. Angeles
- Faculty of Land and Food Systems, Food Nutrition and Health, The University of British Columbia, 2205 East Mall, Vancouver, BC, Canada
| | - Biagina-Carla Farnesi
- Center of Excellence in Adolescent Severe Obesity, Montreal Children's Hospital, McGill University Health Center, 1001 Boulevard Décarie, Montréal, QC, Canada
| | - Angela S. Alberga
- Center of Excellence in Adolescent Severe Obesity, Montreal Children's Hospital, McGill University Health Center, 1001 Boulevard Décarie, Montréal, QC, Canada
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, 1455 Boulevard de Maisonneuve, Montréal, QC, Canada
- Department of Pediatrics, Faculty of Medicine, McGill University, 3605 Rue de la Montagne, Montreal, QC, Canada
| | - Tamara R. Cohen
- Faculty of Land and Food Systems, Food Nutrition and Health, The University of British Columbia, 2205 East Mall, Vancouver, BC, Canada
- BC Children's Hospital Research Institute, Healthy Starts, 938 West 28 Avenue, Vancouver, BC, Canada
| |
Collapse
|
33
|
McClelland PH, Jawed M, Kabata K, Zenilman ME, Gorecki P. Long-term outcomes following laparoscopic Roux-en-Y gastric bypass: weight loss and resolution of comorbidities at 15 years and beyond. Surg Endosc 2023; 37:9427-9440. [PMID: 37676323 DOI: 10.1007/s00464-023-10366-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 07/30/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the gold-standard bariatric procedure with proven efficacy in morbidly obese populations. While the short-term benefits of LRYGB have been well-documented, durable weight loss and long-term resolution of obesity-related comorbidities have been less clearly described. METHODS This single-center study prospectively reports weight loss and comorbidity resolution in patients undergoing LRYGB between August 2001 and September 2007 with at least 15-year follow-up. Data were collected at the time of surgery; 1, 3, 6, and 12 months postoperatively; and then annually thereafter. RESULTS A total of 486 patients were included in this analysis. Patients were predominantly female (88.7%), and the median age was 36.0 [IQR 29.0-45.0] years. Patients were ethnically diverse, including Black/African American (43.6%), White/Caucasian (35.0%), Hispanic (18.3%), and other backgrounds (3.1%). Mean preoperative weight and body mass index were 133.0 ± 21.9 kg and 48.4 ± 6.5 kg/m2, and the median number of comorbidities was 6.0 [IQR 4.0-7.0]. Follow-up rates at 1, 5, 10, and 15 years were 75.3%, 37.2%, 35.2%, and 18.9%, respectively. On average, maximum percentage total weight loss (%TWL) occurred 2 years postoperatively (- 36.2 ± 9.5%), and ≥ 25% TWL was consistently achieved at 1, 5, 10, and 15-year time intervals (- 28.0 ± 13.0% at 15 years). Patients with comorbidities experienced improvement or resolution of their conditions within 1 year, including type 2 diabetes mellitus (83/84, 98.8%), obstructive sleep apnea (112/116, 96.6%), hypertension (142/150, 94.7%), and gastroesophageal reflux disease (217/223, 97.3%). Rates of improved/resolved comorbidities remained consistently high through at least 10 years after surgery. CONCLUSIONS LRYGB provides durable weight loss for at least 15 years after surgery, with stable average relative weight loss of approximately 25% from baseline. This outcome corresponds with sustainable resolution of obesity-related comorbidities for at least 10 years after the initial operation.
Collapse
Affiliation(s)
- Paul H McClelland
- Department of Surgery, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 Sixth Street, Brooklyn, NY, 11215, USA.
| | - Mohsin Jawed
- Department of Surgery, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 Sixth Street, Brooklyn, NY, 11215, USA
| | - Krystyna Kabata
- Department of Surgery, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 Sixth Street, Brooklyn, NY, 11215, USA
| | - Michael E Zenilman
- Department of Surgery, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 Sixth Street, Brooklyn, NY, 11215, USA
| | - Piotr Gorecki
- Department of Surgery, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 Sixth Street, Brooklyn, NY, 11215, USA
| |
Collapse
|
34
|
Salama M, Balagopal B, Fennoy I, Kumar S. Childhood Obesity, Diabetes. and Cardiovascular Disease Risk. J Clin Endocrinol Metab 2023; 108:3051-3066. [PMID: 37319430 DOI: 10.1210/clinem/dgad361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 06/17/2023]
Abstract
This mini-review aims to briefly summarize the pathophysiology of childhood obesity, type 2 diabetes mellitus (T2DM), and cardiovascular disease (CVD) risk in children and adolescents. Recent data on efficacy of lifestyle interventions, medications, and metabolic surgery for obesity, T2DM, and CVD risk factors are also reviewed. We conducted a PubMed search of English-language original and review articles relevant to childhood obesity, T2DM, and CVD risk factors, and biomarkers in children with an emphasis on recent publications. Childhood obesity arises from an intricate interaction between genetic, physiologic, environmental, and socioeconomic factors. The rise in the prevalence of childhood obesity is associated with the development of comorbidities including T2DM and CVD at an early age. A multipronged approach is central to the detection, monitoring, and management of childhood obesity and associated adverse metabolic consequences.
