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Hornick MA, Chao GF, Ying LD, Nadzam G, Duffy A, Ghiassi S, Graetz E, Gibbs KE, Morton JM. Weight Nadir and Long-Term Weight Outcomes After Laparoscopic Sleeve Gastrectomy in a Diverse Cohort of Adolescents and Young Adults. Obes Surg 2024:10.1007/s11695-024-07374-3. [PMID: 38935262 DOI: 10.1007/s11695-024-07374-3] [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: 03/20/2024] [Revised: 06/16/2024] [Accepted: 06/19/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION Laparoscopic sleeve gastrectomy (LSG) is currently the most common bariatric procedure performed in adolescents and young adults in the United States (USA), but there are limited data available on long-term postoperative weight outcomes in these patients. This single-institution US study follows longitudinal weight data in a diverse group of patients undergoing LSG at age 25 years or younger. METHODS We retrospectively reviewed records of all patients 25 years or younger who underwent LSG at our institution between 2013 and 2020. All weight data documented in the medical record through January 2023 was included. We calculated weight change postoperatively as percent total weight loss (%TWL) relative to preoperative weight. RESULTS One hundred forty-one patients underwent LSG, at a mean age of 23.1 years. Within this cohort, 56.1% identified as non-Hispanic Black or Hispanic, and 39.7% had private health insurance. The mean %TWL at weight nadir was 28.5% at a mean of 1.35 years postoperatively. The mean long-term %TWL (in patients with ≥ 4 years of follow-up) was 11.8% at a mean of 5.6 years postoperatively, with 43 of the 84 patients with long-term weight data (51%) within 10% of their preoperative weight at most recent follow-up. CONCLUSION Adolescents and young adults undergoing LSG at our institution had weight nadir comparable to published results during the first 1 to 2 years postoperatively, but the majority developed significant weight recurrence over the ensuing years. Our findings highlight the need for adjuvant weight loss strategies to improve the durability of weight outcomes after LSG in this population.
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Affiliation(s)
- Matthew A Hornick
- Division of Pediatric Surgery, Yale School of Medicine, 330 Cedar St, FMB 131, New Haven, CT, 06510, USA.
| | - Grace F Chao
- Department of Surgery, Yale School of Medicine, 330 Cedar St, New Haven, CT, 06510, USA
| | - Lee D Ying
- Department of Surgery, Yale School of Medicine, 330 Cedar St, New Haven, CT, 06510, USA
| | - Geoffrey Nadzam
- Division of Bariatric & Minimally Invasive Surgery, Yale School of Medicine, 330 Cedar St, New Haven, CT, 06510, USA
| | - Andrew Duffy
- Division of Bariatric & Minimally Invasive Surgery, Yale School of Medicine, 330 Cedar St, New Haven, CT, 06510, USA
| | - Saber Ghiassi
- Division of Bariatric & Minimally Invasive Surgery, Yale School of Medicine, 330 Cedar St, New Haven, CT, 06510, USA
| | - Elena Graetz
- Department of Surgery, Yale School of Medicine, 330 Cedar St, New Haven, CT, 06510, USA
| | - Karen E Gibbs
- Division of Bariatric & Minimally Invasive Surgery, Yale School of Medicine, 330 Cedar St, New Haven, CT, 06510, USA
| | - John M Morton
- Division of Bariatric & Minimally Invasive Surgery, Yale School of Medicine, 330 Cedar St, New Haven, CT, 06510, USA
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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. [PMID: 38947996 PMCID: PMC11212753 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.
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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
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Swertfeger D, Kim A, Sexmith H, Moreno-Fernandez ME, Davidson WS, Helmrath M, Jenkins T, Okura T, Geh E, Xanthakos SA, Szabo S, Nakamura T, Divanovic S, Shah AS. Presurgery health influences outcomes following vertical sleeve gastrectomy in adolescents. Obesity (Silver Spring) 2024; 32:1187-1197. [PMID: 38664233 PMCID: PMC11132933 DOI: 10.1002/oby.24018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/19/2024] [Accepted: 02/21/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE Weight loss following vertical sleeve gastrectomy (VSG) in youth can range from 10% to 50%. We examined whether there are differences in demographic or metabolic parameters before VSG in youth who achieve above-average weight loss (AAWL) versus below-average weight loss (BAWL) at 1 year post VSG and if youth with BAWL still achieve metabolic health improvements at 1 year post VSG. METHODS Demographic, anthropometric, and clinical lab data were collected before VSG and at 1, 3, 6, and 12 months after VSG. RESULTS Forty-three youth with a mean age of 16.9 (SD 1.7) years before VSG were studied; 70% were female, 19% non-Hispanic Black, 58% non-Hispanic White, and 23% mixed/other race. Mean baseline BMI was 51.1 (SD 10.5) kg/m2. Average weight loss was 25.8%. The AAWL group lost 18.6 kg/m2 (35.3%) versus the BAWL group, who lost 8.8 kg/m2 (17.5%). BMI, age, race, sex, and socioeconomic status at baseline were similar between AAWL and BAWL groups; however, the BAWL group had a higher frequency of pre-VSG dysglycemia, steatotic liver disease, and dyslipidemia. At 1 year post VSG, fewer youth in the BAWL group achieved ideal health parameters, and they had less resolution of comorbidities. CONCLUSIONS The presence of comorbidities before VSG is associated with less weight loss and reduced resolution of metabolic conditions at 1 year post VSG.
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Affiliation(s)
- Debi Swertfeger
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Ahlee Kim
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Hannah Sexmith
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Maria E. Moreno-Fernandez
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - W. Sean Davidson
- Center for Lipid and Arteriosclerosis Science, Department of Pathology and Laboratory Medicine, University of Cincinnati, Cincinnati, OH 45237, USA
| | - Michael Helmrath
- Department of Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Todd Jenkins
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Tsuyoshi Okura
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Esmond Geh
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Stavra A. Xanthakos
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Sara Szabo
- Division of Pathology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Takahisa Nakamura
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Senad Divanovic
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
- Division of Immunobiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Center for Inflammation and Tolerance, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Amy Sanghavi Shah
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
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Arab K, Qasim SS, Abu Alqam R, Mortada H. Ethical Considerations and Outcomes in Body Contouring Surgeries Among Adolescents: A Comprehensive Narrative Review. Aesthetic Plast Surg 2024:10.1007/s00266-024-04069-z. [PMID: 38777927 DOI: 10.1007/s00266-024-04069-z] [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: 02/15/2024] [Accepted: 04/09/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Body contouring surgery (BCS) in adolescents, particularly following bariatric surgery, involves a complex array of ethical, psychological, and medical factors. This review focuses on adolescents who have experienced significant weight loss, often due to bariatric surgery, and subsequently require body contouring to address excess skin and soft tissue. METHODS A literature narrative review was conducted using PubMed and Google Scholar databases. Relevant articles were screened and selected based on their discussion of post-bariatric and massive weight loss body contouring surgeries in adolescents, focusing on prevalence, outcomes, and ethical considerations. RESULTS The prevalence of BCS among adolescents is rising, influenced by social media and societal perceptions of beauty. However, the percentage of adolescents receiving BCS after bariatric surgery remains low. Adolescents undergoing BCS experience improvements in physical functioning, body image, and psychological well-being. Complications, although common, are mostly minor. Ethical considerations include ensuring informed consent, assessing emotional maturity, managing patient expectations, and involving adolescents in decision-making. Comparative analysis reveals similar outcomes in adults and adolescents, but adolescents face unique ethical challenges related to autonomy, long-term effects, and ongoing physical and emotional development. CONCLUSION BCS in adolescents following bariatric surgery can lead to improved physical and psychological outcomes. However, the decision to undergo BCS must be carefully considered, taking into account the adolescent's maturity, expectations, and long-term well-being. Ethical considerations are paramount, emphasizing the need for informed consent, realistic expectations, and a multidisciplinary approach. Further research is needed to assess long-term outcomes and the specific ethical implications of BCS in adolescents compared to adults. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Khalid Arab
- Division of Plastic Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Salman Sufian Qasim
- Division of Plastic Surgery, Department of Surgery, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Rakan Abu Alqam
- College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hatan Mortada
- Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
- Department of Plastic Surgery and Burn Unit, King Saud Medical City, Riyadh, Saudi Arabia.
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Cohen Vig L, Straussberg R, Ziv N, Hirschfeld-Dicker L, Konen O, Aharoni S. Neurologic complications of thiamine (B1) deficiency following bariatric surgery in adolescents. Eur J Paediatr Neurol 2024; 50:74-80. [PMID: 38705013 DOI: 10.1016/j.ejpn.2024.04.008] [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: 11/01/2023] [Revised: 04/07/2024] [Accepted: 04/17/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND The prevalence of obesity among children and adolescents is rising and poses a major health concern. Bariatric surgery is well established in adults and has become an option for adolescents. Thiamine (B1) deficiency is common following bariatric surgery in adults. It may present as Beri-Beri, Wernicke encephalopathy, or Korsakoff psychosis. OBJECTIVE Our aim was to describe the clinical features, diagnosis, and treatment of adolescents who presented with B1 deficiency after bariatric surgery at one center, and to summarize the data from the literature. PATIENTS Three adolescents with morbid obesity (two boys and one girl, aged 15.5 to- 17-years-old), presented at Schneider Children's Medical Center of Israel with progressive lower limb pain and weakness 2-3 month following a bariatric procedure (sleeve gastrectomy or narrowing of a bariatric band). The girl also had upper limb involvement and cerebellar signs. All three were non-compliant with micronutrient supplementation. After admission, they received intravenous B1 and oral multivitamin supplementation, and their symptoms improved considerably. CONCLUSIONS Micronutrient supplementation following bariatric surgery is crucial to prevent deficiencies. In adolescents, compliance with micronutrient supplementation should be assessed before and after such surgery. Thiamine deficiency may cause polyneuropathy, among other symptoms. Treatment reduces the severity of neurological complications.
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Affiliation(s)
- Lital Cohen Vig
- Institute of Pediatric Neurology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
| | - Rachel Straussberg
- Institute of Pediatric Neurology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Noa Ziv
- Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel; Pediatric Department C, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Lior Hirschfeld-Dicker
- Pediatric Department C, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Osnat Konen
- Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel; Institute of Pediatric Radiology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Sharon Aharoni
- Institute of Pediatric Neurology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
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Pratt KJ, Boles RE, Michalsky MP, Inge TH, Jenkins TM. Associations between marital status and weight loss trajectories entering into early adulthood: a Teen-LABS study. Surg Obes Relat Dis 2024; 20:376-382. [PMID: 38267352 DOI: 10.1016/j.soard.2023.11.009] [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: 09/06/2023] [Revised: 11/01/2023] [Accepted: 11/12/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Among adolescents who underwent metabolic and bariatric surgery (MBS), it is unclear how relationships and specifically marital status (MS) may be associated with long-term weight loss. OBJECTIVE In this analysis, we tested for associations between the MS of adolescents who underwent MBS and the MS of their primary caregiver and weight loss trajectory over 8 years. SETTING Teen-LABS participating sites. METHODS This sample included 231 participants (75.3% female, 71.4% White, 68.0% Roux-en-Y gastric bypass, 27.7% vertical sleeve gastrectomy, 4.3% laparoscopic adjustable gastric band). A linear mixed model was conducted with the dependent variable percent body mass index (BMI) change from preoperatively through 8 years with between-participant factors (1) participant MS, (2) caregiver MS, and (3) interaction between caregiver and participant MS. RESULTS One third of participants and 87% of caregivers were ever married (EM). Compared with never-married (NM) participants and caregivers (-14.6%), EM participants and caregivers (-20.6%), EM participants and NM caregivers (-25.9%), and NM participants and EM caregivers (-19.8%), each had significantly greater BMI loss at 8 years (each P < .05). No other group comparisons achieved statistical significance. CONCLUSIONS NM participants with NM caregivers had less favorable long-term BMI. Additional research is needed to better understand how relationships affect behavior change and weight loss after MBS.
