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Järvholm K, Gronowitz E, Janson A, Peltonen M, Sjögren L, Beamish AJ, Dahlgren J, Mårtensson J, Olbers T. Cognitive functioning in adolescents with severe obesity undergoing bariatric surgery or intensive non-surgical treatment in Sweden (AMOS2): a multicentre, open-label, randomised controlled trial. EClinicalMedicine 2024; 70:102505. [PMID: 38685922 PMCID: PMC11056597 DOI: 10.1016/j.eclinm.2024.102505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/01/2024] [Accepted: 02/15/2024] [Indexed: 05/02/2024] Open
Abstract
Background Severe obesity during childhood is associated with cognitive deficits. Studies in adults have suggested improvements in executive functioning and memory after bariatric surgery. Our aim was to explore changes in cognitive function in adolescents over two years after bariatric surgery or intensive non-surgical treatment. Methods The Adolescent Morbid Obesity Surgery 2 (AMOS2) is a multicentre, open-label, randomised controlled trial in which adolescents (aged 13-16 years) with severe obesity (defined as body mass index (BMI) ≥35 kg/m2) at three specialised obesity centres in Sweden, were randomly assigned to receive bariatric surgery or intensive non-surgical treatment. Herein we report the results of the prespecified exploratory endpoint of change in cognitive functioning. Inclusion in AMOS2 required Tanner pubertal stage ≥3, previous participation in lifestyle obesity treatment for at least one year, and passed assessment form a paediatrician and a paediatric psychologist. Adolescents with severe intellectual disability or other severe, pervasive developmental disorder were excluded. Participants underwent baseline assessment of general intellectual ability, executive functioning, and memory before randomisation. Tests were administrated by clinical psychologists and repeated at one- and two-year follow-up timepoints. Differences in means between groups during follow-up are provided with confidence intervals. The trial is registered at ClinicalTrials.gov, NCT02378259. Findings Between October 28 2015 and June 7 2017, 46 adolescents (74% girls), with a mean age of 15.8 (±0.92) years and a mean BMI of 42.8 (±5.4) kg/m2, were included and randomised (23 to bariatric surgery and 23 to intensive non-surgical treatment). At baseline 23/46 (50%) of the adolescents had general intellectual functioning classified as borderline or below. For 15/18 (83%) aspects of cognitive functioning, no significant differences in change over two years were identified between groups; Immediate (average difference during follow-up 1.0 [95% CI: -2.6 to 4.6]) and Delayed (0.5 [95% CI: -0.6 to 1.6]) Verbal Recall, Category Fluency (1.1 [95% CI: -1.6 to 3.8]) and Switching (1.5 [95% CI: -0.0 to 2.9]), Number (-6.0 [95% CI: -12.3 to 0.3]) and Letter (0.1 [95% CI: -5.2 to 5.3]) Sequencing, Number-Letter Switching (-10.3 [95% CI: -26.4 to 5.8]), Motor Speed (-8.3 [95% CI: -17.5 to 0.9]), Colour Naming (-1.9 [95% CI: -4.2 to 0.3]), Inhibition (-3.6 [95% CI: -9.6 to 2.5]), Inhibition Switching (-6.7 [95% CI: -15.3 to 1.9]), Mazes (-0.5 [95% CI: -4.9 to 3.9]), Digit Span Forward (0.1 [95% CI: -0.6 to 0.9 ]) and Backward (0.6 [95% CI: -0.4 to 1.6 ]), and Estimated IQ (0.4 [95% CI: -3.9 to 4.8]; all p > 0.05). Three sub-tests assessing fundamental cognitive skills improved more over two years in operated adolescents than in intensive non-surgical treatment; Letter Fluency (average difference during follow-up 3.8 [95% CI: 0.1-7.5]; p = 0.046), Visual Scanning (-6.5 [95% CI: -11.6 to -1.5]; p = 0.011), and Word Reading (-1.9 [95% CI: -3.3 to -0.4]; p = 0.011). Interpretation In contrast to non-randomised studies in adults, we could not demonstrate an association of bariatric surgery and its accompanying significant weight loss with overall greater improvement in executive functions and memory in adolescents over two years compared with a non-surgical group without weight loss. However, lack of statistical power is a potential limitation. The clinical relevance of greater improvements in basic cognitive skills needs to be explored. Funding Sweden's innovation agency (VINNOVA), Swedish Research Council, Joanna Cocozza foundation for paediatric research, The Skane University Hospital Psychology Research and Development Grant, Tore Nilsson's Foundation, SUS Foundations and Donations, and Mary von Sydow's Foundation.
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Affiliation(s)
- Kajsa Järvholm
- Department of Psychology, Lund University, Lund, Sweden
- Childhood Obesity Unit, Skåne University Hospital, Malmö, Sweden
| | - Eva Gronowitz
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annika Janson
- National Childhood Obesity Centre, Karolinska University Hospital, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Lovisa Sjögren
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Regional Obesity Center, Gothenburg, Sweden
| | - Andrew J. Beamish
- Welsh Institute of Metabolic and Obesity Surgery, Morriston Hospital, Swansea, United Kingdom
- Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Jovanna Dahlgren
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Regional Obesity Center, Gothenburg, Sweden
| | - Johan Mårtensson
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Torsten Olbers
- Department of Biomedical and Clinical Sciences and Wallenberg Center for Molecular Medicine, Linköping University, Linköping, Sweden
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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. Lancet Child Adolesc Health 2023; 7:249-260. [PMID: 36848922 DOI: 10.1016/s2352-4642(22)00373-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Janson A, Järvholm K, Sjögren L, Dahlgren J, Beamish AJ, Gronowitz E, Olbers T. Metabolic and Bariatric Surgery in Adolescents: For Whom, When, and How? Horm Res Paediatr 2022; 96:609-619. [PMID: 35263750 DOI: 10.1159/000524002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/28/2022] [Indexed: 11/19/2022] Open
Abstract
Severe obesity in adolescence profoundly impacts health and social well-being. Lifestyle modifications are seldom successful in maintaining sufficient weight loss to mitigate the risk of complications. Metabolic and bariatric surgery (MBS) is a standard treatment for adult patients and has emerged as an option for adolescent patients. Several high-quality studies of adolescent MBS show substantial and sustained improvements both in weight and cardiometabolic parameters, as well as a safety profile similar to that seen in adult patients. Patients report improvements in health- and weight-related quality of life. Concerns around adolescent MBS can be attributed to a fear of side effects on growth and puberty, risk of nutritional deficiencies and osteoporosis, alcohol abuse, psychosocial vulnerability, and the ability to consent in the decision process. Guidelines give somewhat different recommendations, but the most comprehensive guidelines from the American Society for Metabolic and Bariatric Surgery recommend MBS for class III obesity or class II obesity with comorbidity. This mini-review aimed to pre-sent published data on MBS in adolescents. We discuss indications for MBS and the optimal timing in the young person's life, the choice of surgical method, and MBS in relation to the new anti-obesity medications. Based on data primarily from the USA and Sweden, we conclude that MBS is a valuable treatment option for adolescents with severe obesity that appears underutilized against the backdrop of the poor prognosis of severe obesity. We argue for continued research, development of guidelines, multi-professional teamwork, long-term follow-up, and centralization of adolescent MBS.