Collapse
Affiliation(s)
- Mostafa Salama
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, MN 55905, USA
- Department of Pediatrics, Mayo Clinic, Rochester, MN 55905, USA
| | - Babu Balagopal
- Department of Pediatrics, Mayo Clinic, Rochester, MN 55905, USA
- Department of Biomedical Research, Nemours Children's Health System, Jacksonville, FL 32207, USA
| | - Ilene Fennoy
- Division of Pediatric Endocrinology, Diabetes and Metabolism, Columbia University, New York, NY 10032, USA
| | - Seema Kumar
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, MN 55905, USA
- Department of Pediatrics, Mayo Clinic, Rochester, MN 55905, USA
| |
Collapse
|
35
|
Taha A, Eroğlu H, Demirbaş İE, Demir B, Dilektaşli E. Impact of Short-Term Weight Loss on Hemostasis and Thrombosis after Bariatric Surgery. Surg Res Pract 2023; 2023:1729167. [PMID: 38028115 PMCID: PMC10661871 DOI: 10.1155/2023/1729167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Obesity causes thrombophilia and many coagulation problems related to slowing the capillary flow. We aimed to evaluate rapid weight loss outcomes in the early period after bariatric surgery on the coagulation system. Materials and Method. A prospective study enrolled 28 patients with a BMI > 40 kg/m2 who underwent bariatric surgery. Preoperative and postoperative (first and third months) demographic criteria-such as age, gender, weight, height, and alcohol and tobacco use, and biochemical parameters such as PLT, PT, aPTT, INR, bleeding time, coagulation time, fibrinogen, D-dimer, albumin, calcium, ionized calcium, vitamin D, and PTH-were analyzed. Results We found that both bleeding and thrombotic parameters increase in early-slowing surgery. The first-month platelet levels were significantly different from the preoperative values (p < 0.001). The prothrombin time in the first (p < 0.001) and third months (p < 0.009) was also comparable. The PTT in the first month was higher than in the preoperative period (p < 0.011). INR in the first month (p < 0.001) was higher than that in the preoperative period and the third month (p = 0.007) value was higher than in the first month. In terms of fibrinogen levels, all parameters indicated statistical significance within each other; preoperative to the first month (p < 0.001), the first month to the third month (p < 0.016). Third-month D-dimer levels were lower than the first month's values (p = 0.032). Conclusion Thromboembolic events have crucial importance in the converse scenario of haemorrhagic diathesis during the first months of bariatric surgery. Vitamin support and antithrombotic agents may be recommended in the early postoperative period.
Collapse
Affiliation(s)
- Ahmed Taha
- Yalova Training and Research Hospital, Department of General Surgery, Yalova, Türkiye
| | - Hasan Eroğlu
- Yalova Training and Research Hospital, Department of General Surgery, Yalova, Türkiye
| | | | - Berkay Demir
- Malatya Darende Hulusi Efendi State Hospital, Department of General Surgery, Malatya, Türkiye
| | - Evren Dilektaşli
- Bursa Yüksek İhtisas Training and Research Hospital Department of General Surgery, Bursa, Türkiye
| |
Collapse
|
36
|
Griggs CL, Kochis M, Perez NP, Fennoy I, Woo Baidal J, Parkinson K, Lynch L, Bank E, DeFazio J, Zitsman JL. Weight Loss After Laparoscopic Sleeve Gastrectomy in Children and Adolescents. Obes Surg 2023; 33:3186-3192. [PMID: 37626262 DOI: 10.1007/s11695-023-06789-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023]
Abstract
PURPOSE For children and adolescents with severe obesity, metabolic and bariatric surgery including laparoscopic sleeve gastrectomy (LSG) is increasingly used to facilitate weight loss and reduce associated medical problems. Outcomes of LSG are understudied among patients under age 15 years. We sought to examine surgical complications and weight loss outcomes among children and adolescents who underwent LSG. MATERIALS AND METHODS This is a single-center retrospective cohort analysis at a high-volume metropolitan children's hospital in the northeast USA between 2011 and 2021. Weight loss was assessed at routine follow-up appointments for up to 36 months postoperatively. RESULTS There were 12 patients under 13 years of age (< 13), 45 from 13 up to 15 years of age (13-14), and 57 patients aged 15 years or over (≥ 15). Among all patients, 70% were female, 41% were Hispanic, and 18% were non-Hispanic Black. There were no operative mortalities. Two patients had surgical complications requiring reoperation. Follow-up beyond 6 months occurred for 62% of patients. Weight loss was evident for each group at all time points, and there was no statistically significant difference among groups at any time point. BMI Z-score reduction at 6 months was 1.53 for the < 13 group, 0.89 for the 13-14 group, and 0.86 for the ≥ 15 group and at 36 months was 1.79, 1.50, and 1.16, respectively. CONCLUSION These results support that LSG is a safe and effective method of achieving weight loss for young adolescents with severe obesity. Strategies to promote postoperative follow-up are needed.