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Affiliation(s)
- Keeley J Pratt
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, Ohio.
| | - Richard E Boles
- Department of Pediatrics, University of Colorado Anschutz Medical School, Aurora, Colorado
| | - Marc P Michalsky
- Department of Pediatric Surgery, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
| | - Thomas H Inge
- Department of Surgery, Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Todd M Jenkins
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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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.
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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
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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.
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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
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Mitra AT, Das B, Sarraf KM, Ford-Adams M, Fehervari M, Ashrafian H. Bone health following paediatric and adolescent bariatric surgery: a systematic review and meta-analysis. EClinicalMedicine 2024; 69:102462. [PMID: 38333369 PMCID: PMC10850131 DOI: 10.1016/j.eclinm.2024.102462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/17/2024] [Accepted: 01/17/2024] [Indexed: 02/10/2024] Open
Abstract
Background Childhood obesity is a pressing health crisis of epidemic proportions. Bariatric surgery (BS) is an effective weight loss solution however its role in the paediatric population is contentious owing to the paucity of weight specific and generalised health outcomes. This systematic review and meta-analysis aimed to assess the impact of paediatric BS on bone health. Methods This prospectively registered systematic review (PROSPERO ID: CRD42023432035) was performed in accordance with PRISMA guidelines. We searched MEDLINE (1946-1928 September 2023), EMBASE (1947-1928 September 2023) via the Ovid platform, and the Cochrane Review Library to identify scientific publications reporting bone outcome measures in patients under the age of 18 years who underwent BS. Meta-analysis was undertaken on post-operative weight and bone parameters in paediatric patients following BS. Outcomes were reported as weighted or standardized mean difference with 95 percent confidence intervals. Subgroup analysis by intervention, quality scoring and risk of bias were assessed. Findings Twelve studies with 681 patients across 5 countries (mean age 17 ± 0.57 years) were included. The quality of included studies was rated as high and there was substantial between-study heterogeneity for most factors included in the meta-analysis (I2 from 0% to 99.1%). Patients underwent Roux-en-Y gastric bypass (RYGB, n = 216), sleeve gastrectomy (SG, n = 257), gastric band (n = 184) or intragastric balloon placement (n = 24). BS was associated with significant weight reduction, body mass index (BMI) -12.7 kg/m2 (95% CI -14.5 to -10.9, p < 0.001), with RYGB being most effective, BMI -16.58 kg/m2 (95% CI -19.6 to -13.6, p < 0.001). Patients who underwent SG or RYGB had significantly lower lumbar bone mineral density, -0.96 g/cm2 (95% CI -0.1 to -0.03, p < 0.001), Z score, -1.132 (95% CI -1.8 to -0.45, p < 0.001) and subtotal body bone mineral density, -0.7 g/cm2 (95% CI -1.2 to -0.2, p < 0.001) following surgery. This was accompanied with higher markers of bone resorption, C-terminal telopeptide of type 1 collagen 0.22 ng/ml (95% CI 0.12-0.32, p < 0.001) and osteocalcin, 10.83 ng/ml (95% CI 6.01-15.67, p < 0.001). There was a significant reduction in calcium levels following BS, -3.78 mg/dl (95% CI -6.1 to -1.5, p < 0.001) but no difference in 25-hydroxyvitamin D, phosphate, bone alkaline phosphatase, procollagen type 1 N propeptide or parathyroid hormone. Interpretation BS effectively reduces weight in paediatric patients, but RYGB and SG may have adverse effects on bone health in the medium term. It is crucial to monitor and support bone health through appropriate nutritional supplementation and judicious follow-up. Long-term data is needed to fully understand the clinical implications of these findings on bone outcomes. Funding Medical Research Council (MRC), United Kingdom.
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Affiliation(s)
- Anuja Tulip Mitra
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, London, United Kingdom
| | - Bibek Das
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, London, United Kingdom
| | - Khalid Maher Sarraf
- Department of Orthopaedics, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, Paddington, London, United Kingdom
| | - Martha Ford-Adams
- Department of Paediatric Endocrinology, Kings College Hospital NHS Foundation Trust, London, United Kingdom
| | - Matyas Fehervari
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, London, United Kingdom
- Department of Bariatric Surgery, Chelsea and Westminster Hospital, London, United Kingdom
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, London, United Kingdom
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10
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Ikomi C, Baker-Smith CM. Where a child lives matters: neighborhood deprivation and pediatric obesity. Curr Opin Pediatr 2024; 36:3-9. [PMID: 38001559 DOI: 10.1097/mop.0000000000001317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
PURPOSE OF REVIEW This article outlines what is currently known regarding the relationship between neighborhood deprivation and pediatric obesity. It discusses the intersectionality between neighborhood deprivation, race, ethnicity, and pediatric obesity. We conclude by proposing several potential solutions to disparities in pediatric obesity related to neighborhood deprivation. RECENT FINDINGS Neighborhood deprivation, independent of individual socioeconomic status, is a risk factor for pediatric obesity. The obesogenic characteristics of high deprivation neighborhoods (e.g., lack of safe spaces to be active, easy access to fast food) and the psychological aspects of residing within high deprivation neighborhoods may also contribute to this risk. Intervention strategies and policies designed to address neighborhood related risk for pediatric obesity are needed. SUMMARY Pediatric obesity is a growing problem of complex etiology. Neighborhood risk factors should be considered when assessing risk burden and when designing intervention strategies.
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Affiliation(s)
- Chijioke Ikomi
- Division of Endocrinology
- Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Carissa M Baker-Smith
- Center for Cardiovascular Research and Innovation, Nemours Cardiac Center, Nemours Children's Health, Wilmington, Delaware
- Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
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11
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Zolfaghari F, Khorshidi Y, Moslehi N, Golzarand M, Asghari G. Nutrient Deficiency After Bariatric Surgery in Adolescents: A Systematic Review and Meta-Analysis. Obes Surg 2024; 34:206-217. [PMID: 37991712 DOI: 10.1007/s11695-023-06955-y] [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: 04/08/2023] [Revised: 11/04/2023] [Accepted: 11/13/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE This systematic review and meta-analysis study aimed to estimate changes in blood nutrient concentrations and nutrient deficiencies in adolescents following bariatric surgery. METHODS We searched PubMed, Scopus, and the Web of Science to find studies published between January 2000 and August 2023. Observational studies reporting the mean blood concentration of nutrients before and after bariatric surgery or the proportion of nutrient deficiencies after the surgery in healthy adolescents were selected. RESULTS Fifteen studies were included. Gastric bypass and sleeve gastrostomy were the most common types of surgery. Vitamin D, iron, or ferritin, vitamin B12, calcium, and folic acid were the most studied nutrients, respectively. Other nutrients examined in the studies included zinc, phosphorus, and albumin. The serum ferritin increased by 21 mcg/L (95% CI = 10.0, 32.0 mcg/L) after the surgery, but there were no significant alterations in other nutrients. The postoperative prevalence of low albumin, ferritin, vitamin D, and vitamin B12 levels was 10%, 49%, 41%, and 20%, respectively. Also, 23% had an iron deficiency, and 10% had a calcium deficiency after bariatric surgery. CONCLUSIONS The serum ferritin level increased following bariatric surgery in adolescents. Vitamin D and ferritin deficiencies were estimated to be present in more than one-third of adolescents after the surgery.
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Affiliation(s)
- Faraneh Zolfaghari
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-4741, Tehran, Iran
| | - Yasaman Khorshidi
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-4741, Tehran, Iran
| | - Nazanin Moslehi
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-4763, Tehran, Iran.
| | - Mahdieh Golzarand
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-4763, Tehran, Iran
| | - Golaleh Asghari
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-4741, Tehran, Iran.
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12
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Brandt S, Lennerz BS, Wiegand S, Schirmer M, Kleger P, Weyhreter H, Holle R, Hüttl TP, Dietl O, von Schnurbein J, Holl RW, Wabitsch M. Twelve-Month Outcomes after Metabolic and Bariatric Surgery among Youths Participating in a Structured Preparation and Follow-Up Program: Results of the Youth with Extreme Obesity Study. Obes Facts 2023; 17:59-71. [PMID: 38081152 PMCID: PMC10836940 DOI: 10.1159/000535104] [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: 02/10/2023] [Accepted: 10/19/2023] [Indexed: 02/04/2024] Open
Abstract
INTRODUCTION While invasive and associated with risks, metabolic and bariatric surgery (MBS) can promote sustained weight loss and substantial health benefits in youths with extreme obesity. The path toward informed decision making for or against MBS is poorly characterized and postoperative follow-up to assess risks and benefits is inconsistent. In youths with extreme obesity, we aimed to evaluate decision making toward MBS, as well as MBS outcomes and adherence with follow-up and recommendations in the setting of a structured pre- and post-MBS program. METHODS Participants were recruited in the setting of the multicenter "Youth with Extreme Obesity Study" (YES). YES is a cohort study in adolescents and young adults aged 14-24 years with obesity (BMI ≥30.0 kg/m2) who were recruited at four medical centers and one job center in Germany between 2012 and 2018. Participants at two medical centers with BMI ≥35 kg/m2, aged 14-24 years, and interested in pursuing MBS were included in the subproject 3 "Safety and effectiveness of weight loss surgery in adolescents with severe obesity within a structured pre- and post-surgery treatment program - an observational study" that comprised a 2-months pre- and 12-months post-MBS program. RESULTS Twenty-eight of 169 youths (17%) with BMI ≥35 kg/m2 were interested in MBS. Twenty-six fulfilled published eligibility criteria for MBS and participated in the structured pre-MBS preparation program. Of these, 9 participants (2 females) decided against, and 17 (n = 11 females) decided for MBS (sleeve gastrectomy). The 12-month follow-up rate was high (16/17 [94%]) and all participants achieved significant weight reduction (ΔBMI: -16.1 ± 5.6 kg/m2). Eleven of 16 participants (69%) reported taking the prescribed dietary supplements in the first year after MBS, but only five of them (31%) did so daily. In contrast to the high 12-month retention rate, follow-up after completion of the structured program was low at 24-months (9/16 [56%]) and at 36-months (5/15 [36%]), respectively. CONCLUSION Participants demonstrated active decision making for or against MBS and high adherence with the structured pre- and 12 months post-MBS program, but participation was low thereafter. These findings endorse the need for longer term structured post-MBS programs to capture long-term outcomes and provide adequate care in this vulnerable group at the transition to adulthood.