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Affiliation(s)
- Annika Janson
- National Childhood Obesity Centre, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Kajsa Järvholm
- Department of Psychology, Lund University, Lund, Sweden
- Childhood Obesity Unit, Skåne University Hospital, Malmö, Sweden
| | - Lovisa Sjögren
- Department of Paediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatrics, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jovanna Dahlgren
- Department of Paediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatrics, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andrew J Beamish
- Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Eva Gronowitz
- Department of Paediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatrics, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Torsten Olbers
- Department of Biomedical and Clinical Sciences and Wallenberg Centre for Metabolic Medicine, Linköping University, Linköping, Sweden
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Björk A, Dahlgren J, Gronowitz E, Henriksson Wessely F, Janson A, Engström M, Sjögren L, Olbers T, Järvholm K. High prevalence of neurodevelopmental problems in adolescents eligible for bariatric surgery for severe obesity. Acta Paediatr 2021; 110:1534-1540. [PMID: 33325092 PMCID: PMC8246871 DOI: 10.1111/apa.15702] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 12/27/2022]
Abstract
Aim To assess the prevalence of neurodevelopmental problems in adolescents with severe obesity and their associations with binge eating and depression. Methods Data were collected at inclusion in a randomised study of bariatric surgery in 48 adolescents (73% girls; mean age 15.7 ± 1.0 years; mean body mass index 42.6 ± 5.2 kg/m2). Parents completed questionnaires assessing their adolescents’ symptoms of attention‐deficit/hyperactivity disorder and autism spectrum disorder and reported earlier diagnoses. Patients answered self‐report questionnaires on binge eating and depressive symptoms. Results The parents of 26/48 adolescents (54%) reported scores above cut‐off for symptoms of the targeted disorders in their adolescents, but only 15% reported a diagnosis, 32% of adolescents reported binge eating, and 20% reported symptoms of clinical depression. No significant associations were found between neurodevelopmental problems and binge eating or depressive symptoms. Only a third of the adolescents reported no problems in either area. Conclusion Two thirds of adolescents seeking surgical weight loss presented with substantial mental health problems (reported by themselves or their parents). This illustrates the importance of a multi‐professional approach and the need to screen for and treat mental health disorders in adolescents with obesity.
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Affiliation(s)
- Anna Björk
- Department of Paediatrics Institute of Clinical Sciences Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
| | - Jovanna Dahlgren
- Department of Paediatrics Institute of Clinical Sciences Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
- Department of Pediatrics Region Västra GötalandSahlgrenska University Hospital Gothenburg Sweden
| | - Eva Gronowitz
- Department of Paediatrics Institute of Clinical Sciences Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
- Department of Pediatrics Region Västra GötalandSahlgrenska University Hospital Gothenburg Sweden
| | - Fanny Henriksson Wessely
- Department of Pediatrics Region Västra GötalandSahlgrenska University Hospital Gothenburg Sweden
| | - Annika Janson
- National Childhood Obesity Centre Karolinska University Hospital Stockholm Sweden
- Department of Women’s and Children’s Health Karolinska Institutet Stockholm Sweden
| | - My Engström
- Department of Surgery Region Västra GötalandSahlgrenska University Hospital Gothenburg Sweden
- Institute of Health and Care Sciences Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
| | - Lovisa Sjögren
- Department of Paediatrics Institute of Clinical Sciences Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
- Department of Pediatrics Region Västra GötalandSahlgrenska University Hospital Gothenburg Sweden
| | - Torsten Olbers
- Department of Biomedical and Clinical Sciences and Wallenberg Centre for Metabolic Medicine Linköping University Linköping Sweden
| | - Kajsa Järvholm
- Department of Paediatrics Institute of Clinical Sciences Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
- Department of Psychology Lund University Lund Sweden
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Janson A, Järvholm K, Gronowitz E, Sjögren L, Klaesson S, Engström M, Peltonen M, Ekbom K, Dahlgren J, Olbers T. A randomized controlled trial comparing intensive non-surgical treatment with bariatric surgery in adolescents aged 13-16 years (AMOS2): Rationale, study design, and patient recruitment. Contemp Clin Trials Commun 2020; 19:100592. [PMID: 32637723 PMCID: PMC7330152 DOI: 10.1016/j.conctc.2020.100592] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/08/2020] [Accepted: 06/14/2020] [Indexed: 12/23/2022] Open
Abstract
Background Previous non-randomized studies show similar outcomes in adolescents and adults after bariatric surgery. We describe the study protocol, recruitment, and selected baseline data of patients in a randomized multi-center study, the Adolescent Morbid Obesity Surgery 2 (AMOS2). Methods Three clinics in Sweden collaborated in designing the study and recruitment of patients from August 1, 2014 to June 30, 2017. Patients were selected among adolescents 13–16 years of age attending third-level obesity care for at least one year. Patients were randomized 1:1 to bariatric surgery (predominantly Roux-en-Y gastric bypass) or intensive non-surgical treatment starting with an eight-week low-calorie-diet. Results Fifty adolescents (37 girls) were randomized, 25 (19 girls) to bariatric surgery. Mean age was 15.7 years (range 13.3–16.9), weight 122.6 kg (range 95–183.3), Body Mass Index (BMI) 42.6 kg/m2 (range 35.7–54.9) and BMI-SDS 3.45 (range 2.9–4.1). One patient had type 2 diabetes mellitus, and 12/45 (27%) had elevated liver enzymes. There were no significant differences between the groups. For the 39 eligible patients who were offered but declined inclusion, BMI was not different from included patients. However, patients who declined were younger, 15.2 years (p = 0.021). A sex difference was also noted with more of eligible girls, 37/53 (69.8%), than boys, 13/36 (36.1%), wanting to participate in the study (p = 0.002). Conclusions This clinical trial, randomizing adolescents with severe obesity to bariatric surgery or intensive non-surgical treatment, aims at informing about whether it is beneficial to undergo bariatric surgery in early adolescence. It will also enlighten the outcome of comprehensive non-surgical treatment. The study was registered at www.clinicalTrials.gov number NCT02378259. Bariatric surgery is already a treatment option for adolescents with severe obesity in many countries. We recruited 50 patients 13-16 years of age to a randomized controlled trial. We aimed at investigating the optimal time point for bariatric surgery. Adolescents and their families seemed to make well considered decisions to participate in the study.