Collapse
Affiliation(s)
| | - Michael Kochis
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
| | - Numa P Perez
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Ilene Fennoy
- Columbia Vagelos College of Physicians and Surgeons, 3959 Broadway, New York, NY, 10032, USA
| | - Jennifer Woo Baidal
- Columbia Vagelos College of Physicians and Surgeons, 3959 Broadway, New York, NY, 10032, USA
| | - Kristina Parkinson
- Columbia Vagelos College of Physicians and Surgeons, 3959 Broadway, New York, NY, 10032, USA
| | - Lori Lynch
- Columbia Vagelos College of Physicians and Surgeons, 3959 Broadway, New York, NY, 10032, USA
| | - Elina Bank
- Morgan Stanley Children's Hospital of New York-Presbyterian, 3959 Broadway, New York, NY, 10032, USA
| | - Jennifer DeFazio
- Columbia Vagelos College of Physicians and Surgeons, 3959 Broadway, New York, NY, 10032, USA
| | - Jeffrey L Zitsman
- Morgan Stanley Children's Hospital of New York-Presbyterian, 3959 Broadway, New York, NY, 10032, USA
| |
Collapse
|
37
|
Beamish AJ, Dengel OH, Palzer EF, Gronowitz E, Kelly AS, Dengel DR, Rudser KD, Brissman M, Olbers T, Dahlgren J, Flodmark CE, Marcus C, Ryder JR. Changes in adipose tissue distribution and relation to cardiometabolic risk factors after Roux-en-Y gastric bypass in adolescents. Surg Obes Relat Dis 2023; 19:1154-1161. [PMID: 37296018 DOI: 10.1016/j.soard.2023.04.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/27/2023] [Accepted: 04/05/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) among adolescents with obesity results in significant weight loss; however, depot-specific changes have been understudied. OBJECTIVE We hypothesized that visceral adipose tissue (VAT) reduction in adolescents undergoing RYGB would be greater than other depots and associated with improvement in cardiometabolic risk factors. SETTING Three specialized treatment centers in Sweden. METHODS Fifty-nine adolescents underwent dual x-ray absorptiometry before surgery and at 1, 2, and 5 years after RYGB. Changes in body composition in multiple depots (total fat, lean body, gynoid fat, android fat, subcutaneous adipose tissue, and VAT) and cardiometabolic risk factors were assessed using multiple linear regression analysis and generalized estimating equations adjusting for age, sex, and baseline risk factor levels. Data are presented as percent change (95% CI) with regression models showing slopes and estimated P values. RESULTS At 1 year post-RYGB, a significant reduction was observed across all body composition measures (P < .001) with the greatest reduction observed in VAT (-65.1% [-68.7, -61.8]). From year 1 to 5 years post-RYGB, a regain was observed in all depots except lean body mass (1.2% [.3, 2.7], P = .105). A sex-specific difference in overall trajectories was only observed in lean body mass with males consistently having higher mean levels. Change in VAT at 1 year correlated with change in triglycerides (slope: .21 mg/dL/kg, P = .034) and fasting plasma insulin (slope: 44 pmol/L/kg, P = .027). CONCLUSIONS Adiposity measures all decreased after RYGB but poorly predicted change in cardiometabolic risk. Despite significant reductions at 1 year, a steady regain was observed out to 5 years, with values still well below baseline. Further research should consider control group comparison and extended follow-up.
Collapse
Affiliation(s)
- Andrew J Beamish
- Department of Gastrosurgical Research and Education, Sahlgrenska University Hospital, Institute of Clinical Sciences, Gothenburg, Sweden; Swansea University Medical School, Swansea University, Swansea, United Kingdom; Research Department, Royal College of Surgeons of England, London, United Kingdom
| | - Olivia H Dengel
- College of Veterinary Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Elise F Palzer
- School of Public Health, Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota
| | - Eva Gronowitz
- Department of Pediatrics, Sahlgrenska University Hospital, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Aaron S Kelly
- Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Donald R Dengel
- Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota; School of Kinesiology, University of Minnesota, Minneapolis, Minnesota
| | - Kyle D Rudser
- School of Public Health, Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota; Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Markus Brissman
- Department of Clinical Science, Intervention and Technology (CLINTEC), Glasgow, United Kingdom
| | - Torsten Olbers
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Jovanna Dahlgren
- Department of Pediatrics, Sahlgrenska University Hospital, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | | | - Claude Marcus
- Department of Clinical Science, Intervention and Technology (CLINTEC), Glasgow, United Kingdom
| | - Justin R Ryder
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Northwestern Feinberg School of Medicine, Chicago, Illinois.
| |
Collapse
|
38
|
Pereira SS, Guimarães M, Monteiro MP. Towards precision medicine in bariatric surgery prescription. Rev Endocr Metab Disord 2023; 24:961-977. [PMID: 37129798 PMCID: PMC10492755 DOI: 10.1007/s11154-023-09801-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 05/03/2023]
Abstract
Obesity is a complex, multifactorial and chronic disease. Bariatric surgery is a safe and effective treatment intervention for obesity and obesity-related diseases. However, weight loss after surgery can be highly heterogeneous and is not entirely predictable, particularly in the long-term after intervention. In this review, we present and discuss the available data on patient-related and procedure-related factors that were previously appointed as putative predictors of bariatric surgery outcomes. In addition, we present a critical appraisal of the available evidence on which factors could be taken into account when recommending and deciding which bariatric procedure to perform. Several patient-related features were identified as having a potential impact on weight loss after bariatric surgery, including age, gender, anthropometrics, obesity co-morbidities, eating behavior, genetic background, circulating biomarkers (microRNAs, metabolites and hormones), psychological and socioeconomic factors. However, none of these factors are sufficiently robust to be used as predictive factors. Overall, there is no doubt that before we long for precision medicine, there is the unmet need for a better understanding of the socio-biological drivers of weight gain, weight loss failure and weight-regain after bariatric interventions. Machine learning models targeting preoperative factors and effectiveness measurements of specific bariatric surgery interventions, would enable a more precise identification of the causal links between determinants of weight gain and weight loss. Artificial intelligence algorithms to be used in clinical practice to predict the response to bariatric surgery interventions could then be created, which would ultimately allow to move forward into precision medicine in bariatric surgery prescription.