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Affiliation(s)
- Stephanie Brandt
- Interdisciplinary Obesity Unit, Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany,
| | - Belinda S Lennerz
- New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Susanna Wiegand
- Center for Social-Pediatric Care/Pediatric Endocrinology and Diabetology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Melanie Schirmer
- Interdisciplinary Obesity Unit, Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Pauline Kleger
- Interdisciplinary Obesity Unit, Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Helmut Weyhreter
- Interdisciplinary Obesity Unit, Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Rolf Holle
- Institute of Medical Data Processing, Biometrics and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany
| | - Thomas P Hüttl
- Department of General and Visceral Surgery, Dr. Lubos Kliniken Bogenhausen Pasing, Munich, Germany
| | - Otto Dietl
- Department of General and Visceral Surgery, Dr. Lubos Kliniken Bogenhausen Pasing, Munich, Germany
| | - Julia von Schnurbein
- Interdisciplinary Obesity Unit, Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Martin Wabitsch
- Interdisciplinary Obesity Unit, Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
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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: 3] [Impact Index Per Article: 3.0] [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.
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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
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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.
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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.
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15
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Guan W, Lin S, Fu Z, Yang N, Shen J, Liu R, Li C, Zhou H, Liang H. Five-Year Physical and Psychosocial Outcomes in Obese Adolescents With and Without Metabolic Bariatric Surgery. J Adolesc Health 2023; 73:784-789. [PMID: 37395697 DOI: 10.1016/j.jadohealth.2023.05.034] [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: 12/01/2022] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE Metabolic bariatric surgery (MBS) is increasingly accepted as a treatment for severely obese adolescents. However, its long-term efficacy and safety are not well characterized, particularly in the Eastern Asian population. We aimed to explore the long-term effects of MBS on Chinese adolescents with severe obesity. METHODS A total of 44 obese adolescents (≤18 years old) underwent MBS at our institution from May 2011 to May 2017. A matched nonsurgical control group, including 43 patients, was recruited from lifestyle modification programs in the same period. All patients completed assessments at presurgery/baseline and five years after surgery. The data were collected and analyzed using the χ2 test and an independent sample t-test. RESULTS Comparing the surgical and control groups revealed that the surgical patients showed significant weight loss and improvement in comorbidities, while the nonsurgical patients showed a trend of weight gain and increased comorbidities (p < .05). Furthermore, the surgical patients had a higher composite physical quality of life (as determined by the Short Form-36 questionnaire). On the other hand, the patients who underwent MBS had a higher risk of malnutrition. DISCUSSION Compared with nonsurgical patients, severely obese adolescents who undergo MBS exhibit more effective long-term weight loss, remission of comorbidities, and improved quality of life. Furthermore, more attention should be paid to helping adolescents avoid malnutrition after they undergo MBS.
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Affiliation(s)
- Wei Guan
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China
| | - Shibo Lin
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China
| | - Zhenzhen Fu
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China
| | - Ningli Yang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China
| | - Jiajia Shen
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China
| | - Ruiping Liu
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China
| | - Cong Li
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China
| | - Hongwen Zhou
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China.
| | - Hui Liang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China.
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16
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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.
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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.
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17
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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.
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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
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18
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van Olst N, Reiber BMM, Vink MRA, Gerdes VEA, Galenkamp H, van der Peet DL, van Rijswijk AS, Bruin SC. Are male patients undergoing bariatric surgery less healthy than female patients? Surg Obes Relat Dis 2023; 19:1013-1022. [PMID: 36967264 DOI: 10.1016/j.soard.2023.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 02/06/2023] [Accepted: 02/15/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Male patients are underrepresented in bariatric surgery (BS) despite a relatively equal proportion of men and women experiencing obesity. OBJECTIVES Differences in frequency and severity of obesity-associated medical problems (OAMPs) between men and women undergoing BS or in a control group (HELIUS [HEalthy Life In an Urban Setting]) were evaluated. The hypothesis was that men undergoing BS are less healthy than women. SETTING A cross-sectional study of 2 cohorts undergoing BS in 2013 (BS2013) and 2019 (BS2019) and a control group of patients with severe obesity from a general population (HELIUS). METHODS Characteristics concerning weight and OAMPs, medication usage, intoxications, postoperative complications (for BS2019) were compared between men and women. Members of the HELIUS cohort were tested for eligibility for BS. RESULTS Of 3244 patients included, the majority were female (>78.4%). Median (interquartile range) age and body mass index (kg/m2) in male versus female patients were 47.0 (41.0-53.8) versus 43.0 (36.0-51.0) years and 41.5 (38.4-45.2) versus 42.3 (40.2-45.9), respectively, in BS2013, and 52.0 (39.8-57.0) versus 45.0 (35.0-53.0) years and 40.4 (37.4-43.8) versus 41.3 (39.0-44.1) in BS2019 (P < .05). The rates of men with OAMPs were 71.4% and 82.0% compared with 50.2% and 56.9% of women in BS2013 and BS2019, respectively. Overall medication usage was higher in male patients (P = .014). In BS2019, male patients exhibited a higher median HbA1C (P < .001) and blood pressure (P = .003) and used more antihypertensives and antidiabetics (P = .004). Postoperative complications did not differ between men and women. In the control cohort, 66.5% of men and 66.6% of women were eligible for BS. CONCLUSION Men undergoing BS more often experience OAMPs than women, and OAMPs are more advanced in men.
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Affiliation(s)
- Nienke van Olst
- Department of Bariatric Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands; Department of Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
| | - Beata M M Reiber
- Department of Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Marjolein R A Vink
- Department of Bariatric Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands
| | - Victor E A Gerdes
- Department of Bariatric Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands; Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam University Medical Centers, Amsterdam, the Netherlands; Health Behaviors and Chronic Diseases, Amsterdam Public Health, Amsterdam, the Netherlands
| | - Donald L van der Peet
- Department of Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | | | - Sojoerd C Bruin
- Department of Bariatric Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands
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19
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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: 7] [Impact Index Per Article: 7.0] [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.
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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
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Vajravelu ME, Tas E, Arslanian S. Pediatric Obesity: Complications and Current Day Management. Life (Basel) 2023; 13:1591. [PMID: 37511966 PMCID: PMC10381624 DOI: 10.3390/life13071591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
Obesity affects approximately 1 in 5 youth globally and increases the risk of complications during adolescence and young adulthood, including type 2 diabetes, dyslipidemia, hypertension, non-alcoholic fatty liver disease, obstructive sleep apnea, and polycystic ovary syndrome. Children and adolescents with obesity frequently experience weight stigma and have an impaired quality of life, which may exacerbate weight gain. Pediatric obesity is typically defined using sex-, age-, and population-specific body mass index percentiles. Once identified, pediatric obesity should always be managed with lifestyle modification. However, adolescents with obesity may also benefit from anti-obesity medications (AOM), several of which have been approved for use in adolescents by the US Food and Drug Administration, including liraglutide, phentermine/topiramate, and semaglutide. For children with specific, rare monogenic obesity disorders, setmelanotide is available and may lead to significant weight loss. Metabolic and bariatric surgery may be used for the management of severe obesity in youth; though highly effective, it is limited to specialized centers and has had relatively low pediatric uptake. In this narrative review using pediatric-focused data from original research, reviews, clinical practice guidelines, governmental agencies, and pharmaceutical companies, we review obesity-related metabolic complications in youth and management strategies, including AOM and bariatric surgery.
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Affiliation(s)
- Mary Ellen Vajravelu
- Center for Pediatric Research in Obesity and Metabolism, UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave., Faculty Pavilion 6th Floor, Pittsburgh, PA 15224, USA
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Emir Tas
- Center for Pediatric Research in Obesity and Metabolism, UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave., Faculty Pavilion 6th Floor, Pittsburgh, PA 15224, USA
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Silva Arslanian
- Center for Pediatric Research in Obesity and Metabolism, UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave., Faculty Pavilion 6th Floor, Pittsburgh, PA 15224, USA
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
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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.
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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
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Lacrosniere SM, Dubern B, Pelta S, Karsenty A, Bernert C, Chantereau H, Oderda L, Lemoine A, Bouillot JL, Tounian P. Bariatric procedures including Roux-en-Y gastric bypass in French adolescents. Arch Pediatr 2023:S0929-693X(23)00096-9. [PMID: 37407324 DOI: 10.1016/j.arcped.2023.06.006] [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: 01/23/2022] [Revised: 09/11/2022] [Accepted: 06/04/2023] [Indexed: 07/07/2023]
Abstract
INTRODUCTION In France, approximately 100 obese adolescents undergo a bariatric procedure every year. To date, only data from laparoscopic adjustable gastric banding (LAGB) or sleeve gastrectomy (SG) have been published. Our objective was to report the outcomes of a series of French obese adolescents who underwent a Roux-en-Y gastric bypass (RYGB). METHODS We included all obese adolescents aged 13-19 years who underwent RYGB in our department from 2008 with at least 2 years of follow-up after surgery. We analyzed the course of the anthropometric data, comorbidities, and subsequent adverse events. RESULTS Starting in September 2008, out of 93 obese adolescents who requested bariatric surgery, 39 (35%) underwent a bariatric procedure. From these adolescents, 2-year follow-up data were available for 26 patients who had a RYGB. At the time of surgery, the mean patient age was 17.4 years (standard deviation [SD]=1.4) and the body mass index (BMI) was 52.0 kg/m² (SD=7.8). One patient was lost to follow-up. At 2 years after surgery, the mean BMI was 35.7 kg/m² (SD=9.4) with a mean decrease in BMI of 31.9% (SD=11.6). Comorbidities improved for most of the patients: high blood pressure (2/2) and pseudotumor cerebri (1/1) were cured after surgery, and dyslipidemia improved globally. The complications observed were anemia, abdominal pain requiring celioscopy (n = 2), and oxalic nephrolithiasis. CONCLUSION Only one third of the obese adolescents requesting bariatric surgery were operated on. Our series including exclusively obese adolescents who underwent an RYGB presents the results of this technique on weight loss and comorbidities; mechanical and nutritional complications remain uncommon. These results are similar to those obtained in studies of adult patients.
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Affiliation(s)
| | - Béatrice Dubern
- Pediatric Nutrition and Gastroenterology Department, Trousseau Hospital, APHP, Paris, France; Sorbonne University, Inserm Nutriomics, Paris, France
| | - Sarah Pelta
- Pediatric Nutrition and Gastroenterology Department, Trousseau Hospital, APHP, Paris, France
| | - Alexandra Karsenty
- Pediatric Nutrition and Gastroenterology Department, Trousseau Hospital, APHP, Paris, France
| | - Christine Bernert
- Sorbonne University, Inserm Nutriomics, Paris, France; Nutrition Department, Pitié-Salpêtrière, APHP, Paris, France
| | - Hélène Chantereau
- Pediatric Nutrition and Gastroenterology Department, Trousseau Hospital, APHP, Paris, France
| | - Leslie Oderda
- Pediatric Nutrition and Gastroenterology Department, Trousseau Hospital, APHP, Paris, France
| | - Anais Lemoine
- Pediatric Nutrition and Gastroenterology Department, Trousseau Hospital, APHP, Paris, France
| | - Jean-Luc Bouillot
- Digestive and Metabolic Surgery Department, Ambroise Paré Hospital, APHP, Paris, France
| | - Patrick Tounian
- Pediatric Nutrition and Gastroenterology Department, Trousseau Hospital, APHP, Paris, France; Sorbonne University, Inserm Nutriomics, Paris, France.