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Affiliation(s)
- Annika Janson
- National Childhood Obesity Centre, Karolinska University Hospital, Sweden.,Division of Pediatric Endocrinology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Kajsa Järvholm
- Childhood Obesity Unit, Skåne University Hospital, Malmö, Sweden.,Region Västra Götaland, Pediatric Obesity Center, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eva Gronowitz
- Region Västra Götaland, Pediatric Obesity Center, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lovisa Sjögren
- Region Västra Götaland, Pediatric Obesity Center, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sven Klaesson
- Department of Women's and Children's Health, Södertälje Hospital, Sweden.,Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - My Engström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Markku Peltonen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Kerstin Ekbom
- Division of Pediatric Endocrinology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Jovanna Dahlgren
- Region Västra Götaland, Pediatric Obesity Center, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Torsten Olbers
- Department of Gastrosurgical Research, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Biomedical and Clinical Sciences and Wallenberg Center for Molecular Medicine, Linköping University, Linköping, Sweden and Department of Surgery, Vrinnevi Hospital, Norrköping, Sweden
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Järvholm K, Bruze G, Peltonen M, Marcus C, Flodmark CE, Henfridsson P, Beamish AJ, Gronowitz E, Dahlgren J, Karlsson J, Olbers T. 5-year mental health and eating pattern outcomes following bariatric surgery in adolescents: a prospective cohort study. The Lancet Child & Adolescent Health 2020; 4:210-219. [DOI: 10.1016/s2352-4642(20)30024-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/29/2019] [Accepted: 11/29/2019] [Indexed: 01/06/2023]
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Järvholm K, Olbers T, Marcus C, Flodmark CE, Peltonen M, Gronowitz E, Dahlgren J, Karlsson J. A371 Predictors of suicidal ideation in adolescents five years after bariatric surgery – results from a prospective Swedish nationwide study (AMOS). Surg Obes Relat Dis 2019. [DOI: 10.1016/j.soard.2019.08.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Henfridsson P, Laurenius A, Wallengren O, Beamish AJ, Dahlgren J, Flodmark CE, Marcus C, Olbers T, Gronowitz E, Ellegard L. Micronutrient intake and biochemistry in adolescents adherent or nonadherent to supplements 5 years after Roux-en-Y gastric bypass surgery. Surg Obes Relat Dis 2019; 15:1494-1502. [PMID: 31371184 DOI: 10.1016/j.soard.2019.06.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 06/02/2019] [Accepted: 06/12/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is an effective obesity treatment in adults and has become established in adolescents. Lower adherence to supplementation in adolescents confers a risk for long-term nutritional deficiencies. OBJECTIVES To assess adherence to supplementation, micronutrient intake, and biochemistry in adolescents through 5 years after RYGB. SETTING University hospitals, multicenter study, Sweden. METHODS Micronutrient intake and adherence to supplementation were assessed by diet history interviews and biochemistry preoperatively, 1, 2, and 5 years after RYGB in 85 adolescents (67% females), aged 16.5 years (± 1.2) with a body mass index of 45.5 kg/m2 (± 6.0). Adherence was defined as taking prescribed supplements ≥3 times a week. Micronutrient intake and biochemistry were compared with matched controls at 5 years. RESULTS Over 75% completed the dietary assessments across 5 years after RYGB. Adherence ranged between 44-61% through 5 years. At 5 years, ferritin and hemoglobin decreased (P < .04) and 61% had iron deficiency (P ≤ .001). Among females with iron deficiency, most did not adhere to supplementation (P = .005), and 59% of these had anemia (P < .001). Vitamin D insufficiency continued after surgery and 80% of participants who did not adhere to supplementation had insufficiency (P = .002). Adolescents not adhering had lower levels of vitamin D, B12, and ferritin (females) compared with both adhering adolescents and the control group (all P < .04). CONCLUSIONS Half of adolescents after RYGB reported sufficient long-term adherence to supplementation. Adhering to supplements and reporting a higher micronutrient intake were associated with more favorable biochemistry. Results support the recommendations for monitoring micronutrient intake and biochemistry in all patients who have undergone RYGB surgery, and the recommendation of higher preventive supplementation of vitamin D and iron in both sexes. As hypothesized, adolescents not adhering had a higher prevalence of long-term micronutrient deficiencies.
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Affiliation(s)
- Pia Henfridsson
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
| | - Anna Laurenius
- Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Ola Wallengren
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Andrew J Beamish
- Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jovanna Dahlgren
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | | | - Claude Marcus
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Pediatrics, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Torsten Olbers
- Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Norrköping, Linköping University, Linköping, Sweden
| | - Eva Gronowitz
- Department of Pediatrics and Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Lars Ellegard
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Forsell C, Gronowitz E, Larsson Y, Kjellberg BM, Friberg P, Mårild S. Four-year outcome of randomly assigned lifestyle treatments in primary care of children with obesity. Acta Paediatr 2019; 108:718-724. [PMID: 30230026 DOI: 10.1111/apa.14583] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 08/28/2018] [Accepted: 09/14/2018] [Indexed: 12/12/2022]
Abstract
AIM To assess the four-year outcome in children with obesity randomised to one of two 12-month lifestyle treatment programmes in primary care. METHODS At baseline, 64 children with obesity aged 8.0-13.0 years were randomised to a treatment programme managed either by a nurse, dietician and physiotherapist (n = 32) or by a nurse and dietician (n = 32). RESULTS From baseline to follow-up, the mean body mass standard deviation score (BMISDS) had decreased by -0.50 [standard deviation (SD) 0.73], p = 0.002, in the nurse, dietician and physiotherapist group (n = 27), by -0.26 (SD 0.73), p = 0.057 in the other group (n = 29); adjusted mean difference was -0.22, 95% confidence interval -0.59; 0.16, p = 0.25. Changes in weight categories did not differ between the groups: both had a change from obesity to normal weight in 1 and to overweight in 6; in the physiotherapist group 1 case of severe obesity changed to obesity. The combined treatment groups (n = 56) had a mean reduction in BMISDS of -0.37 (SD 0.73) and an improved distribution in weight categories, p = 0.015. CONCLUSION After four years, there was no difference in outcome between the treatment options. In the treatment groups combined the number of children with obesity and their adiposity measures were significantly lower.
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Affiliation(s)
- Christer Forsell
- Paediatric Department; Alingsås Hospital; Västra Götaland Region Sweden
| | - Eva Gronowitz
- Department of Paediatrics; Sahlgrenska Academy at Gothenburg University; Gothenburg Sweden
| | - Yvonne Larsson
- Paediatric Department; Alingsås Hospital; Västra Götaland Region Sweden
| | | | - Peter Friberg
- Department of Physiology; Sahlgrenska Academy at Gothenburg University; Gothenburg Sweden
| | - Staffan Mårild
- Department of Paediatrics; Sahlgrenska Academy at Gothenburg University; Gothenburg Sweden
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11
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Henfridsson P, Laurenius A, Wallengren O, Gronowitz E, Dahlgren J, Flodmark CE, Marcus C, Olbers T, Ellegård L. Five-year changes in dietary intake and body composition in adolescents with severe obesity undergoing laparoscopic Roux-en-Y gastric bypass surgery. Surg Obes Relat Dis 2018; 15:51-58. [PMID: 30497848 DOI: 10.1016/j.soard.2018.10.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/07/2018] [Accepted: 10/13/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Information is scarce on long-term changes in energy intake (EI), dietary energy density (DED), and body composition in adolescents undergoing laparoscopic Roux-en-Y gastric bypass (RYGB). OBJECTIVES To investigate long-term changes in EI, DED, and body composition in adolescents after LRYGB. SETTING University hospitals, multicenter study, Sweden. METHODS Eighty-five adolescents (67% girls; mean ± standard deviation, age 16.0 ± 1.2 yr, body mass index 45.5 ± 6.1 kg/m2) were assessed preoperatively (baseline) and 1, 2, and 5 years after LRYGB with diet history interviews and dual-energy x-ray absorptiometry. Matched obese adolescent controls receiving nonsurgical treatment were assessed only at 5 years. RESULTS Weight decreased 31%, 33%, and 28% at 1, 2, and 5 years after LRYGB (P < .001) while controls gained 13% over 5 years (P < .001). Dietary assessments were completed in 98%, 93%, 87%, and 75% at baseline and 1, 2, and 5 years, respectively, and in 65% of controls. Baseline EI (2558 kcal/d), decreased by 34%, 22%, and 10% after 1, 2, and 5 years (P < .05). DED decreased at 1 year (P = .03). Macronutrient distribution was not different from controls at 5 years, but EI and DED were 31% and 14% lower (P < .015). Fat, fat-free, and muscle mass decreased through 5 years after LRYGB (P < .001). Boys preserved muscle mass more than girls (P < .01). Adequate protein intake was associated with preservation of muscle mass (P = .003). CONCLUSIONS In adolescents undergoing LRYGB EI remained 10% lower 5 years after surgery. Decreased EI and DED, rather than macronutrient distribution, are important factors in weight loss after surgery. Higher protein intake may facilitate preservation of muscle mass.