Collapse
Affiliation(s)
- Sofia S Pereira
- UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge Viterbo Ferreira 228, 4050-313, Porto, Portugal
- ITR - Laboratory of Integrative and Translocation Research in Population Health, Rua das Taipas 135, 4050-600, Porto, Portugal
| | - Marta Guimarães
- UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge Viterbo Ferreira 228, 4050-313, Porto, Portugal
- ITR - Laboratory of Integrative and Translocation Research in Population Health, Rua das Taipas 135, 4050-600, Porto, Portugal
- Department of General Surgery, Hospital São Sebastião, Centro Hospitalar de Entre o Douro e Vouga, Rua Dr. Cândido Pinho, 4050-220, Santa Maia da Feira, Portugal
| | - Mariana P Monteiro
- UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge Viterbo Ferreira 228, 4050-313, Porto, Portugal.
- ITR - Laboratory of Integrative and Translocation Research in Population Health, Rua das Taipas 135, 4050-600, Porto, Portugal.
| |
Collapse
|
39
|
Zhu X, Zhou G, Gu X, Jiang X, Huang H, You S, Zhang G. Comparing bariatric surgery and medical therapy for obese adolescents with type 2 diabetes. Asian J Surg 2023; 46:4337-4343. [PMID: 36369137 DOI: 10.1016/j.asjsur.2022.10.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 10/16/2022] [Accepted: 10/27/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Mounting evidence in recent years has demonstrated that the number of obese adolescents has continued to rise. Obese adolescents are more likely to be diagnosed with type 2 diabetes, which causes additional harm. This study aimed to compare the clinical outcomes of bariatric surgery and medical treatment. METHODS We conducted a multicenter, nonrandomized, retrospective study on 202 obese adolescents with type 2 diabetes who received surgery or medical treatment in three hospitals from 2017 to 2019. We analyzed the effects of surgery and medical treatment in terms of weight loss, glycemic control and the remission of type 2 diabetes. Propensity score matching was conducted to balance the confounding factors. RESULTS Among the 202 adolescents, 109 adolescents underwent surgery, and the remaining 93 adolescents received nonsurgical treatment. Both in the entire cohort and in the propensity-score matching cohort, the mean body mass index (BMI) and total weight in the surgery group notably decreased. Similarly, the effect of surgery on glycemic control (with respect to HBG, HbA1c, HOMA-IR) was superior to that of medical treatment. In the surgery group, the remission rate of diabetes was 76.1% in the entire cohort and 80.5% in the matched group, which was significantly higher than that in the control group (6.5% and 5.7%, respectively). In addition, LRYGB had better effects on weight loss and glycemic control than LSG. CONCLUSION Bariatric surgery is more effective in the control of weight loss and type 2 diabetes than medical treatment. The effects between different types of bariatric surgeries remain to be further investigated, and longer follow-up times are needed.
Collapse
Affiliation(s)
- Xinqiang Zhu
- Department of General Surgery, Suining People's Hospital, No.2 Bayi West Road, Xuzhou, 221200, China
| | - Gang Zhou
- Department of Gastrointestinal Pancreatic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, NO.169 Hushan Road, Nanjing, 211100, China
| | - Xingwei Gu
- Department of General Surgery, The People's Hospital of Danyang Affiliated Danyang Hospital of Nantong University, Danyang, 212300, Jiangsu Province, China
| | - Xuetong Jiang
- Department of General Surgery, The Affiliated Suqian Hospital of Xuzhou Medical University, No.138 Huanghe South Road, Suqian, 223800, China
| | - Hailong Huang
- Department of General Surgery, The Affiliated Suqian Hospital of Xuzhou Medical University, No.138 Huanghe South Road, Suqian, 223800, China
| | - Sainan You
- Department of General Surgery, The Affiliated Suqian Hospital of Xuzhou Medical University, No.138 Huanghe South Road, Suqian, 223800, China
| | - Gong Zhang
- Department of Gastrointestinal Pancreatic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, NO.169 Hushan Road, Nanjing, 211100, China.