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23
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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.
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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
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Abstract
Obesity in the pediatric population is increasing in the United States and globally. Childhood obesity is associated with cardiometabolic and psychosocial comorbidities and decreased overall life span. The cause of pediatric obesity is multifactorial and includes genetic predisposition, lifestyle, behavioral patterns, and consequences of social determinants of health. Routine screening of BMI and comorbid conditions is essential to identifying patients who require treatment. The AAP recommends immediate Intensive Health Behavior and Lifestyle Treatment for children with obesity, encompassing lifestyle changes, behavioral changes, and mental health treatments. Pharmacologic interventions and metabolic and bariatric surgery are also available when indicated.
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Affiliation(s)
- Gunther Wong
- Department of Medicine, Division of Diabetes, Endocrinology & Metabolism, Vanderbilt University School of Medicine, Nashville, TN, USA; Department of Surgery, Vanderbilt University School of Medicine; Department of Pediatrics, Vanderbilt University School of Medicine; Vanderbilt Weight Loss Center, Vanderbilt University Medical Center, Thompson Lane, Suite 22200, Nashville, TN 37204, USA
| | - Gitanjali Srivastava
- Department of Medicine, Division of Diabetes, Endocrinology & Metabolism, Vanderbilt University School of Medicine, Nashville, TN, USA; Department of Surgery, Vanderbilt University School of Medicine; Department of Pediatrics, Vanderbilt University School of Medicine; Vanderbilt Weight Loss Center, Vanderbilt University Medical Center, Thompson Lane, Suite 22200, Nashville, TN 37204, USA.
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25
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Farnesi BC, Kaffash K, Cohen TR, Alberga AS. A qualitative exploration on the needs of health care providers working with adolescents who are undergoing bariatric surgery. OBESITY PILLARS (ONLINE) 2023; 6:100067. [PMID: 37990654 PMCID: PMC10661974 DOI: 10.1016/j.obpill.2023.100067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/20/2023] [Indexed: 11/23/2023]
Abstract
Background With increasing prevalence of severe obesity in youth, more adolescents are becoming candidates for bariatric surgery. In Canada, bariatric surgery in adolescents is in its infancy, and long-term health outcomes are not well known. It is unknown what health care providers (HCPs) are using to prepare and guide their adolescent patients for bariatric surgery. The needs of HCPs should be explored with the aim to improve patient outcomes. Therefore, the purpose of this study was to investigate the resource needs of HCPs working with adolescents living with severe obesity who are undergoing bariatric surgery. Methods This qualitative study consisted of a focus group with seven HCPs from an adolescent bariatric program using a semi-structured interview guide. The focus group discussion was audio-recorded, and the recording was transcribed verbatim. A thematic analysis was conducted. Results Four data-generated themes emerged highlighting the perceived needs and challenges faced by HCPs. These included (1) gaps in patient education materials on the subject of the bariatric surgery process, obesity as a chronic disease and mental health, (2) the need for designing resources that are teen-friendly, adaptable, and accessible, (3) the need for resources to facilitate decision-making and patient evaluation delivering more streamlined care and; (4) challenges to addressing resource needs due to limited clinical time and budgets. Conclusion This needs assessment study highlights the need for appropriate resources for patient education, as well as pre and post-operative preparation. The hope is that HCPs can improve quality of care delivered and positively impact surgical outcomes in their patients.
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Affiliation(s)
- Biagina-Carla Farnesi
- Centre of Excellence in Adolescent Severe Obesity, Adolescent Medicine, Montreal Children's Hospital, 1040 Ave Atwater W-105, H3Z 1X3, Montreal, Quebec, Canada
| | - Kimiya Kaffash
- Department of Health, Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street West, H4B 1R6, Montreal, Quebec, Canada
| | - Tamara R. Cohen
- Food, Nutrition and Health, Faculty of Land and Food Systems, The University of British Columbia, 218-2205 East Mall, V6T 1Z4, Vancouver, British Columbia, Canada
- Department of Pediatrics, Faculty of Medicine, McGill University, 3605 Rue de la Montagne, Montreal, Quebec, Canada
- BC Children’s Hospital Research Institute, Healthy Starts, 938 West 28th Avenue, Vancouver, BC V5Z 4H4, Canada
| | - Angela S. Alberga
- Department of Health, Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street West, H4B 1R6, Montreal, Quebec, Canada
- Department of Pediatrics, Faculty of Medicine, McGill University, 3605 Rue de la Montagne, Montreal, Quebec, Canada
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26
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Bejarano CM, Gowey M, Reiter-Purtill J, Ley S, Mitchell JE, Zeller MH. Trajectories of Psychopathology and Dysregulation 2-4 Years following Adolescent Bariatric Surgery. J Pediatr Psychol 2023; 48:479-489. [PMID: 36898044 PMCID: PMC10199728 DOI: 10.1093/jpepsy/jsad009] [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: 08/01/2022] [Revised: 02/02/2023] [Accepted: 02/08/2023] [Indexed: 03/12/2023] Open
Abstract
OBJECTIVE This study examined psychopathology and weight over 4 years following bariatric surgery in adolescents with obesity, as compared to a nonsurgical group. The role of psychological dysregulation in relation to psychopathology in the 2-4 year "maintenance phase" following surgery was also examined. METHODS Adolescent participants (122 surgical and 70 nonsurgical) completed height/weight and psychopathology assessments annually for 4 years, with dysregulation assessed at Year 2. Analyses examined the association of "High" and "Low" psychopathology with weight over time using logistic regression. Mediation analyses in the surgical group examined indirect effects of dysregulation on percent weight loss through Year 4 psychopathology. RESULTS There were lower odds of "High" internalizing symptoms in the surgical group versus the nonsurgical group from baseline (presurgery) to Year 4 (OR = .39; p < .001; 42.3% "High" internalizing in surgical; 66.7% in nonsurgical) and during the 2-4 year maintenance phase (OR = .35, p < .05; 35.1% "High" internalizing in surgical; 60.8% in nonsurgical). There was a significant mediation effect in the surgical group: higher dysregulation was associated with greater Year 4 internalizing symptoms (β = .41, p < .001) which in turn was associated with less Year 4 percent weight loss (β = -.27, p < .05). CONCLUSIONS While the surgical group was less likely to experience internalizing symptoms, internalizing psychopathology was related to less percent weight loss in this group. Internalizing symptoms mediated the relationship between dysregulation and percent weight loss in the surgical group. Postoperative mental health follow-up is needed for adolescents into young adulthood.
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Affiliation(s)
- Carolina M Bejarano
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | - Jennifer Reiter-Purtill
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Sanita Ley
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - James E Mitchell
- Department of Clinical Neuroscience, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, North Dakota, USA
| | - Meg H Zeller
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Lister NB, Baur LA, Felix JF, Hill AJ, Marcus C, Reinehr T, Summerbell C, Wabitsch M. Child and adolescent obesity. Nat Rev Dis Primers 2023; 9:24. [PMID: 37202378 DOI: 10.1038/s41572-023-00435-4] [Citation(s) in RCA: 58] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 05/20/2023]
Abstract
The prevalence of child and adolescent obesity has plateaued at high levels in most high-income countries and is increasing in many low-income and middle-income countries. Obesity arises when a mix of genetic and epigenetic factors, behavioural risk patterns and broader environmental and sociocultural influences affect the two body weight regulation systems: energy homeostasis, including leptin and gastrointestinal tract signals, operating predominantly at an unconscious level, and cognitive-emotional control that is regulated by higher brain centres, operating at a conscious level. Health-related quality of life is reduced in those with obesity. Comorbidities of obesity, including type 2 diabetes mellitus, fatty liver disease and depression, are more likely in adolescents and in those with severe obesity. Treatment incorporates a respectful, stigma-free and family-based approach involving multiple components, and addresses dietary, physical activity, sedentary and sleep behaviours. In adolescents in particular, adjunctive therapies can be valuable, such as more intensive dietary therapies, pharmacotherapy and bariatric surgery. Prevention of obesity requires a whole-system approach and joined-up policy initiatives across government departments. Development and implementation of interventions to prevent paediatric obesity in children should focus on interventions that are feasible, effective and likely to reduce gaps in health inequalities.
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Affiliation(s)
- Natalie B Lister
- Children's Hospital Westmead Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Louise A Baur
- Children's Hospital Westmead Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
- Weight Management Services, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
| | - Janine F Felix
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Andrew J Hill
- Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Claude Marcus
- Division of Paediatrics, Department of Clinical Science Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Thomas Reinehr
- Vestische Hospital for Children and Adolescents Datteln, University of Witten/Herdecke, Datteln, Germany
| | - Carolyn Summerbell
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
| | - Martin Wabitsch
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, Ulm University Medical Centre, Ulm, Germany
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Wu Z, Gao Z, Qiao Y, Chen F, Guan B, Wu L, Cheng L, Huang S, Yang J. Long-Term Results of Bariatric Surgery in Adolescents with at Least 5 Years of Follow-up: a Systematic Review and Meta-Analysis. Obes Surg 2023:10.1007/s11695-023-06593-4. [PMID: 37115416 DOI: 10.1007/s11695-023-06593-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023]
Abstract
OBJECTS The purpose of this study was to investigate the long-term outcomes of bariatric surgery in adolescents with obesity by including studies with a follow-up of at least 5 years. METHODS PubMed, EMBASE, and CENTRAL were systematically searched. Studies that met the criteria were included in the analysis. RESULT We identified 29 cohort studies with a total population of 4970. Preoperative age ranged from 12 to 21 years; body mass index (BMI) ranged from 38.9 to 58.5 kg/m2. Females were the predominant gender (60.3%). After at least 5-year of follow-up, the pooled BMI decline was 13.09 kg/m2 (95%CI 11.75-14.43), with sleeve gastrectomy (SG) was 15.27 kg/m2, Roux-en-Y gastric bypass (RYGB) was 12.86 kg/m2, and adjustable gastric banding (AGB) was 7.64 kg/m2. The combined remission rates of type 2 diabetes mellitus (T2DM), dyslipidemia, hypertension (HTN), obstructive sleep apnea (OSA), and asthma were 90.0%, 76.6%, 80.7%, 80.8%, and 92.5%, (95%CI 83.2-95.6, 62.0-88.9, 71.5-88.8, 36.4-100, and 48.5-100), respectively. Postoperative complications were underreported. Combined with the current study, we found a low level of postoperative complications. Iron and vitamin B12 deficiencies were the main nutritional deficiency complications identified so far. CONCLUSION For adolescents with severe obesity, bariatric surgery (especially RYGB and SG) is the independent and effective treatment option. After at least 5 years of follow-up, bariatric surgery in adolescents showed a desirable reduction in BMI and significant remission of T2DM, dyslipidemia, and HTN. Surgical and nutrition-related complications still need to be further explored by more long-term studies.