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Affiliation(s)
- Pia Henfridsson
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Anna Laurenius
- Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ola Wallengren
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva Gronowitz
- Department of Pediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jovanna Dahlgren
- Department of Pediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Claude Marcus
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Torsten Olbers
- Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Norrköping, Linköping University, Linköping, Sweden
| | - Lars Ellegård
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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12
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Brissman M, Ekbom K, Hagman E, Mårild S, Gronowitz E, Flodmark CE, Olbers T, Marcus C. Physical Fitness and Body Composition Two Years after Roux-En-Y Gastric Bypass in Adolescents. Obes Surg 2017; 27:330-337. [PMID: 27379769 DOI: 10.1007/s11695-016-2282-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND We have previously shown promising results 2 years after Roux-en-Y gastric bypass surgery, within the Adolescence Morbid Obesity Surgery study (AMOS). The aim of the current study was to describe the 2-year outcome in cardiorespiratory fitness, body composition, and functional capacity in the Stockholm subset of the AMOS study. METHODS Forty-one adolescents (10 male, 31 female, age 14-18 years, body mass index 35-69 kg·m-2) were included. In addition to anthropometric measurements, participants performed a submaximal bicycle test, 6-min walk test, dual-energy X-ray absorptiometry, and a short interview at baseline, 1 and 2 years after surgery. RESULTS Relative improvements in maximal oxygen consumption (VO2max) per kilogram body mass (+62 %) and per kilogram fat-free mass (+21 %), as well as walking distance (+13 %) were observed after 1 year, and persisted 2 years after surgery. Despite a reduction of fat-free mass (-15 %), absolute VO2max was maintained across the full group (+8 %, p = ns) and significantly increased in non-smokers. Body mass and fat mass were significantly decreased (-45.4 and -33.3 kg, respectively). Self-reported physical activity was significantly increased, and pain associated with movement was reduced. CONCLUSIONS In adolescents with obesity, Roux-en-Y gastric bypass improved VO2max more than could be explained by fat mass loss alone. In combination with improved functional capacity and body composition, these results suggest that surgery in adolescence might add specific benefits of importance for future health.
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Affiliation(s)
- Markus Brissman
- Department of Clinical Science, Intervention and Technology, Division of Paediatrics, Karolinska Institutet, B62, 141 86, Stockholm, Sweden.
| | - Kerstin Ekbom
- Department of Clinical Science, Intervention and Technology, Division of Paediatrics, Karolinska Institutet, B62, 141 86, Stockholm, Sweden
| | - Emilia Hagman
- Department of Clinical Science, Intervention and Technology, Division of Paediatrics, Karolinska Institutet, B62, 141 86, Stockholm, Sweden
| | - Staffan Mårild
- Department of Surgery, Sahlgrenska University of Gothenburg, Gothenburg, Sweden
| | - Eva Gronowitz
- Department of Surgery, Sahlgrenska University of Gothenburg, Gothenburg, Sweden
| | | | - Torsten Olbers
- Department of Surgery, Sahlgrenska University of Gothenburg, Gothenburg, Sweden
| | - Claude Marcus
- Department of Clinical Science, Intervention and Technology, Division of Paediatrics, Karolinska Institutet, B62, 141 86, Stockholm, Sweden
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13
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Benninge VB, Gronowitz E, Karlsson AK, Gelander L, Henriksson G, Friberg P, Chen Y. Childhood BMI trajectories and adolescence psychological well-being and physical health. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- VB Benninge
- Departments of Molecular and Clinical Medicine/Clinical Physiology, University of Gothenburg, Gothenburg, Sweden
| | - E Gronowitz
- Departments of Molecular and Clinical Medicine/Clinical Physiology, University of Gothenburg, Gothenburg, Sweden
| | - AK Karlsson
- Departments of Pediatrics, University of Gothenburg, Gothenburg, Sweden
| | - L Gelander
- Departments of Pediatrics, University of Gothenburg, Gothenburg, Sweden
| | - G Henriksson
- Department of Social Analysis, Region Västra Götaland, Gothenburg, Sweden
| | - P Friberg
- Departments of Molecular and Clinical Medicine/Clinical Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Y Chen
- Departments of Molecular and Clinical Medicine/Clinical Physiology, University of Gothenburg, Gothenburg, Sweden
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14
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Beamish AJ, Gronowitz E, Olbers T, Flodmark CE, Marcus C, Dahlgren J. Body composition and bone health in adolescents after Roux-en-Y gastric bypass for severe obesity. Pediatr Obes 2017; 12:239-246. [PMID: 27071497 DOI: 10.1111/ijpo.12134] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 02/19/2016] [Accepted: 02/22/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Laparoscopic Roux-en-Y gastric bypass (RYGB) causes changes in body composition and bone metabolism, yet little is known about effects in adolescents. OBJECTIVES The objective of this study was to report dual-energy X-ray absorptiometry measures and serum bone markers, hypothesizing that bone turnover increases after surgery. METHODS Inclusion criteria included the following: age 13-18 years and body mass index (BMI) >35 kg/m2 . Seventy-two adolescents (22 boys; mean age 16.5 years; BMI 44.8 kg/m2 ) undergoing RYGB underwent dual-energy X-ray absorptiometry and serum bone marker analyses preoperatively and annually for 2 years. RESULTS Mean BMI reduction at 2 years was 15.1 kg/m2 . Body composition changes included a reduction in fat mass (51.8% to 39.6%, p < 0.001) and relative increase in lean mass (47.0% to 58.1%, p < 0.001). In contrast to previous studies in adults, adolescent boys lost a greater percentage of their body fat than girls (-17.3% vs. -9.5%, p < 0.001). Individual bone mineral density Z-scores (BMD-Z) at baseline were within or above the normal range. The mean (SD) BMD-Z was 2.02 (1.2) at baseline, decreasing to 0.52 (1.19) at 2 years. Higher concentrations of serum CTX (p < 0.001) and osteocalcin (p < 0.001) were observed in boys throughout the study period. Levels rose in the first year, before decreasing modestly in the second. Levels of serum markers of bone synthesis and resorption were higher in boys, whose skeletal maturity occurs later than girls'. CONCLUSIONS Differences in body fat and lean mass proportions were observed according to sex following RYGB. Bone turnover increased, and BMD decreased to levels approaching a norm for age. Long-term outcome will determine the clinical relevance.