| |
Collapse
|
40
|
Piester TL, Jagtap N, Kalapala R. Review of paediatric obesity and non-alcoholic fatty liver disease-A focus on emerging non-pharmacologic treatment strategies. Pediatr Obes 2023; 18:e13067. [PMID: 37602954 DOI: 10.1111/ijpo.13067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 06/23/2023] [Accepted: 07/10/2023] [Indexed: 08/22/2023]
Abstract
Obesity in paediatrics has become one of the most serious public health concerns worldwide. Paediatric obesity leads to increased adult obesity and is associated with several comorbidities, both physical and psychological. Within gastroenterology, non-alcoholic fatty liver disease (NAFLD) is now the most common cause of paediatric liver disease and the most common cause of liver transplantation in young adults. Treatment for NAFLD largely focuses on treatment of obesity with weight loss strategies. Unfortunately, the traditional method of weight loss using multicomponent lifestyle modification (dietary changes, increased exercise and behavioural modification) has often led to disappointing results. In adult patients with obesity, treatment strategies have evolved to include bariatric surgery and, more recently, bariatric endoscopy. In paediatrics, the obesity and NAFLD epidemics will likely require this variety of treatment to address children in a personalized manner. Here, we present a review of paediatric obesity, paediatric NAFLD and the various treatment strategies to date. We focus on non-pharmacologic and emerging therapies, including bariatric surgery and bariatric endoscopy-based treatments. With such a large population of children and adolescents with obesity, further development of these treatments, including paediatric-focused clinical trials, is essential for these emerging modalities.
Collapse
Affiliation(s)
- Travis L Piester
- Department of Pediatrics, Division of Gastroenterology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Nitin Jagtap
- Department of Medical Gastroenterology and Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Rakesh Kalapala
- Department of Medical Gastroenterology and Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
| |
Collapse
|
41
|
Cheng V, Grinberg GG, Ashbrook M, Silva J, Samakar K, Yenumula PR. Predictors of Complications Following Bariatric Surgery for Adolescent Patients. Am Surg 2023; 89:4031-4037. [PMID: 37171881 DOI: 10.1177/00031348231175463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Bariatric surgery for adolescent patients has been shown to be safe but potentially underutilized. A better understanding of operative risk in adolescents may temper apprehension to its adoption. This study intends to examine the association between preoperative risk factors and complications following bariatric surgery for adolescent patients. METHODS The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program databank (2015-2020) was queried for all adolescent patients (10 to 19 years). Only patients who underwent sleeve gastrectomy or gastric bypass were included. Multivariable regression examined the association between patient characteristics and complications. RESULTS A total of 7785 adolescent patients satisfied inclusion criteria. The median age was 18 years, 1737 (22%) were male, and the median body mass index was 46. Of all patients, 6675 (86%) and 1310 (14%) underwent sleeve gastrectomy and gastric bypass, respectively. Preoperative chronic steroid use was significantly associated with higher rates of leak (odds ratio [OR] 7.327, P = .009), bleeding (OR 10.791, P = .003), and reoperation (OR 7.685, P < .001). While Pacific Islander race was also significantly associated with higher rates of reoperation (OR 11.773, P = .039), Asian race was significantly associated with higher rates of bleeding (OR 14.527, P = .042). A history of gastroesophageal reflux disease was associated with higher rates of postoperative reintervention (OR 2.306, P = .004). DISCUSSION Readily identifiable preoperative patient characteristics are significantly associated with higher rates of postoperative complications following adolescent bariatric surgery. Additional research is required to determine whether tailoring treatment based on these characteristics can improve outcomes.
Collapse
Affiliation(s)
- Vincent Cheng
- Department of Bariatric Surgery, Kaiser Permanente South Sacramento Medical Center, Sacramento, CA, USA
| | - Gary G Grinberg
- Department of Bariatric Surgery, Kaiser Permanente South Sacramento Medical Center, Sacramento, CA, USA
| | - Matthew Ashbrook
- Division of Upper GI and General Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Jack Silva
- Division of Upper GI and General Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Kamran Samakar
- Department of Bariatric Surgery, Kaiser Permanente South Sacramento Medical Center, Sacramento, CA, USA
| | - Panduranga R Yenumula
- Department of Bariatric Surgery, Kaiser Permanente South Sacramento Medical Center, Sacramento, CA, USA
| |
Collapse
|
42
|
Wasserman H, Jenkins T, Inge T, Ryder J, Michalsky M, Sisley S, Xie C, Kalkwarf H. Bone mineral density 5 to 11 years after metabolic and bariatric surgery in adolescents with severe obesity compared to peers. RESEARCH SQUARE 2023:rs.3.rs-3345103. [PMID: 37790519 PMCID: PMC10543495 DOI: 10.21203/rs.3.rs-3345103/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Objective Metabolic and bariatric surgery (MBS) is associated with decreased bone mineral density (BMD) in adults. The long-term impact of MBS during adolescence on BMD is unknown. We report bone health status 5 to 11 years after Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) from the Teen-LABS study cohort. Methods Between 2016 and 2022, BMD was measured by dual energy x-ray absorptiometry (DXA) in 106 young adults who had undergone MBS as adolescents. Volumetric BMD by peripheral quantitative computed tomography was measured on a subset. Ninety-one controls who had not undergone MBS were recruited for comparison. Results Compared to controls, adjusted mean DXA-BMD of the RYGB (n = 58) and VSG (n = 48) groups were lower at the hip (-10.0% and - 6.3%), femoral neck (-9.6% and - 5.7%) and ultra-distal radius (-7.9% and - 7.0%; all p < 0.001), respectively. DXA-BMD did not differ between RYGB and VSG groups. Trabecular volumetric BMD at the radius and tibia were lower in the RYGB (-30% and - 26%) and VSG (-15% and - 14%) groups compared to the control group (p < 0.001). Greater time since MBS was associated with lower BMD Z-scores at the hip (p = 0.05) and femoral neck (p = 0.045). Percent change in body mass index (BMI) from baseline or in the first year after MSB were not associated with bone measures at a median of 9.3 years post MSB. Conclusion BMD, especially of the hip and femoral neck, was lower in young adults who underwent MBS during adolescence compared to matched peers who had not undergone MBS. BMD Z-scores of the femoral neck decreased with time since MBS but were not associated with BMI change.