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Affiliation(s)
- Zhenpeng Wu
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Zhiguang Gao
- Department of Gastrointestinal Surgery, The Affiliated Dongguan Shilong People's Hospital of Southern Medical University, Dongguan, 523320, China
| | - Yuhan Qiao
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Fazhi Chen
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Bingsheng Guan
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Lina Wu
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Lvjia Cheng
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Shifang Huang
- Intensive Care Unit, First Affiliated Hospital of Jinan University, 613 Huangpu Avenue West, Guangzhou, 510630, Guangdong Province, China.
| | - Jingge Yang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, 613 Huangpu Avenue West, Guangzhou, 510630, Guangdong Province, China.
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Al Sabah S, Haddad EA, Shuaibi S, Qadhi I, Al-Saidan L, Khayat A. Long-term Outcomes of Sleeve Gastrectomy in Adolescent Patients: The Effect of Weight Loss in Younger Years to Outcomes in Adulthood. BMC Surg 2023; 23:103. [PMID: 37118797 PMCID: PMC10148482 DOI: 10.1186/s12893-023-02006-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 04/12/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Childhood obesity is associated with a variety of complications that see their light throughout adulthood. Due to the serious side effects of these morbidities, early intervention is essential. Laparoscopic sleeve gastrectomy (SG) is a safe and effective procedure for the treatment of obesity, however, the long-term data on its use in adolescents is lacking in the literature. METHODS A retrospective analysis was conducted on all patients that underwent SG aged between 12 and 21 years old at a public hospital in Kuwait. Data on their weight and comorbidities was collected and analyzed. RESULTS 164 adolescent patients with a mean age of 19 underwent SG. 71% of the patients were female, while the mean weight at surgery was 128.6 kg, corresponding to a BMI of 47.8 Kg/m2. 32% of patients had a starting BMI more than 50, while 6.7% had a BMI over 60. The highest weight loss was achieved at 18 months post-op, corresponding to an EWL of 82.66%. On long-term follow-up, weight loss was maintained over the 13 years post-op. Obstructive sleep apnea resolved in 75% of the patients while hypertension persisted in the 2 patients who were diagnosed with it pre-op. 21 patients developed gastro-esophageal reflux disease 5.7 years post-op, while 20 patients were treated for gall bladder stones 4.4 years post-op. CONCLUSION It is of ample importance to tackle obesity during childhood before complications ensue later in life. Bariatric surgery, specifically SG, has been found to be an effective and safe weight loss tool, with sustained long-term weight maintenance and resolution of early comorbidities.
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Affiliation(s)
- Salman Al Sabah
- Department of Surgery, Kuwait University, Kuwait City, Kuwait.
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30
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Yiğit MV, Bahçe ZŞ. Long-Term Results of Adolescent Patients who Underwent Laparoscopic Sleeve Gastrectomy. Indian J Surg 2023. [DOI: 10.1007/s12262-023-03752-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Järvholm K, Janson A, Peltonen M, Neovius M, Gronowitz E, Engström M, Laurenius A, Beamish AJ, Dahlgren J, Sjögren L, Olbers T. Metabolic and bariatric surgery versus intensive non-surgical treatment for adolescents with severe obesity (AMOS2): a multicentre, randomised, controlled trial in Sweden. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:249-260. [PMID: 36848922 DOI: 10.1016/s2352-4642(22)00373-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 03/01/2023]
Abstract
BACKGROUND Severe obesity in adolescents has a profound impact on current and future health. Metabolic and bariatric surgery (MBS) is increasingly used in adolescents internationally. However, to our knowledge, there are no randomised trials examining the currently most used surgical techniques. Our aim was to evaluate changes in BMI and secondary health and safety outcomes after MBS. METHODS The Adolescent Morbid Obesity Surgery 2 (AMOS2) study is a randomised, open-label, multicentre trial done at three university hospitals in Sweden (located in Stockholm, Gothenburg, and Malmö). Adolescents aged 13-16 years with a BMI of at least 35 kg/m2, who had attended treatment for obesity for at least 1 year, passed assessments from a paediatric psychologist and a paediatrician, and had a Tanner pubertal stage of at least 3, were randomly assigned (1:1) to MBS or intensive non-surgical treatment. Exclusion criteria included monogenic or syndromic obesity, major psychiatric illness, and regular self-induced vomiting. Computerised randomisation was stratified for sex and recruitment site. Allocation was concealed for both staff and participants until the end of the inclusion day, and then all participants were unmasked to treatment intervention. One group underwent MBS (primarily gastric bypass), while the other group received intensive non-surgical treatment starting with 8 weeks of low-calorie diet. The primary outcome was 2-year change in BMI, analysed as intention-to-treat. The trial is registered at ClinicalTrials.gov, NCT02378259. FINDINGS 500 people were assessed for eligibility between Aug 27, 2014, and June 7, 2017. 450 participants were excluded (397 did not meet inclusion criteria, 39 declined to participate, and 14 were excluded for various other reasons). Of the 50 remaining participants, 25 (19 females and six males) were randomly assigned to receive MBS and 25 (18 females and seven males) were assigned to intensive non-surgical treatment. Three participants (6%; one in the MBS group and two in the intensive non-surgical treatment group) did not participate in the 2-year follow-up, and in total 47 (94%) participants were assessed for the primary endpoint. Mean age of participants was 15·8 years (SD 0·9) and mean BMI at baseline was 42·6 kg/m2 (SD 5·2). After 2 years, BMI change was -12·6 kg/m2 (-35·9 kg; n=24) among adolescents undergoing MBS (Roux-en-Y gastric bypass [n=23], sleeve gastrectomy [n=2]) and -0·2 kg/m2 (0·4 kg; [n=23]) among participants in the intensive non-surgical treatment group (mean difference -12·4 kg/m2 [95% CI -15·5 to -9·3]; p<0·0001). Five (20%) patients in the intensive non-surgical group crossed over to MBS during the second year. Adverse events (n=4) after MBS were mild but included one cholecystectomy. Regarding safety outcomes, surgical patients had a reduction in bone mineral density, while controls were unchanged after 2 years (z-score change mean difference -0·9 [95% CI -1·2 to -0·6]). There were no significant differences between the groups in vitamin and mineral levels, gastrointestinal symptoms (except less reflux in the surgical group), or in mental health at the 2-year follow-up. INTERPRETATION MBS is an effective and well tolerated treatment for adolescents with severe obesity resulting in substantial weight loss and improvements in several aspects of metabolic health and physical quality of life over 2 years, and should be considered in adolescents with severe obesity. FUNDING Sweden's Innovation Agency, Swedish Research Council Health.
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Affiliation(s)
- 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; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Martin Neovius
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Eva Gronowitz
- Department of Paediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - My Engström
- Institute of Clinical Sciences, and Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Laurenius
- Department of Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Andrew J Beamish
- Welsh Institute of Metabolic and Obesity Surgery, Morriston Hospital, Swansea, UK; Swansea University Medical School, Swansea University, Swansea, UK
| | - Jovanna Dahlgren
- Department of Paediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Regional Obesity Center, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lovisa Sjögren
- Department of Paediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Regional Obesity Center, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Torsten Olbers
- Childhood Obesity Unit, Skåne University Hospital, Malmö, Sweden; Department of Biomedical and Clinical Sciences and Wallenberg Center for Molecular Medicine, Linköping University, Linköping, Sweden
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Rodriquez IM, O’Sullivan KL. Youth-Onset Type 2 Diabetes: Burden of Complications and Socioeconomic Cost. Curr Diab Rep 2023; 23:59-67. [PMID: 36961664 PMCID: PMC10037371 DOI: 10.1007/s11892-023-01501-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2023] [Indexed: 03/25/2023]
Abstract
PURPOSE OF REVIEW With the rise in prevalence of youth-onset type 2 diabetes (T2DM), it is imperative to understand the clinical burden of the disease and the socioeconomic burden this disease imposes. We review the most recent data on youth-onset T2DM, including its pathophysiology, complications, and treatment. We also review existing data to determine the socioeconomic burden of youth-onset T2DM. RECENT FINDINGS The incidence of youth-onset T2DM is rising, and significantly accelerated following the COVID-19 pandemic. Youth with T2DM are more frequently from families of racial/ethnic minorities and lower socioeconomic status. Youth-onset T2DM has more rapid disease progression compared to adult-onset type 2 diabetes. It results in earlier and more severe microvascular and macrovascular complications compared to both adult-onset T2DM and youth-onset type 1 diabetes (T1DM). While there is a lack of data describing the socioeconomic cost of youth-onset T2DM, based on extrapolation from analyses of the burden of T2DM in adults and T1DM in youth, we propose that youth-onset T2DM has higher direct and indirect costs than adult-onset T2DM. Youth-onset T2DM presents a significant clinical and socioeconomic burden due to its aggressive presentation and earlier appearance of complications. Additional research is needed regarding the cost of illness in this population.
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Affiliation(s)
- Isabella Marranzini Rodriquez
- Medical Center, Section of Adult & Pediatric Endocrinology, Diabetes & Metabolism, University of Chicago, 5841 S. Maryland Avenue, MC 5053, Chicago, IL 60637 USA
| | - Katie L. O’Sullivan
- Medical Center, Section of Adult & Pediatric Endocrinology, Diabetes & Metabolism, University of Chicago, 5841 S. Maryland Avenue, MC 5053, Chicago, IL 60637 USA
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Tung JYL, Poon GWK, Du J, Wong KKY. Obesity in children and adolescents: Overview of the diagnosis and management. Chronic Dis Transl Med 2023. [DOI: 10.1002/cdt3.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Affiliation(s)
- Joanna Y. L. Tung
- Department of Paediatrics and Adolescent Medicine The University of Hong Kong Pokfulam Hong Kong China
- Department of Paediatrics and Adolescent Medicine Hong Kong Children's Hospital Hong Kong China
| | - Grace W. K. Poon
- Department of Paediatrics and Adolescent Medicine The University of Hong Kong Pokfulam Hong Kong China
| | - Juan Du
- Department of Endocrinology Jilin Province People's Hospital Jilin China
- The Paediatric Precision Medicine Centre Children's Hospital of Changchun Jilin China
| | - Kenneth K. Y. Wong
- Department of Surgery The University of Hong Kong Pokfulam Hong Kong China
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Griffin KL, Ragan MV, Patterson KN, Diefenbach KA, Needleman BJ, Aldrink JH, Michalsky MP. Robotic-Assisted Metabolic and Bariatric Surgery in the Pediatric Population. Semin Pediatr Surg 2023; 32:151257. [PMID: 36739691 DOI: 10.1016/j.sempedsurg.2023.151257] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Kristine L Griffin
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Mecklin V Ragan
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kelli N Patterson
- Department of Surgery, The Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Karen A Diefenbach
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Bradley J Needleman
- Department of Surgery, The Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Jennifer H Aldrink
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Marc P Michalsky
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
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DeMello AS, Acorda DE, Thompson D, Allen DL, Aman R, Brandt ML, Sisley S. Growing Up After Adolescent Bariatric Surgery. Clin Nurs Res 2023; 32:115-125. [PMID: 36169264 DOI: 10.1177/10547738221120338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This study investigates the effects of adolescent bariatric surgery among young adults approximately 10 years post-surgery. Participants were recruited from a hospital-based bariatric registry. We used an exploratory, qualitatively-driven mixed methods design. Findings were integrated with medical chart data and the SF-36, Body QoL, and the Transition Readiness Assessment Questionnaire. Of the 22 participants who completed surveys (14 females and 8 males), 20 participants also completed a phone interview. Median participant age was 25 years (range = 19-30). Median weight-loss was 23% (6.0%‒58%). Four themes emerged: taking control, weight loss challenges, body image adjustment, and growing up. Participants reported physical benefits of surgery yet were challenged by eating habits, body image, and interpersonal relationships. Participants were indifferent to preventative healthcare, despite the potential for vitamin deficiencies and the return of weight-related comorbidities. Clinicians can facilitate the transition to young adulthood by providing continued mental support, education, and medical monitoring.