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Affiliation(s)
- A J Beamish
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, the University of Gothenburg, Gothenburg, Sweden.,Department of Research, Royal College of Surgeons of England, Lincoln's Inn Fields, London, UK
| | - E Gronowitz
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, the University of Gothenburg, Gothenburg, Sweden.,Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, the University of Gothenburg, Gothenburg, Sweden
| | - T Olbers
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, the University of Gothenburg, Gothenburg, Sweden
| | - C-E Flodmark
- Childhood Obesity Unit, Skåne University Hospital, Malmö, Sweden
| | - C Marcus
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - J Dahlgren
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, the University of Gothenburg, Gothenburg, Sweden
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15
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Olbers T, Beamish AJ, Gronowitz E, Flodmark CE, Dahlgren J, Bruze G, Ekbom K, Friberg P, Göthberg G, Järvholm K, Karlsson J, Mårild S, Neovius M, Peltonen M, Marcus C. Laparoscopic Roux-en-Y gastric bypass in adolescents with severe obesity (AMOS): a prospective, 5-year, Swedish nationwide study. Lancet Diabetes Endocrinol 2017; 5:174-183. [PMID: 28065734 PMCID: PMC5359414 DOI: 10.1016/s2213-8587(16)30424-7] [Citation(s) in RCA: 190] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 11/18/2016] [Accepted: 11/21/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Severe obesity in adolescence is associated with reduced life expectancy and impaired quality of life. Long-term benefits of conservative treatments in adolescents are known to be modest, whereas short-term outcomes of adolescent bariatric surgery are promising. We aimed to compare 5-year outcomes of adolescent surgical patients after Roux-en-Y gastric bypass with those of conservatively treated adolescents and of adults undergoing Roux-en-Y gastric bypass, in the Adolescent Morbid Obesity Surgery (AMOS) study. METHODS We did a nationwide, prospective, non-randomised controlled study of adolescents (aged 13-18 years) with severe obesity undergoing Roux-en-Y gastric bypass at three specialised paediatric obesity treatment centres in Sweden. We compared clinical outcomes in adolescent surgical patients with those of matched adolescent controls undergoing conservative treatment and of adult controls undergoing Roux-en-Y gastric bypass. The primary outcome measure was change in BMI over 5 years. We used multilevel mixed-effect regression models to assess longitudinal changes. This trial is registered with ClinicalTrials.gov, number NCT00289705. FINDINGS Between April, 2006, and May, 2009, 100 adolescents were recruited to the study, of whom 81 underwent Roux-en-Y gastric bypass (mean age 16·5 years [SD 1·2], bodyweight 132·8 kg [22·1], and BMI 45·5 kg/m2 [SD 6·1]). 80 matched adolescent controls and 81 matched adult controls were enrolled for comparison of outcomes. The change in bodyweight in adolescent surgical patients over 5 years was -36·8 kg (95% CI -40·9 to -32·8), resulting in a reduction in BMI of -13·1 kg/m2 (95% CI -14·5 to -11·8), although weight loss less than 10% occurred in nine (11%). Mean BMI rose in adolescent controls (3·3 kg/m2, 95% CI 1·1-4·8) over the 5-year study period, whereas the BMI change in adult controls was similar to that in adolescent surgical patients (mean change -12·3 kg/m2, 95% CI -13·7 to -10·9). Comorbidities and cardiovascular risk factors in adolescent surgical patients showed improvement over 5 years and compared favourably with those in adolescent controls. 20 (25%) of 81 adolescent surgical patients underwent additional abdominal surgery for complications of surgery or rapid weight loss and 58 (72%) showed some type of nutritional deficiency; health-care consumption (hospital attendances and admissions) was higher in adolescent surgical patients compared with adolescent controls. 20 (25%) of 81 adolescent controls underwent bariatric surgery during the 5-year follow-up. INTERPRETATION Adolescents with severe obesity undergoing Roux-en-Y gastric bypass had substantial weight loss over 5 years, alongside improvements in comorbidities and risk factors. However, gastric bypass was associated with additional surgical interventions and nutritional deficiencies. Conventional non-surgical treatment was associated with weight gain and a quarter of patients had bariatric surgery within 5 years. FUNDING Swedish Research Council; Swedish Governmental Agency for Innovation Systems; National Board of Health and Welfare; Swedish Heart and Lung Foundation; Swedish Childhood Diabetes Foundation; Swedish Order of Freemasons Children's Foundation; Stockholm County Council; Västra Götaland Region; Mrs Mary von Sydow Foundation; Stiftelsen Göteborgs Barnhus; Stiftelsen Allmänna Barnhuset; and the US National Institute of Diabetes, Digestive, and Kidney Diseases (National Institutes of Health).
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Affiliation(s)
- Torsten Olbers
- Department of Gastrosurgical Research, Sahlgrenska University Hospital, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.
| | - Andrew J Beamish
- Department of Gastrosurgical Research, Sahlgrenska University Hospital, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden; Department of Research, Royal College of Surgeons of England, London, UK
| | - Eva Gronowitz
- Department of Gastrosurgical Research, Sahlgrenska University Hospital, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden; Department of Paediatrics, Sahlgrenska University Hospital, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | | | - Jovanna Dahlgren
- Department of Paediatrics, Sahlgrenska University Hospital, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Gustaf Bruze
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska University Hospital, Stockholm, Sweden
| | - Kerstin Ekbom
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Peter Friberg
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Gunnar Göthberg
- Department of Paediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Kajsa Järvholm
- Childhood Obesity Unit, Skåne University Hospital, Malmö, Sweden; Department of Psychology, Lund University, Lund, Sweden
| | - Jan Karlsson
- Department of Psychology, Lund University, Lund, Sweden
| | - Staffan Mårild
- Department of Health and Care Sciences, Sahlgrenska University Hospital, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Martin Neovius
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska University Hospital, Stockholm, Sweden
| | - Markku Peltonen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Claude Marcus
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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16
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Järvholm K, Karlsson J, Olbers T, Peltonen M, Marcus C, Dahlgren J, Gronowitz E, Johnsson P, Flodmark CE. Characteristics of adolescents with poor mental health after bariatric surgery. Surg Obes Relat Dis 2016; 12:882-890. [PMID: 27134198 DOI: 10.1016/j.soard.2016.02.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 11/28/2015] [Accepted: 02/01/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND About 20% of adolescents experience substantial mental health problems after bariatric surgery. OBJECTIVES The aim of this study was to explore differences between adolescents with poor mental health (PMH) 2 years after surgery and those with average/good mental health. SETTING Three university hospitals in Sweden. METHODS Mental health and health-related quality of life were assessed in 82 of 88 adolescents (mean age: 16.8 yr, 67% female) at baseline and 1 and 2 years after laparoscopic gastric bypass. Possible associations among mental health, weight, and biochemical outcomes were explored. RESULTS Two years after surgery 16 (20%) adolescents were identified as having PMH. More symptoms of anxiety and depression and worse mental health at baseline significantly predicted PMH 2 years later. The decline in mental health for the PMH group happened mainly during the second year after surgery. Suicidal ideation was reported in 14% of the total sample 2 years postsurgery and was more frequent in the PMH group. Weight outcomes between groups were comparable at all time points, and physical health was equally improved 2 years after surgery. CONCLUSIONS Although adolescents with PMH after surgery lose as much weight and have similar improvements in physical health compared with other adolescents, special attention should be given to adolescents who report mental health problems at baseline and follow-up, especially during the second year after gastric bypass. The high prevalence of suicidal ideation in adolescents 2 years after bariatric surgery is another indication that longer follow-up is necessary.
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Affiliation(s)
- Kajsa Järvholm
- Childhood Obesity Unit, Skåne University Hospital, Malmö, Sweden; Department of Psychology, Lund University, Lund, Sweden.
| | - Jan Karlsson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Torsten Olbers
- Department of Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Markku Peltonen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Claude Marcus
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Jovanna Dahlgren
- Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eva Gronowitz
- Department of Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Per Johnsson
- Department of Psychology, Lund University, Lund, Sweden
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Jarvholm K, Karlsson J, Peltonen M, Marcus C, Olbers T, Johnsson P, Dahlgren J, Flodmark CE, Gronowitz E. Characteristics of adolescents with a poor mental health outcome after bariatric surgery. Surg Obes Relat Dis 2015. [DOI: 10.1016/j.soard.2015.08.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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18
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Järvholm K, Karlsson J, Olbers T, Peltonen M, Marcus C, Dahlgren J, Gronowitz E, Johnsson P, Flodmark CE. Two-year trends in psychological outcomes after gastric bypass in adolescents with severe obesity. Obesity (Silver Spring) 2015; 23:1966-72. [PMID: 26227556 DOI: 10.1002/oby.21188] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 05/21/2015] [Accepted: 05/26/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study aimed to evaluate changes in mental health over 2 years in adolescents undergoing gastric bypass. METHODS Eighty-eight adolescents (65% girls) aged 13 to 18 years were assessed at baseline and 1 and 2 years after surgery. Generic and obesity-specific questionnaires were used to evaluate outcomes in mental health, also in relation to age- and gender-specific norms. RESULTS Symptoms of anxiety (P = 0.001), depression (P = 0.001), anger (P = 0.001), and disruptive behavior (P = 0.022) were significantly reduced at 2 years after surgery, as were obesity-related problems (P < 0.001). Self-esteem (P < 0.001), self-concept (P < 0.001), and overall mood (P = 0.025) improved significantly. Improvements were mainly observed during the first year after surgery. The second year was characterized by stabilization. Symptoms of anxiety, depression, anger, disruptive behavior, and self-concept were at normative levels after surgery. However, 19% of the adolescents had depressive symptoms in the clinical range. CONCLUSIONS A substantial improvement in mental health in adolescents over the first 2 years after gastric bypass was found. Most adolescents had a level of mental health and self-concept similar to norms, but a marked subgroup showed substantial depressive symptoms 2 years after surgery.