Collapse
Affiliation(s)
| | | | | | | | - Marc Michalsky
- Center for Healthy Weight and Nutrition at Nationwide Children's Hospital, Columbus, Ohio
| | | | | | - Heidi Kalkwarf
- Cincinnati Children's Hospital Medical Center, Cincinatti OH
| |
Collapse
|
43
|
Fischer PR, Johnson CR, Leopold KN, Thacher TD. Treatment of vitamin D deficiency in children. Expert Rev Endocrinol Metab 2023; 18:489-502. [PMID: 37861060 DOI: 10.1080/17446651.2023.2270053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION Vitamin D deficiency affects from 10% to 50% in various pediatric population groups and causes life-threatening hypocalcemia in infants, crippling rickets in infants and children, and increased risk of subsequent adult metabolic and neurologic problems. AREAS COVERED An English language literature search of PubMed was performed since 1940 as were the authors' personal literature collections. References identified in the reviewed literature are considered. DIAGNOSIS The diagnosis of vitamin D deficiency is based on serum 25-hydroxyvitamin D levels. Clinical features of rickets include bone deformities and elevated alkaline phosphatase. Most children and adolescents who are biochemically vitamin D deficient do not have specific symptoms or signs of deficiency. PREVENTION Prevention of vitamin D deficiency is via exposure to sunshine, food and beverage fortification, and dietary supplementation. TREATMENT Effective treatment of vitamin D deficiency is via oral or injectable administration of vitamin D. Dosing and duration of vitamin D therapy have been described for healthy children and for children with underlying medical conditions, but recommendations vary. EXPERT OPINION Further investigation is needed to determine long-term non-skeletal effects of childhood vitamin D deficiency, benefits of supplementation in asymptomatic individuals with biochemical vitamin D deficiency, and appropriate screening for vitamin D deficiency in asymptomatic children and adolescents.
Collapse
Affiliation(s)
- Philip R Fischer
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN USA
- Sheikh Shakhbout Medical City, Abu Dhabi, UAE
- Khalifa University College of Health and Medical Science, Abu Dhabi, UAE
| | - Casey R Johnson
- Pediatric Gastroenterology and Nutrition, Boston Children's Hospital, Boston, MN, USA
| | - Kaitlin N Leopold
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN USA
| | | |
Collapse
|
44
|
Abstract
PURPOSE OF REVIEW Chronic kidney disease (CKD) is a common condition and a major cause of morbidity and mortality in adults, but children and adolescents are also at risk for early kidney injury and development of CKD. Obesity contributes both directly and indirectly to the development of CKD. The purpose of this review is to describe obesity-related kidney disease (ORKD) and diabetic kidney disease (DKD) and their impact in the pediatric population. RECENT FINDINGS Although obesity-related CKD in childhood and adolescence is uncommon, nascent kidney damage may magnify the lifetime risk of CKD. Glomerular hyperfiltration is an early phenotype of both ORKD and DKD and typically manifests prior to albuminuria and progressive decline in GFR. Novel treatments for obesity and type 2 diabetes exerting protective effects on the kidneys are being investigated for use in the pediatric population. It is important to understand the impact of obesity on the kidneys more fully in the pediatric population to help detect injury earlier and intervene prior to the onset of irreversible progression of disease and to guide future research in this area.
Collapse
Affiliation(s)
- Alexandra Sawyer
- Department of Pediatrics, Division of Endocrinology, University of Colorado School of Medicine, 13123 East 16Th Avenue, Box 158, Aurora, CO, 80045, USA.
| | - Evan Zeitler
- Department of Medicine, Division of Nephrology and Hypertension, University of North Carolina Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Howard Trachtman
- Department of Pediatrics, Division of Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Petter Bjornstad
- Department of Pediatrics, Division of Endocrinology, University of Colorado School of Medicine, 13123 East 16Th Avenue, Box 158, Aurora, CO, 80045, USA
| |
Collapse
|
45
|
Hollon H. Preventive cardiology in pediatrics. A fellow's voice. Am J Prev Cardiol 2023; 15:100582. [PMID: 37746524 PMCID: PMC10514090 DOI: 10.1016/j.ajpc.2023.100582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 09/26/2023] Open
Affiliation(s)
- Hannah Hollon
- Department of Pediatric Cardiology, Children's Hospital Colorado, Denver, CO, United States
| |
Collapse
|
46
|
Beamish AJ, Ryan Harper E, Järvholm K, Janson A, Olbers T. Long-term Outcomes Following Adolescent Metabolic and Bariatric Surgery. J Clin Endocrinol Metab 2023; 108:2184-2192. [PMID: 36947630 PMCID: PMC10438888 DOI: 10.1210/clinem/dgad155] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/24/2023]
Abstract
Severe obesity in adolescence negatively impacts upon health and wellbeing. Lifestyle modifications do not usually achieve a sufficient degree or durability of weight loss to mitigate the risk of medical complications. In recent years, metabolic and bariatric surgery (MBS), already a well-established treatment for adults with severe obesity, has emerged as an option in adolescents. Controlled studies in this age group have demonstrated substantial and sustained weight loss, improvements in associated health parameters, and a safety profile surpassing that observed in adult patients. This review aims to present published data on the results of MBS in adolescents with a focus on long-term outcomes. Indications for bariatric surgery and aspects of timing in the young person's life are also presented, along with safety considerations and factors influencing patient selection for surgery. We conclude, predominantly from short- to medium-term outcomes data, that MBS is a safe and valuable therapeutic option for adolescents with severe obesity. Considering the poor health and social wellbeing prognosis in this group, MBS appears to be underutilized. The need for continued research, multiprofessional specialist provision, coherent contemporary clinical guidelines, and routine long-term follow-up in adolescents undergoing MBS is highlighted.