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Affiliation(s)
| | | | | | | | - Rahema Aman
- The University of Texas Health Science Center, Houston, TX, USA
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Wang K, Zeng C. Extracellular Vesicles and Obesity. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1418:143-153. [PMID: 37603278 DOI: 10.1007/978-981-99-1443-2_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Extracellular vesicles (EVs) are a group of vesicles with membrane structure released by cells, including exosomes, microvesicles, apoptotic bodies, and oncosomes. EVs are now recognized as important tools of cell-to-cell communication, allowing cells to exchange proteins, lipids, and genetic material to participate in physiological and pathological processes. It has been reported that EVs regulate host-pathogen interactions and participate in pathological processes of infectious disease, neurological diseases, cancer, cardiovascular diseases, etc., it also plays an important role in the process of growth and development. EVs have a bright future in clinical application. They can be used to monitor clinical status, therapeutic effect, and disease progression. At the same time, EVs have the potential to be developed as clinical drug delivery vectors due to their ability to deliver biomolecules. However, it is still unclear whether EVs are reliable and useful markers for the diagnosis or early detection of obesity, and whether they can be used as drug vectors for the treatment of obesity. In this review, we summarize the research progress of EVs and obesity. It is hoped that EVs may become a new target in the diagnosis and treatment of obesity.
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Affiliation(s)
- Kai Wang
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Cong Zeng
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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37
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Laparoscopic Sleeve Gastrectomy in Adolescents: Ten-Years Follow-up. Obes Surg 2023; 33:32-37. [PMID: 36414817 DOI: 10.1007/s11695-022-06348-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/15/2022] [Accepted: 10/25/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Metabolic and bariatric surgery (MBS) has emerged as the most effective treatment for adolescents with severe obesity. Despite the steady increase in frequency of MBS in adolescents, most reports focus on short-term (1-2 years) follow-up. OBJECTIVE To report on long-term weight loss and status of obesity-related comorbidities of adolescents who underwent laparoscopic sleeve gastrectomy (LSG). METHODS A retrospective analysis of prospectively collected data of patients younger than 18 years who underwent LSG between January 2008 and July 2014 was performed. RESULTS During the study period, 46 patients (mean age 16.19 ± 1.07 years) underwent LSG, 31 of them (67.39%) completed long-term follow-up and were included in the study. Mean follow-up time was 10.84 ± 2.35 years. There were 18 females (58%). Mean body-mass index (BMI) was 44.94 ± 4.33 kg/m2 and 30.11 ± 710, before, and 10-year following surgery, respectively, a reduction of 33.24% (P < 0.001). Long-term TWL% was 32.31 ± 12.02. Twenty-one patients (67.74%) achieved a BMI < 30 kg/m2. Following weight reduction, resolution of hypertension was noted in 8 patients (88.9%, P < 0.001). Frequent long-term side effects of surgery were gastrointestinal reflux disease (GERD) and alopecia in 22.58% and 48.39%, respectively. Symptomatic cholelithiasis necessitated cholecystectomy in 22.58% of the patients. Using a 1-10 scale, the overall patient satisfaction in the long term was 8.97. CONCLUSION Our data suggests that LSG is a durable intervention for weight reduction in adolescents.
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Eisenberg D, Shikora SA, Aarts E, Aminian A, Angrisani L, Cohen RV, de Luca M, Faria SL, Goodpaster KPS, Haddad A, Himpens JM, Kow L, Kurian M, Loi K, Mahawar K, Nimeri A, O'Kane M, Papasavas PK, Ponce J, Pratt JSA, Rogers AM, Steele KE, Suter M, Kothari SN. 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery. Obes Surg 2023; 33:3-14. [PMID: 36336720 PMCID: PMC9834364 DOI: 10.1007/s11695-022-06332-1] [Citation(s) in RCA: 136] [Impact Index Per Article: 136.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
MAJOR UPDATES TO 1991 NATIONAL INSTITUTES OF HEALTH GUIDELINES FOR BARIATRIC SURGERY: Metabolic and bariatric surgery (MBS) is recommended for individuals with a body mass index (BMI) >35 kg/m2, regardless of presence, absence, or severity of co-morbidities.MBS should be considered for individuals with metabolic disease and BMI of 30-34.9 kg/m2.BMI thresholds should be adjusted in the Asian population such that a BMI >25 kg/m2 suggests clinical obesity, and individuals with BMI >27.5 kg/m2 should be offered MBS.Long-term results of MBS consistently demonstrate safety and efficacy.Appropriately selected children and adolescents should be considered for MBS.(Surg Obes Relat Dis 2022; https://doi.org/10.1016/j.soard.2022.08.013 ) © 2022 American Society for Metabolic and Bariatric Surgery. All rights reserved.
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Affiliation(s)
- Dan Eisenberg
- Department of Surgery, Stanford School of Medicine, VA Palo Alto Health Care System, 3801 Miranda Avenue, GS 112, Palo Alto, CA, 94304, USA.
| | - Scott A Shikora
- Department of Surgery, Center for Metabolic and Bariatric Surgery, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Edo Aarts
- WeightWorks Clinics and Allurion Clinics, Amersfoort, The Netherlands
| | - Ali Aminian
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Luigi Angrisani
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Ricardo V Cohen
- Center for the Treatment of Obesity and Diabetes, Hospital Alemão Oswaldo Cruz, Sao Paolo, Brazil
| | | | - Silvia L Faria
- Gastrocirurgia de Brasilia, University of Brasilia, Brasilia, Brazil
| | | | - Ashraf Haddad
- Gastrointestinal Bariatric and Metabolic Center, Jordan Hospital, Amman, Jordan
| | | | - Lilian Kow
- Adelaide Bariatric Centre, Flinders University of South Australia, Adelaide, Australia
| | - Marina Kurian
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Ken Loi
- St. George Hospital and Sutherland Hospital, Kogarah, New South Wales, Australia
| | - Kamal Mahawar
- Department of General Surgery, Sunderland Royal Hospital, Sunderland, UK
| | - Abdelrahman Nimeri
- Department of Surgery, Carolinas Medical Center, University of North Carolina, Charlotte, NC, USA
| | - Mary O'Kane
- Department of Nutrition and Dietetics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Pavlos K Papasavas
- Division of Metabolic and Bariatric Surgery, Hartford Hospital, Hartford, CT, USA
| | - Jaime Ponce
- Bariatric Surgery Program, CHI Memorial Hospital, Chattanooga, TN, USA
| | - Janey S A Pratt
- Department of Surgery, Stanford School of Medicine, VA Palo Alto Health Care System, 3801 Miranda Avenue, GS 112, Palo Alto, CA, 94304, USA
- Division of Pediatric Surgery, Lucille Packard Children's Hospital, Palo Alto, CA, USA
| | - Ann M Rogers
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Kimberley E Steele
- NIDDK Metabolic and Obesity Research Unit, National Institutes of Health, Bethesda, MD, USA
| | - Michel Suter
- Department of Surgery, Riviera-Chablais Hospital, Rennaz, Switzerland
- Department of Visceral Surgery, University Hospital, Lausanne, Switzerland
| | - Shanu N Kothari
- Prisma Health, Department of Surgery, University of South Carolina School of Medicine, Greenville, SC, USA
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Steinberger AE, Nickel KB, Keller M, Wallendorf M, Sprague J, Nicol GE, Dimou FM, Eagon JC, Eckhouse SR, Shakhsheer BA. National Trends in Pediatric Metabolic and Bariatric Surgery: 2010-2017. Pediatrics 2022; 150:189942. [PMID: 36373280 DOI: 10.1542/peds.2022-057316] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The childhood obesity epidemic has grown exponentially and is known to disproportionately affect minority groups. Successful treatment of this complex health issue requires a multidisciplinary approach including metabolic and bariatric surgery (MBS) for qualifying pediatric patients. This study examines current national trends in pediatric bariatric surgery from 2010 to 2017 using the National Inpatient Sample. METHODS This study analyzed MBS among pediatric patients <19 years old using weighted discharge data from 2010 to 2017. The primary outcome was national procedure rates. Secondary analyses included procedure type, demographics, BMI, comorbidities, length of stay, and complication rates. RESULTS From 2010 to 2017, annual bariatric procedure rates increased from 2.29 to 4.62 per 100 000 (P < .001). Laparoscopic sleeve gastrectomy outpaced Roux-en-Y gastric bypass and laparoscopic adjustable gastric band over time (0.31-3.99 per 100 000, P < .0001). The mean age was stable over time 18.10-17.96 (P = .78). The cohort was primarily female (76.5% to 75.4%), white (54.0% to 45.0%), and privately-insured (59.9% to 53.4%). Preoperative BMI increased from 2010 to 2017 (P < .001), whereas number of obesity-related comorbidities was stable (P > .05). Length of stay was <2 days (2.02-1.75, P = .04) and in-hospital complication rates were low (7.2% to 6.45%, P = .88). CONCLUSIONS Pediatric MBS is underutilized nationally with disproportionately lower rates among minority groups. Despite incremental progress, further investigation into the racial and social determinants that limit access to pediatric weight loss surgery is critical.
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Affiliation(s)
| | - Katelin B Nickel
- Division of Infectious Diseases, Department of Medicine, Washington University, St. Louis, Missouri
| | - Matthew Keller
- Division of Infectious Diseases, Department of Medicine, Washington University, St. Louis, Missouri
| | | | | | - Ginger E Nicol
- Child and Adolescent Psychiatry, Department of Psychiatry
| | | | | | | | - Baddr A Shakhsheer
- Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO
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2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): Indications for Metabolic and Bariatric Surgery. Surg Obes Relat Dis 2022; 18:1345-1356. [PMID: 36280539 DOI: 10.1016/j.soard.2022.08.013] [Citation(s) in RCA: 182] [Impact Index Per Article: 91.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 11/06/2022]
Abstract
Major updates to 1991 National Institutes of Health guidelines for bariatric surgery.