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Affiliation(s)
- Kajsa Järvholm
- Childhood Obesity Unit, Skåne University Hospital, Malmö, Sweden
- Department of Psychology, Lund University, Lund, Sweden
| | - Jan Karlsson
- Centre for Health Care Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Torsten Olbers
- Department of Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Markku Peltonen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Claude Marcus
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Jovanna Dahlgren
- Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eva Gronowitz
- Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Per Johnsson
- Department of Psychology, Lund University, Lund, Sweden
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Göthberg G, Gronowitz E, Flodmark CE, Dahlgren J, Ekbom K, Mårild S, Marcus C, Olbers T. Laparoscopic Roux-en-Y gastric bypass in adolescents with morbid obesity--surgical aspects and clinical outcome. Semin Pediatr Surg 2014; 23:11-6. [PMID: 24491362 DOI: 10.1053/j.sempedsurg.2013.10.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In this paper, we address surgical aspects on bariatric surgery in adolescents from a nationwide Swedish study. Laparoscopic gastric bypass surgery was performed for 81 adolescents with morbid obesity (13-18 years), while 81 adolescents with obesity-matched by age, sex, and BMI received conventional care. Another comparison group was adults undergoing gastric bypass at the same institution during the same time period. This report addresses the 2-year clinical outcome and five-year surgical adverse event rate. Body weight decreased from 133 kg (SD = 22) at inclusion to 92 kg (SD = 17) after 1 year and was 89 (SD = 18) after 2 years (p < 0·001) representing a 32% (-35 to -30) weight loss after 2 years, corresponding to 76% (-81 to -71) excess weight loss. Weight loss was similar in the adult gastric bypass patients (-31%) while weight gain (+3%) was seen in the conventionally treated obese adolescents. Significant improvement in cardiovascular and metabolic risk factors and inflammation was seen after surgery. The treatment was generally well tolerated and quality of life improved significantly. The surgical adverse events included cholecystectomies (10%) and operations for internal hernia (9%) but no postoperative mortality. Adolescents undergoing laparoscopic gastric bypass surgery achieve similar weight loss to adults. Improvements in risk factors and quality of life were substantial. There were surgical complications similar to the adult group, which may be preventable.
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Affiliation(s)
- Gunnar Göthberg
- Department of Surgery, Medicine and Pediatrics, Sahlgrenska Academy at University of Gothenburg, Institute of Clinical Sciences, and Centre of Obesity at the Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Eva Gronowitz
- Department of Surgery, Medicine and Pediatrics, Sahlgrenska Academy at University of Gothenburg, Institute of Clinical Sciences, and Centre of Obesity at the Queen Silvia Children's Hospital, Gothenburg, Sweden
| | | | - Jovanna Dahlgren
- Department of Surgery, Medicine and Pediatrics, Sahlgrenska Academy at University of Gothenburg, Institute of Clinical Sciences, and Centre of Obesity at the Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Kerstin Ekbom
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Division of Paediatrics, and National Childhood Obesity Centre, Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Staffan Mårild
- Department of Surgery, Medicine and Pediatrics, Sahlgrenska Academy at University of Gothenburg, Institute of Clinical Sciences, and Centre of Obesity at the Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Claude Marcus
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Division of Paediatrics, and National Childhood Obesity Centre, Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Torsten Olbers
- Department of Surgery, Medicine and Pediatrics, Sahlgrenska Academy at University of Gothenburg, Institute of Clinical Sciences, and Centre of Obesity at the Queen Silvia Children's Hospital, Gothenburg, Sweden.
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Mårild S, Gronowitz E, Forsell C, Dahlgren J, Friberg P. A controlled study of lifestyle treatment in primary care for children with obesity. Pediatr Obes 2013; 8:207-17. [PMID: 23172847 DOI: 10.1111/j.2047-6310.2012.00105.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 08/22/2012] [Accepted: 08/31/2012] [Indexed: 11/28/2022]
Abstract
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT Lifestyle intervention is the most common treatment strategy for children with obesity. Specialized units for the care of children with obesity report significant effects of lifestyle treatment. In children, the physical activity component in lifestyle treatment is often well accepted. WHAT THIS STUDY ADDS Two lifestyle treatment programmes in primary care for children with obesity both gave a reduction of body mass index significantly greater than the change observed in a non-intervention comparison group of children with obesity. Substituting one-third of nurse-led treatment sessions with sessions led by physiotherapists in one of the programmes did not improve the outcome. The efficacy of treatment in primary care seems to be comparable to that reported in the literature. OBJECTIVE To evaluate the efficacy of lifestyle treatment in primary care for children with obesity. METHODS In a multicentre study, sixty-four 9- to 13-year-old children with obesity were randomized to one of two 12-month lifestyle treatment programmes. The only difference between the programmes was that a physiotherapist substituted the nurse in one-third of the sessions in an attempt to stimulate physical activity. For comparison, children with normal weight and overweight, and an age-, sex- and body mass index-matched non-intervention group of children with obesity were used. RESULTS Anthropometry and laboratory data differed significantly between children with obesity and normal weight at baseline. The follow-up at the end of treatment was attended by 55 children with obesity, 28 and 27 in each treatment arm. The mean (standard deviation) body mass standard deviation score changed by -0.36 (0.3) in the arm involving a physiotherapist and by -0.33 (0.2) in the other arm. These outcomes were not significantly different. Both reductions were significantly greater than the change of -0.14 (0.3) observed in the non-intervention comparison group of children with obesity CONCLUSION The efficacy of treatment in primary care for children with obesity seems to be comparable to that reported in the literature. ISRCTN44919688.
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Affiliation(s)
- S Mårild
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden.
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Karlsson AK, Kullberg J, Stokland E, Allvin K, Gronowitz E, Svensson PA, Dahlgren J. Measurements of total and regional body composition in preschool children: A comparison of MRI, DXA, and anthropometric data. Obesity (Silver Spring) 2013; 21:1018-24. [PMID: 23784906 DOI: 10.1002/oby.20205] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 11/11/2012] [Indexed: 01/18/2023]
Abstract
OBJECTIVE There are clear sex differences in the distribution of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) in adults, with males having more VAT and less SAT than females. This study assessed whether these differences between the sexes were already present in preschool children. It also evaluated which measures of body composition were most appropriate for assessing abdominal obesity in this age group. DESIGN AND METHODS One-hundred and five children (57 boys and 48 girls) participated in the study. Body composition was measured using dual-energy X-ray absorptiometry (DXA). Weight, height, and waist circumference (WC) were also recorded. Magnetic resonance imaging (MRI) of the entire abdomen using sixteen 10-mm-thick T1 -weighted slices was performed in a subgroup of 48 children (30 boys and 18 girls); SAT and VAT volumes were measured using semiautomated segmentation. RESULTS Boys had significantly more VAT than girls (0.17 versus 0.10 l, P < 0.001). Results showed that VAT correlated significantly with all measurements of anthropometry (P < 0.01) after adjusting for SAT and for total fat mass measured with DXA. The mean limits of agreement between DXA and MRI regarding truncal FM were calculated to be -11.4 (range -17.8 to -3.6), using a Bland-Altman plot. CONCLUSION Sex differences in adipose tissue distribution are apparent at an early age. MRI is the best method with which to study abdominal fat distribution in young children.