Collapse
Affiliation(s)
- Andrew J Beamish
- Department of General Surgery, Welsh Institute of Metabolic and Obesity Surgery, Morriston Hospital, Swansea, UK
- Department of Medicine, Swansea University Medical School, Swansea, UK
| | | | - Kajsa Järvholm
- Department of Psychology, Lund University, Lund, Sweden
- Childhood Obesity Unit, Skåne University Hospital, Malmö, Sweden
| | - Annika Janson
- National Childhood Obesity Centre, Karolinska University Hospital, Stockholm, Sweden
- Division of Pediatric Endocrinology, Department of Women's and Children's Health Karolinska Institutet, Stockholm, Sweden
| | - Torsten Olbers
- Childhood Obesity Unit, Skåne University Hospital, Malmö, Sweden
- Department of Biomedical and Clinical Sciences and Wallenberg Centre for Molecular Medicine, Linköping University, Linköping, Sweden
| |
Collapse
|
47
|
Abebe TB, Doyle MB, Khan A, Eagon JC, Dimou FM, Eckhouse SR, Shakhsheer BA. Should Bariatric Surgery Play a Larger Role in the Management of Pediatric Patients with Severe Obesity and End-Stage Organ Disease? Obes Surg 2023; 33:2585-2587. [PMID: 37273156 DOI: 10.1007/s11695-023-06661-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 05/25/2023] [Accepted: 05/31/2023] [Indexed: 06/06/2023]
Affiliation(s)
- Tsehay B Abebe
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
| | - Majella B Doyle
- Department of Surgery, Section of Abdominal Transplant Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Adeel Khan
- Department of Surgery, Section of Abdominal Transplant Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - J Christopher Eagon
- Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Francesca M Dimou
- Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Shaina R Eckhouse
- Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Baddr A Shakhsheer
- Department of Surgery, Division of Pediatric Surgery, Washington University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
48
|
Wolfe G, Salehi V, Browne A, Riddle R, Hall E, Fam J, Tichansky D, Myers S. Metabolic and bariatric surgery for obesity in Prader Willi syndrome: systematic review and meta-analysis. Surg Obes Relat Dis 2023; 19:907-915. [PMID: 36872159 DOI: 10.1016/j.soard.2023.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 01/12/2023] [Accepted: 01/21/2023] [Indexed: 02/04/2023]
Abstract
Obesity is the leading cause of morbidity and mortality in patients with Prader-Willi Syndrome (PWS). Our objective was to compare changes in body mass index (BMI) after metabolic and bariatric surgery (MBS) for the treatment of obesity (BMI ≥35 kg/m2) in PWS. A systematic review of MBS in PWS was performed using PubMed, Embase, and Cochrane Central, identifying 254 citations. Sixty-seven patients from 22 articles met criteria for inclusion in the meta-analysis. Patients were organized into 3 groups: laparoscopic sleeve gastrectomy (LSG), gastric bypass (GB), and biliopancreatic diversion (BPD). No mortality within 1 year was reported in any of the 3 groups after a primary MBS operation. All groups experienced a significant decrease in BMI at 1 year with a mean reduction in BMI of 14.7 kg/m2 (P < .001). The LSG groups (n = 26) showed significant change from baseline in years 1, 2, and 3 (P value at year 3 = .002) but did not show significance in years 5, 7, and 10. The GB group (n = 10) showed a significant reduction in BMI of 12.1 kg/m2 in the first 2 years (P = .001). The BPD group (n = 28) had a significant reduction in BMI through 7 years with an average reduction of 10.7 kg/m2 (P = .02) at year 7. Individuals with PWS who underwent MBS had significant BMI reduction sustained in the LSG, GB, and BPD groups for 3, 2, and 7 years, respectively. No deaths within 1 year of these primary MBS operations were reported in this study or any other publication.