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Richter LR, Albert BI, Zhang L, Ostropolets A, Zitsman JL, Fennoy I, Albers DJ, Hripcsak G. Data assimilation on mechanistic models of glucose metabolism predicts glycemic states in adolescents following bariatric surgery. Front Physiol 2022; 13:923704. [PMID: 36518108 PMCID: PMC9744230 DOI: 10.3389/fphys.2022.923704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 10/11/2022] [Indexed: 11/29/2022] Open
Abstract
Type 2 diabetes mellitus is a complex and under-treated disorder closely intertwined with obesity. Adolescents with severe obesity and type 2 diabetes have a more aggressive disease compared to adults, with a rapid decline in pancreatic β cell function and increased incidence of comorbidities. Given the relative paucity of pharmacotherapies, bariatric surgery has become increasingly used as a therapeutic option. However, subsets of this population have sub-optimal outcomes with either inadequate weight loss or little improvement in disease. Predicting which patients will benefit from surgery is a difficult task and detailed physiological characteristics of patients who do not respond to treatment are generally unknown. Identifying physiological predictors of surgical response therefore has the potential to reveal both novel phenotypes of disease as well as therapeutic targets. We leverage data assimilation paired with mechanistic models of glucose metabolism to estimate pre-operative physiological states of bariatric surgery patients, thereby identifying latent phenotypes of impaired glucose metabolism. Specifically, maximal insulin secretion capacity, σ, and insulin sensitivity, SI, differentiate aberrations in glucose metabolism underlying an individual's disease. Using multivariable logistic regression, we combine clinical data with data assimilation to predict post-operative glycemic outcomes at 12 months. Models using data assimilation sans insulin had comparable performance to models using oral glucose tolerance test glucose and insulin. Our best performing models used data assimilation and had an area under the receiver operating characteristic curve of 0.77 (95% confidence interval 0.7665, 0.7734) and mean average precision of 0.6258 (0.6206, 0.6311). We show that data assimilation extracts knowledge from mechanistic models of glucose metabolism to infer future glycemic states from limited clinical data. This method can provide a pathway to predict long-term, post-surgical glycemic states by estimating the contributions of insulin resistance and limitations of insulin secretion to pre-operative glucose metabolism.
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Affiliation(s)
- Lauren R. Richter
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, United States
| | - Benjamin I. Albert
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, United States
| | - Linying Zhang
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, United States
| | - Anna Ostropolets
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, United States
| | - Jeffrey L. Zitsman
- Division of Pediatric Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, United States
| | - Ilene Fennoy
- Division of Pediatric Endocrinology, Metabolism, and Diabetes, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, United States
| | - David J. Albers
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, United States,Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, United States,Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, United States,*Correspondence: George Hripcsak,
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Wernicke's encephalopathy in an adolescent following bariatric surgery. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Shah AS, Zeitler PS, Wong J, Pena AS, Wicklow B, Arslanian S, Chang N, Fu J, Dabadghao P, Pinhas-Hamiel O, Urakami T, Craig ME. ISPAD Clinical Practice Consensus Guidelines 2022: Type 2 diabetes in children and adolescents. Pediatr Diabetes 2022; 23:872-902. [PMID: 36161685 DOI: 10.1111/pedi.13409] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 11/29/2022] Open
Abstract
Since the 2018 ISPAD guidelines on this topic, follow-up of large cohorts from around the globe have continued informing the current incidence and prevalence of co-morbidities and complications in young adults with youth-onset type 2 diabetes (T2D). This chapter focuses on the risk factors, diagnosis and presentation of youth-onset T2D, the initial and subsequent management of youth-onset T2D, and management of co-morbidities and complications. We include key updates from the observational phase of the multi-center Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) clinical trial, the SEARCH for Diabetes in Youth (SEARCH) study and new data from the Restoring Insulin Secretion (RISE) study, a head-to-head comparison of youth onset vs adult-onset T2D. We also include an expanded section on risk factors associated with T2D, algorithms and tables for treatment, management, and assessment of co-morbidities and complications, and sections on recently approved pharmacologic therapies for the treatment of youth-onset T2D, social determinants of health, and settings of care given COVID-19 pandemic.
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Affiliation(s)
- Amy S Shah
- Division of Pediatric Endocrinology, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, Ohio, USA
| | - Philip S Zeitler
- Division of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jencia Wong
- Department of Endocrinology, Royal Prince Alfred Hospital and Central Clinical School, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Alexia S Pena
- The University of Adelaide, Robinson Research Institute, North Adelaide, South Australia, Australia
| | - Brandy Wicklow
- Division of Endocrinology, Winnipeg Children's Hospital and University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Silva Arslanian
- Division of Pediatric Endocrinology, Metabolism, and Diabetes Mellitus, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nancy Chang
- Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Junfen Fu
- Division of Endocrinology, The Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Preeti Dabadghao
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Orit Pinhas-Hamiel
- Edmond and Lily Safra Children's Hospital, Sackler School of Medicine, Tel-Aviv, Israel
| | - Tatsuhiko Urakami
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Maria E Craig
- The Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia.,Discipline of Pediatrics & Child Health, School of Clinical Medicine, University of NSW Medicine and Health, Sydney, New South Wales, Australia
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Sun G, Li L, Zhang X. A visualized and scientometric analysis of research trends of weight loss in overweight/obese children and adolescents (1958-2021). Front Public Health 2022; 10:928720. [PMID: 36339176 PMCID: PMC9632180 DOI: 10.3389/fpubh.2022.928720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 10/04/2022] [Indexed: 01/24/2023] Open
Abstract
Background Weight loss is an appropriate approach to reduce the health risks associated with overweight/obese children and adolescents, and the optimal method of weight loss requires further research. This study systematically explores scientific co-operation, disciplinary interaction, hotspots and trends in the field of weight loss in overweight/obese children and adolescents (WLOCA), and provides references for further research. Methods Citespace 5.8.R1 (64-bit) was adopted to conduct a comprehensive visualization analysis of the literature on WLOCA from Web of Science Core Collection, including publication, institution, country/region, author, journal, keywords and reference. Results 2,513 papers were found in the Web of Science Core Collection, and the annual number of papers published has increased significantly since 2003. Cincinnati Children's Hospital is the institution with the largest number of publications, while Washington University plays a pivotal role in the collaboration network. In terms of nations, USA has made greater contributions than the rest in terms of the number of publications and global co-operation research. The most influential authors in this field are Thomas H. Inge, Thomas Reinehr, Todd M. Jenkins, Epstein LH, Ogden CL, etc. The most active journals are "Obesity," "International Journal of Obesity," "Obesity Surgery," "Pediatrics," etc. which are characterized by interdisciplinary interactions. Research hot topics mainly include "assessment of obesity and pathophysiological mechanism," "comprehensive intervention," and "bariatric surgery," and there's a gradual shift from "lifestyle intervention" and "pathophysiological mechanism" to "clinical surgical application." In addition, disciplinary integration and comprehensive research, targeted intervention and treatment, and prospective research are the future research trends. Conclusion The overall trend in WLOCA study is positive. The main contribution of this study is to reveal the overall picture of the research in this field with visual maps and detailed data by combining quantitative with qualitative approaches, which can provide valuable references for relevant researchers to quickly understand the status of studies on WLOCA, to seek co-operation, and grasp research hotspots and frontier trends.
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Affiliation(s)
- Guotao Sun
- School of Physical Education, Chengdu Sport University, Chengdu, China,College of Education and Sports Science, Yangtze University, Jingzhou, China
| | - Long Li
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, China,School of Physical Education, Xichang University, Xichang, China
| | - Xiaolin Zhang
- Sport Research Office, Chengdu Sport University, Chengdu, China,*Correspondence: Xiaolin Zhang
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de la Cruz-Muñoz N, Xie L, Quiroz HJ, Kutlu OC, Atem F, Lipshultz SE, Mathew MS, Messiah SE. Long-Term Outcomes after Adolescent Bariatric Surgery. J Am Coll Surg 2022; 235:592-602. [PMID: 36102560 PMCID: PMC9484037 DOI: 10.1097/xcs.0000000000000325] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Metabolic and bariatric surgery (MBS) is a safe and effective treatment option for adolescents with severe obesity, but no long-term studies are available with more than10 years of follow-up data to document sustained improved outcomes. METHODS A total of 96 patients who completed MBS at 21 years of age or younger in a tertiary academic center 2002 to 2010 were contacted for a telehealth visit. Body weight, comorbidity status, social/physical function status, and long-term complications were evaluated 10 to 18 years after surgery. RESULTS Mean participant (83% female, 75% Hispanic) age at MBS was 18.8 (±1.6) years (median age 19 years, range 15-21 years), and median pre-MBS BMI was 44.7 kg/m 2 (SD 6.5). At follow-up (mean 14.2 [±2.2] years) post-MBS (90.6% Roux-en-Y gastric bypass [RYGB] or 8.3% laparoscopic adjustable gastric banding [LAGB]) mean total body weight decreased by 31.3% (interquartile range [IQR] 20.0% to 38.9%); 32.0% (IQR, 21.3% to 40.1%) among RYGB participants and 22.5% (IQR, 0.64% to 28.3%) among LAGB participants. Patients with pre-MBS hyperlipidemia (14.6%), asthma (10.4%), and diabetes/hyperglycemia (5.2%) reported 100% remission at follow-up (p < 0.05 for all). Pre-post decrease in hypertension (13.5% vs 1%, p = 0.001), sleep apnea (16.7% vs 1.0%, p < 0.001), gastroesophageal reflux disease (13.5% vs 3.1%, p = 0.016), anxiety (7.3% vs 2.1%, p = 0.169), and depression (27.1% vs 4.2%, p < 0.001) were also found. CONCLUSIONS Significant sustained reductions in weight and comorbidities, and low rates of long-term complications, a decade or more after completing MBS as an adolescent were found. These findings have important implications for adolescents who may be considering MBS for weight reduction and overall health improvements that extend into adulthood.
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Affiliation(s)
- Nestor de la Cruz-Muñoz
- Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Luyu Xie
- University of Texas Health Science Center, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, UTHealth School of Public Health and Children’s Health System of Texas, Dallas, TX
| | - Hallie J Quiroz
- Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Onur C Kutlu
- Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Folefac Atem
- University of Texas Health Science Center, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, UTHealth School of Public Health and Children’s Health System of Texas, Dallas, TX
| | - Steven E Lipshultz
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
- Oishei Children’s Hospital, Buffalo, NY
| | - M Sunil Mathew
- University of Texas Health Science Center, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, UTHealth School of Public Health and Children’s Health System of Texas, Dallas, TX
| | - Sarah E Messiah
- University of Texas Health Science Center, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, UTHealth School of Public Health and Children’s Health System of Texas, Dallas, TX
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Mazur A, Zachurzok A, Baran J, Dereń K, Łuszczki E, Weres A, Wyszyńska J, Dylczyk J, Szczudlik E, Drożdż D, Metelska P, Brzeziński M, Kozioł-Kozakowska A, Matusik P, Socha P, Olszanecka-Gilianowicz M, Jackowska T, Walczak M, Peregud-Pogorzelski J, Tomiak E, Wójcik M. Childhood Obesity: Position Statement of Polish Society of Pediatrics, Polish Society for Pediatric Obesity, Polish Society of Pediatric Endocrinology and Diabetes, the College of Family Physicians in Poland and Polish Association for Study on Obesity. Nutrients 2022; 14:nu14183806. [PMID: 36145182 PMCID: PMC9505061 DOI: 10.3390/nu14183806] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/05/2022] [Accepted: 09/09/2022] [Indexed: 11/16/2022] Open
Abstract
Childhood obesity is one of the most important problems of public health. Searching was conducted by using PubMed/MEDLINE, Cochrane Library, Science Direct, MEDLINE, and EBSCO databases, from January 2022 to June 2022, for English language meta-analyses, systematic reviews, randomized clinical trials, and observational studies from all over the world. Five main topics were defined in a consensus join statement of the Polish Society of Pediatrics, Polish Society for Pediatric Obesity, Polish Society of Pediatric Endocrinology and Diabetes and Polish Association for the Study on Obesity: (1) definition, causes, consequences of obesity; (2) treatment of obesity; (3) obesity prevention; (4) the role of primary care in the prevention of obesity; (5) Recommendations for general practitioners, parents, teachers, and regional authorities. The statement outlines the role of diet, physical activity in the prevention and treatment of overweight and obesity, and gives appropriate recommendations for interventions by schools, parents, and primary health care. A multisite approach to weight control in children is recommended, taking into account the age, the severity of obesity, and the presence of obesity-related diseases. Combined interventions consisting of dietary modification, physical activity, behavioral therapy, and education are effective in improving metabolic and anthropometric indices. More actions are needed to strengthen the role of primary care in the effective prevention and treatment of obesity because a comprehensive, multi-component intervention appears to yield the best results.