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Affiliation(s)
- Ann-Katrine Karlsson
- Göteborg Pediatric Growth Research Center, Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
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Fadel HT, Pliaki A, Gronowitz E, Mårild S, Ramberg P, Dahlèn G, Yucel-Lindberg T, Heijl L, Birkhed D. Clinical and biological indicators of dental caries and periodontal disease in adolescents with or without obesity. Clin Oral Investig 2013; 18:359-68. [PMID: 23515945 DOI: 10.1007/s00784-013-0972-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 03/04/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This study aims to assess clinical, microbiological and inflammatory parameters as indicators for caries and periodontal disease in adolescents with obesity. MATERIAL AND METHODS Twenty-seven adolescents with obesity [body mass index (BMI) 37 ± 4 kg/m(2)] and 28 controls (BMI 20 ± 2 kg/m(2)) answered questionnaires and were investigated regarding salivary parameters, plaque pH drop after a 1-min glucose rinse, oral clinical parameters, inflammatory markers in gingival crevicular fluid (GCF) and sub-gingival mirobiota. RESULTS Compared with controls, adolescents with obesity had a lower stimulated salivary secretion rate (1.55 ± 0.63 vs. 2.05 ± 1.05 mL/min, p < 0.05), higher concentrations of secretory immunoglobulin A (sIgA) (p < 0.001), more decayed tooth surfaces (3.4 ± 6.6 vs. 0.8 ± 1.1, p < 0.05) and more gingivitis (p < 0.01) after controlling for possible confounders. Overall, similar snacking habits, plaque amounts and numbers of deep periodontal pockets were observed. Following the glucose rinse, a slightly more pronounced drop in plaque pH was observed in the obesity group (p > 0.05). No differences in sub-gingival inflammatory or microbial indicators were detected (p > 0.01). CONCLUSIONS More caries and gingival inflammation were observed in adolescents with obesity. Of the indicators tested, salivary secretion rate was lower and sIgA levels were higher in the obesity group. We are unable to confirm whether differences in caries and gingival inflammation are due to systemic changes that are associated with obesity or due to possible irregular dietary/oral hygiene habits. CLINICAL RELEVANCE Customised oral health preventive programmes and appropriate collaboration with medical personnel in selecting the best diet, medication and psychological support can help improve the general well-being, including oral health, of children with obesity. This may even reduce the risk of oral diseases.
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Affiliation(s)
- Hani T Fadel
- Department of Cariology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden,
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Järvholm K, Olbers T, Marcus C, Mårild S, Gronowitz E, Friberg P, Johnsson P, Flodmark CE. Short-term psychological outcomes in severely obese adolescents after bariatric surgery. Obesity (Silver Spring) 2012; 20:318-23. [PMID: 21996668 DOI: 10.1038/oby.2011.310] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Bariatric surgery is suggested as a treatment option for severely obese adolescents. Because adolescence is characterized by intense psychosocial adjustment and development, it is important to study the effect of this procedure on adolescents' psychological health. This study examined baseline status and short-term changes in anxiety, depression, anger, disruptive behavior, and self-concept in 37 adolescents (mean age 16.6 ± 1.3). Participants completed the Beck Youth Inventories (BYI) at inclusion and (on average) 4 months after undergoing Roux-en-Y gastric bypass (RYGB). Internalizing (anxiety and depression) and externalizing (anger and disruptive behavior) symptoms were higher at baseline than gender-specific norms. One fifth had a very low self-concept. Four months after surgery, the adolescents showed significantly fewer symptoms of anxiety and depression and significantly improved self-concept from baseline. Anger and disruptive behavior showed no significant changes. An analysis of clinically meaningful changes was conducted, and besides the overall positive outcome, 16% (n = 6) of the adolescents had deteriorated on two or more inventories in BYI shortly after surgery. This impaired group did not show any specific features at inclusion. The results indicate the importance of psychological monitoring immediately after bariatric surgery and the need for additional psychosocial support to be available for vulnerable sub-groups of adolescents. Further studies with larger samples are necessary to identify characteristics predictive of short-term adverse psychological outcomes in adolescents after bariatric surgery.
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Affiliation(s)
- Kajsa Järvholm
- Childhood Obesity Unit, Skåne University Hospital, Malmö, Sweden.
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Chen Y, Dangardt F, Osika W, Berggren K, Gronowitz E, Friberg P. Age- and sex-related differences in vascular function and vascular response to mental stress. Atherosclerosis 2012; 220:269-74. [DOI: 10.1016/j.atherosclerosis.2011.10.030] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 09/30/2011] [Accepted: 10/21/2011] [Indexed: 10/16/2022]
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Dangardt F, Osika W, Chen Y, Gronowitz E, Strandvik B, Friberg P. SUPPLEMENT WITH OMEGA 3 FATTY ACIDS IMPROVES ENDOTHELIAL FUNCTION IN OBESE ADOLESCENTS. ATHEROSCLEROSIS SUPP 2008. [DOI: 10.1016/s1567-5688(08)70555-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Gronowitz E, Lorentzon M, Ohlsson C, Mellström D, Strandvik B. Docosahexaenoic acid is associated with endosteal circumference in long bones in young males with cystic fibrosis. Br J Nutr 2007; 99:160-7. [PMID: 17697399 DOI: 10.1017/s000711450780105x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In children, but not adults with cystic fibrosis (CF), associations between essential fatty acids (FA) and bone mass have been reported. Low bone mineral density (BMD) is common in these patients. Previously we found a normal annual increase of BMD, suggesting a potential for attaining normal bone mass. The aim of the present study was to investigate phospholipid FA pattern in relation to bone in young adult men with CF compared with healthy controls. Fourteen male patients with CF were compared with forty-two healthy controls, using dual-energy X-ray absorptiometry for total bone, lumbar spine and femur and peripheral quantitative computerised tomography for tibia and radius. A questionnaire concerning physical activity and nutrition was used. FA in serum phospholipids were measured using capillary GLC. CF patients did not differ in physical activity and anthropometry from controls. There were no differences in bone parameters between the two groups, but patients chronically colonised withPseudomonas aeruginosahad lower BMD than non-colonised patients. The trabecular BMD in the tibia differed between patients and controls, but not after adjustment for age and weight. The endosteal circumference of the radius was significantly associated with serum phospholipid concentration of DHA and inversely with then-6:n-3 FA ratio in CF patients but not in controls. The present study showed that young physically active adult males with classical CF obtained similar bone mass as controls, although influenced by pseudomonas colonisation. The association between DHA and long bone endosteal circumference suggested a later peak bone mass in those with CF compared with controls.
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Affiliation(s)
- Eva Gronowitz
- West Swedish CF Center, Sahlgrenska Academy, Gothenburg University, Queen Silvia Children's Hospital, 416 85 Gothenburg, Sweden.