Collapse
Affiliation(s)
- Gunnar Wolfe
- Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Vesta Salehi
- Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania; St. Christopher's Hospital for Children, Tower Health, Philadelphia, Pennsylvania
| | | | - Renee Riddle
- Tower Health Weight Loss Surgery and Wellness Center, Reading Hospital, Wyomissing, Pennsylvania
| | - Erin Hall
- Temple University College of Medicine, Philadelphia, Pennsylvania
| | - John Fam
- Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania; Tower Health Weight Loss Surgery and Wellness Center, Reading Hospital, Wyomissing, Pennsylvania
| | - David Tichansky
- Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania; Tower Health Weight Loss Surgery and Wellness Center, Reading Hospital, Wyomissing, Pennsylvania
| | - Stephan Myers
- Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania; Tower Health Weight Loss Surgery and Wellness Center, Reading Hospital, Wyomissing, Pennsylvania; St. Christopher's Hospital for Children, Tower Health, Philadelphia, Pennsylvania.
| |
Collapse
|
49
|
Gottardi L, Tinoco A, Alberti LR. LAPAROSCOPIC BARIATRIC SURGERY IN ADOLESCENTS: EARLY AND FIVE- YEAR CLINICAL AND LABORATORY ASSESSMENT. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2023; 36:e1748. [PMID: 37466568 DOI: 10.1590/0102-672020230030e1748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/15/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Obesity has reached epidemic proportions among adolescents. Methods, such as bariatric surgery, have become the most effective treatment for patients with classes III and IV obesity. AIM To evaluate weight loss, comorbidity remission, and long-term results of bariatric surgery in adolescents. METHODS Study with adolescent patients undergoing bariatric surgery, evaluating laboratory tests, comorbidities, and the percentage of excess weight loss in the preoperative period and at one, two, and five years postoperatively. RESULTS A total of 65 patients who met the inclusion criteria, with a mean age of 18.6 years, were included in the analysis. In the preoperative period, 30.8% of hypercholesterolemia, 23.1% of systemic arterial hypertension, and 18.4% of type 2 diabetes were recorded, with remission of these percentages occurring in 60, 66.7 and 83.4%, respectively. The mean percentage of excess weight loss was 63.48% after one year of surgery, 64.75% after two years, and 57.28% after five years. The mean preoperative total cholesterol level was 180.26 mg/dL, and after one, two, and five years, it was 156.89 mg/dL, 161.39 mg/dL, and 150.97 mg/dL, respectively. The initial mean of low-density lipoprotein was 102.19mg/dL and after five years the mean value reduced to 81.81 mg/dL. The mean preoperative glycemia was 85.08 mg/dL and reduced to 79.13 mg/dL after one year, and to 76.19 mg/dL after five years. CONCLUSIONS Bariatric surgery is safe and effective in adolescents, with low morbidity, resulting in a loss of excess weight and long-term stability, improving laboratory tests, and leading to remission of comorbidities, such as diabetes mellitus, hypercholesterolemia, and systemic arterial hypertension.
Collapse
Affiliation(s)
- Lorena Gottardi
- Hospital São José do Avaí, Surgery Unit - Itaperuna (RJ), Brazil
| | - Augusto Tinoco
- Hospital São José do Avaí, Surgery Unit - Itaperuna (RJ), Brazil
| | | |
Collapse
|
50
|
Sorek A, Eldar SM, Cohen S, Mazkeret Mayer I, Sukhtnik I, Lubetzky R, Moran-Lev H. Laparoscopic Sleeve Gastrectomy Versus One Anastomosis Gastric Bypass in Adolescents With Obesity. J Pediatr Gastroenterol Nutr 2023; 77:131-136. [PMID: 36930967 DOI: 10.1097/mpg.0000000000003780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
OBJECTIVE Large studies comparing outcomes between laparoscopic sleeve gastrectomy (LSG) and one anastomosis gastric bypass (OAGB) are scarce and involve adult populations. The aim of the study was to compare perioperative, early postoperative, and 1-year postoperative outcomes of adolescents with obesity who underwent LSG or OAGB surgery. METHODS The medical records of adolescents with obesity who underwent LSG or OAGB at the Tel Aviv Sourasky Medical Center from January 2017 to January 2021 were retrospectively reviewed. Data on their gastrointestinal (GI) symptoms and postoperative quality of life were obtained by a telephone interview. RESULTS Included were 75 adolescents (median [interquartile range, IQR] age 17.3 [16-18] years) of whom 22 underwent OAGB and 53 underwent LSG. There were no significant preoperative group differences in age, sex, and body mass index score. A low rate of perioperative (5.7% vs 0) and postoperative complication (15.1% vs 10%) with no statistical differences between LSG and OAGB group, respectively, was noted. At 12 months, the percent excessive weight loss + IQR was 42.40% [30.00, 45.00] and 38.00% [33.550, 44.20] in the LSG and OAGB group, respectively ( P = NS). The results of the Pediatric Quality of Life Inventory Gastrointestinal Symptoms scale revealed significantly less food limitation and heartburn after OAGB compared to LSG (food limitation 71.63 vs 53.85 and heartburn 83.654 vs 61.6, P = 0.03 and P = 0.029, respectively). CONCLUSIONS Both surgeries are effective and safe for weight loss in the adolescent population. OAGB was associated with significantly fewer GI symptoms compared to LSG.
Collapse
Affiliation(s)
- Adi Sorek
- From the Department of Pediatrics, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sukhotnik Meron Eldar
- the Bariatric Unit, Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Cohen
- the Pediatric Gastroenterology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inbar Mazkeret Mayer
- the Pediatric Gastroenterology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Igor Sukhtnik
- the Department of Paediatric Surgery, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronit Lubetzky
- From the Department of Pediatrics, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadar Moran-Lev
- From the Department of Pediatrics, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- the Pediatric Gastroenterology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|