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Affiliation(s)
- Artur Mazur
- Institute of Medical Sciences, Medical College of Rzeszow University, University of Rzeszów, 35-310 Rzeszów, Poland
- Correspondence: (A.M.); (A.Z.); (M.W.)
| | - Agnieszka Zachurzok
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Zabrze, Poland
- Correspondence: (A.M.); (A.Z.); (M.W.)
| | - Joanna Baran
- Institute of Health Sciences, Medical College of Rzeszow University, University of Rzeszów, 35-310 Rzeszów, Poland
| | - Katarzyna Dereń
- Institute of Health Sciences, Medical College of Rzeszow University, University of Rzeszów, 35-310 Rzeszów, Poland
| | - Edyta Łuszczki
- Institute of Health Sciences, Medical College of Rzeszow University, University of Rzeszów, 35-310 Rzeszów, Poland
| | - Aneta Weres
- Institute of Health Sciences, Medical College of Rzeszow University, University of Rzeszów, 35-310 Rzeszów, Poland
| | - Justyna Wyszyńska
- Institute of Health Sciences, Medical College of Rzeszow University, University of Rzeszów, 35-310 Rzeszów, Poland
| | - Justyna Dylczyk
- Children’s University Hospital, Jagiellonian University Medical College, 31-008 Kraków, Poland
| | - Ewa Szczudlik
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Pediatric Institute, Jagiellonian University Medical College, 31-008 Kraków, Poland
| | - Dorota Drożdż
- Department of Pediatric Nephrology and Hypertension, Chair of Pediatrics, Pediatric Institute, Jagiellonian University Medical College, 31-008 Kraków, Poland
| | - Paulina Metelska
- Department of Public Health and Social Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Michał Brzeziński
- Chair and Department of Paediatrics, Gastroenterology, Allergology and Child Nutrition, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Agnieszka Kozioł-Kozakowska
- Department of Pediatrics, Gastroenterology and Nutrition, Jagiellonian University Medical College, 31-008 Kraków, Poland
| | - Paweł Matusik
- Department of Pediatrics, Pediatric Obesity and Metabolic Bone Diseases, Chair of Pediatrics and Pediatric Endocrinology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Piotr Socha
- The Children’s Memorial Health Institute, 04-736 Warsaw, Poland
| | - Magdalena Olszanecka-Gilianowicz
- Health Promotion and Obesity Management Unit, Department of Pathophysiology, Medical Faculty in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Teresa Jackowska
- Department of Pediatrics, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland
| | - Mieczysław Walczak
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Disorders and Cardiology of the Developmental Age, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Jarosław Peregud-Pogorzelski
- Department of Pediatrics, Pediatric Oncology and Immunology, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Elżbieta Tomiak
- The College of Family Physicians in Poland, 00-209 Warszawa, Poland
| | - Małgorzata Wójcik
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Pediatric Institute, Jagiellonian University Medical College, 31-008 Kraków, Poland
- Correspondence: (A.M.); (A.Z.); (M.W.)
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Abstract
PURPOSE OF REVIEW In this review, we discuss new medical and surgical options for the treatment of children and adolescents with obesity. We review the impact of COVID-19 on this vulnerable population. We also discuss the recent availability of screening tests for rare genetic causes of obesity. RECENT FINDINGS COVID-19 increased the prevalence of obesity among children and adolescents. This population is at increased risk for severe disease. The field of pediatric obesity has benefited from the approval of two new antiobesity medications: liraglutide and setmelanotide. We discuss indications for their use. New guidelines for surgical options for the treatment of children and adolescents with obesity are reviewed. These options are increasingly used as part of the comprehensive care for these children. SUMMARY The epidemic of childhood obesity continues. COVID-19 and the associated isolation contributed to the problem. However, promising new medical and surgical therapies and screening tests for rare genetic causes of obesity are available. These new diagnostic and therapeutic options bring renewed enthusiasm to the treatment of children and adolescents with obesity and increased recognition that obesity is a chronic disease starting in childhood deserving intervention to prevent consequences.
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How safe is adolescent bariatric surgery? An analysis of short-term outcomes. J Pediatr Surg 2022; 57:1654-1659. [PMID: 34593239 DOI: 10.1016/j.jpedsurg.2021.08.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/23/2021] [Accepted: 08/27/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The prevalence of childhood obesity in the U.S. has tripled over the last three decades. However, fewer than 1% of children with severe obesity undergo surgical weight loss interventions each year. MATERIALS AND METHODS All patients age 10 to 19 years old who underwent laparoscopic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) from 2015 through 2018 in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database were included in this retrospective cohort analysis. The primary outcomes were mortality and overall complications. Procedural trends, readmission and reoperation rates were also examined using a multivariate regression model. RESULTS Patients had a mean BMI of 47.3 kg/m2 and 80.0% were either 18 or 19 years old (n = 4,051). There were two reported deaths. Reoperation within 30 days occurred in 1.1% of patients, readmission in 3.5%, and complications in 1.2%. Among all readmissions, primary reasons included nausea/vomiting or nutritional depletion (41.3%) and abdominal pain (16.3%). RYGB was associated with higher odds for readmission (p = 0.006) and complications (p = 0.005). Higher BMI and younger age were not associated with an increased likelihood to experience poorer outcomes. The proportion of patients undergoing SG increased yearly over RYGB from 73.9% in 2015 to 84.3% in 2018. CONCLUSIONS Bariatric surgery appears to be low risk for adolescents and SG has become the operation of choice. More research on early consideration of surgical therapy in adolescents with severe obesity is needed given the safety profile. LEVEL OF EVIDENCE III.
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Disparity Between United States Adolescent Class II and III Obesity Trends and Bariatric Surgery Utilization, 2015-2018. Ann Surg 2022; 276:324-333. [PMID: 32941272 PMCID: PMC9825050 DOI: 10.1097/sla.0000000000004493] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Class II (120% > body mass index [BMI] < 140% of the 95th percentile for age and sex) and Class III (BMI >140% of the 95th percentile for age and sex) obesity are the fastest growing subcategories of obesity in the United States pediatric population. Metabolic and bariatric surgery (MBS) is a safe and effective treatment option for with class II/III obesity. The primary objectives of this analysis were to determine the (1) current US MBS utilization rates in those with class II/III obesity and (2) utilization rates and 30-day postoperative outcomes. BACKGROUND The 2015 to 2018 National Health and Nutrition Examination Survey cross-sectional data (N = 19,225) generated US with class II/III obesity prevalence estimates. The 2015 to 2018 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) longitudinal (30 days) cohort data were used to compare adolescent and adult (N = 748,622) postoperative outcomes and to calculate utilization rates. METHODS The 2015 to 2018 youth and adult MBS utilization rates were calculated using MBSAQIP data (numerator) and National Health and Nutrition Examination Survey data (denominator). Two-sample tests of proportions were performed to compare the MBS utilization rates by age, ethnicity, and sex and expressed per 1000. RESULTS Mean age of the analytical MBSAQIP sample was 17.9 (1.15) years in youth (n = 3846) and 45.1 (11.5) in adults (N = 744,776), majority female (77.4%, 80.7%, respectively) and non-Hispanic White (68.5%, 59.4%, respectively). The overall 2015 to 2018 MBS utilization rate for youth was 1.81 per 1000 and 5.56 per 1000 for adults ( P < 0.001). Adult patients had slightly higher percentage (4.2%) of hospital readmissions compared to youth (3.4%, P = 0.01) but there were no other post-MBS complication differences. From 2015 to 2018 the US prevalence of youth with class II/III obesity increased in Hispanics and non-Hispanic Blacks (P trend < 0.001), but among youth who did complete MBS non-Hispanic Whites had higher rates of utilization (45.8%) compared to Hispanics (22.7%) and non-Hispanic blacks 14.2% (P = 0.006). CONCLUSIONS MBS is an underutilized obesity treatment tool for both youth and adults, and among ethnic minority groups in particular.
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Goldenshluger A, Maor T, Via-Kagan R, Zelekha O, Gepner Y. Short-Term Changes in Mental, Physical, and Social Factors After Metabolic Bariatric Surgery in Adolescents: A Nationwide Prospective Cohort Study. Front Nutr 2022; 9:878202. [PMID: 35634384 PMCID: PMC9133935 DOI: 10.3389/fnut.2022.878202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Metabolic bariatric surgery (MBS) is an effective treatment for adolescents with severe obesity. However, changes in mental, physical, and social factors, as well as their association with the extent of excess weight loss (%EWL) after MBS, remain controversial. Methods We followed 97 adolescents (64% females, aged 17 ± 0.9 years, BMI 46.1 ± 5.9 kg/m2) before and 9 months following MBS in a multi-center, prospective cohort study. Changes in mental, physical, and social factors were assessed by self-reported questionnaires, and associations with %EWL were evaluated after adjustment for potential confounders. Results The body mass index (BMI) decreased by 30%, and all physical parameters significantly improved (p ≤ 0.001). Energy level increased by 24%, mood level by 14%, and mental health by 9.5% (p ≤ 0.002). Social parameters were also improved, with a significant decrease in social rejection (p = 0.02), and an increase in participation in after-school social activities (p = 0.008). Mental health improvement was associated with baseline social rejection (r = 0.514, p < 0.001). The improvement in all factors was not related to the extent of %EWL. Conclusion Metabolic bariatric surgery MBS in adolescents led to a meaningful decrease in BMI and to an improvement in short-term physical, mental, and social factors that were not related to %EWL. Patients experiencing social rejection may improve their mental health following BS.
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Affiliation(s)
- Ariela Goldenshluger
- Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, School of Public Health, Sylvan Adams Sports Institute, Tel-Aviv University, Tel-Aviv, Israel
| | - Tamar Maor
- Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, School of Public Health, Sylvan Adams Sports Institute, Tel-Aviv University, Tel-Aviv, Israel
| | - Renana Via-Kagan
- Israel Center for Disease Control, Ministry of Health, Jerusalem, Israel
| | - Orly Zelekha
- Israel Center for Disease Control, Ministry of Health, Jerusalem, Israel
| | - Yftach Gepner
- Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, School of Public Health, Sylvan Adams Sports Institute, Tel-Aviv University, Tel-Aviv, Israel
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