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Keen C, Olin AC, Edentoft A, Gronowitz E, Strandvik B. Airway nitric oxide in patients with cystic fibrosis is associated with pancreatic function, Pseudomonas infection, and polyunsaturated fatty acids. Chest 2007; 131:1857-64. [PMID: 17400678 DOI: 10.1378/chest.06-2635] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Airway nitric oxide (NO) is low or normal in cystic fibrosis (CF) patients. This may affect bacterial status since NO has antimicrobial properties. Arachidonic acid (AA), which is increased in the serum and airways of CF patients, has been shown to reduce NO levels. The aim of this study was to investigate whether airway NO level correlates with genotype and pancreatic function, and whether low airway NO level is associated with bacterial infection and increased serum AA level in CF patients. METHOD Nasal NO (nNO) and exhaled NO (eNO) were measured according to the European Respiratory Society/American Thoracic Society standard in 59 CF patients aged 7 to 55 years, 80% of whom were pancreatic insufficient (PI) and 51% were chronically infected with Pseudomonas aeruginosa. RESULTS PI CF patients had significantly lower nNO levels than pancreatic-sufficient (PS) patients. Airway NO level did not correlate with lung function or inflammatory parameters. PI patients chronically infected with P aeruginosa had significantly lower nNO levels than noninfected PI patients. nNO level correlated inversely with the AA/docosahexaenoic acid ratio, and eNO with the essential fatty acid (FA) deficiency index, which is the ratio between mead acid and AA. CONCLUSIONS CF patients with PI, which is associated with more severe genotypes, had lower airway NO levels than patients with PS. Low NO level was correlated to chronic P aeruginosa infection, and an association was found between airway NO level and the abnormal serum phospholipid FA pattern.
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Affiliation(s)
- Christina Keen
- Department of Pediatrics, Sahlgrenska Academy, Göteborg, Sweden.
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Gronowitz E, Mellström D, Strandvik B. Serum phospholipid fatty acid pattern is associated with bone mineral density in children, but not adults, with cystic fibrosis. Br J Nutr 2007; 95:1159-65. [PMID: 16768839 DOI: 10.1079/bjn20061778] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Essential fatty acids (EFA) have proved to be important for normal bone mineral density (BMD) and bone growth in animal studies. Patients with cystic fibrosis often have low serum EFA levels, and low BMD has also been reported in patients with normal anthropometry. The aim of the present study was to analyse if BMD during a 2-year period was related to fatty acid status in patients with cystic fibrosis. Fifty-four patients, aged 6–33 years, were studied prospectively. BMD was measured with dual X-ray absorptiometry, and fatty acid concentrations in serum phospholipids were determined with capillary GLC. The cystic fibrosis patients showed low linoleic acid concentration and a high arachidonic acid (AA):DHA ratio in serum. The high eicosatrienoic acid:AA ratio, an indicator of EFA deficiency, increased further over 2 years, as did the total concentration of saturated fatty acids. In the adults there were no significant changes in fatty acids during the study. In the children, positive correlations were found between palmitic acid and bone mineral content in the lumbar spine and femoral neck. The lumbar spine BMDZscore correlated negatively with the AA:DHA ratio. No correlation was seen in adults except for a positive correlation between EFA deficiency index and the areas of lumbar spine and femoral neck. The present results imply that fatty-acid status influenced BMD in cystic fibrosis children, but not in adults, indicating that fatty-acid status wouldbe important for bone growth.
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Affiliation(s)
- Eva Gronowitz
- Department of Paediatrics, Sahlgrenska Academy, Gothenburg University, Queen Silvia Children's Hospital, SE-41685 Gothenburg, Sweden
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Gronowitz E, Mellström D, Strandvik B. 280 Serum phospholipid fatty acid pattern is associated with bone growth in children but not adults with Cystic Fibrosis. J Cyst Fibros 2006. [DOI: 10.1016/s1569-1993(06)80255-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Gronowitz E, Larkö O, Gilljam M, Hollsing A, Lindblad A, Mellström D, Strandvik B. Ultraviolet B radiation improves serum levels of vitamin D in patients with cystic fibrosis. Acta Paediatr 2005; 94:547-52. [PMID: 16188742 DOI: 10.1111/j.1651-2227.2005.tb01937.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ultraviolet B (UVB) radiation can be used in the prevention and treatment of vitamin D deficiency. AIM To investigate, in a controlled study of patients with cystic fibrosis (CF), whether regular UVB radiation would improve serum levels of calcidiol during the dark season (October-April). METHODS Thirty patients with mild to moderate disease were included (aged 9-40 y). All patients had cholecalciferol supplementation. One group (15 patients) was given UVB one to three times a week for 6 mo and one group (15 sex- and age-matched patients) served as controls. The radiation source consisted of three TL 12/40W UVB fluorescent lamps. Initial treatment duration was 1 min, subsequently increased by 0.5-1 min/treatment to a maximum of 10 min. RESULTS The mean initial serum calcidiol levels were 21 ng/ml in the controls and 22 ng/ml in the intervention group. Serum calcidiol levels increased to 44 ng/ml after 8 wk and to 50 ng/ml after 24 wk of UVB radiation; the corresponding serum levels in the controls were 19 and 25 ng/ml, respectively. The mean serum calcitriol levels increased in the treated group and were unaltered in the control group. CONCLUSIONS UVB radiation was effective in increasing vitamin D levels in patients with CF. The study results imply that UVB radiation is valuable in chronic conditions associated with vitamin D deficiency.
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Affiliation(s)
- Eva Gronowitz
- Department of Paediatrics, Göteborg Univsersity, Göteborg, Sweden.
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Abstract
OBJECTIVES To determine prospectively for 2 years the change in bone mineral density (BMD) in patients with cystic fibrosis (CF) and to correlate clinical data and routine biochemical parameters of bone metabolism and infection with BMD. METHODS Fifty-four patients with CF, aged 6 to 33 years, were included. BMD was measured using dual-energy x-ray absorptiometry in lumbar spine (LS) and femoral neck (FN). Anthropometric data and biochemical markers of bone metabolism and infection were measured. The number of intravenous antibiotic courses per year (ivAC) and pulmonary function were assessed. RESULTS The patients had normal anthropometric data and normal growth, but 36% and 33% of the patients had BMD z score <-1 standard deviation in LS and in FN, respectively. Nevertheless, BMD increased at a normal rate during the 2 years and was correlated to weight and lung function. Intact parathyroid hormone was positively correlated with the increase of BMD in both LS and FN during childhood. Blood sedimentation rate, serum concentration of immunoglobulin G, and ivAC were negatively correlated with BMD in FN. Patients with 2 more severe CF transmembrane conductance regulator mutations had significantly lower BMD in FN than other genetic combinations. CONCLUSION The study suggests that low BMD in CF is multifactorial and depends on infection and nutritional parameters. Differences in BMD of LS and FN suggested higher susceptibility to infection in FN at all ages. Longitudinal studies starting early before bacterial colonization would be valuable to determine the relative role of infection in the development of BMD in CF.
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Affiliation(s)
- Eva Gronowitz
- Department of Pediatrics, West Swedish CF Center, Queen Silvia Children's Hospital, 416 85 Göteborg, Sweden.
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Abstract
UNLABELLED In cystic fibrosis (CF), mucus plugging in the airways and in the gastrointestinal tract leads to severe morbidity and mortality. The mucin-associated antigens CA 19-9 and CA 125 are markers of gastrointestinal malignancy, and CA 19-9 has also been reported in association with pulmonary function in CF. AIM To test whether these antigens might serve as markers for the severity of pulmonary and gastrointestinal disease in CF. METHODS In 99 patients, aged 1 to 48 y, serum levels of CA 19-9 and CA 125 were measured by RIA and ELISA and related to clinical data. RESULTS Patients with severe mutations had significantly increased serum levels of CA 125, indicating an association with a more severe CF phenotype. This was further supported by the association with lung function, chronic pulmonary colonization of Pseudomonas aeruginosa and pancreatic insufficiency. CA 19-9 was also shown to be associated with lung function and Ps. aeruginosa colonization. No gastrointestinal malignancy was found in our patients despite very high values of CA 19-9 in some patients. During a 5-y follow-up, the very high serum levels of CA 19-9 decreased along with improved general condition of the patients. CONCLUSION Increased serum levels of CA 125 in CF patients were associated with severe cystic fibrosis transmembrane conductance regulator mutations and a severe phenotype. Both antigens were associated with pseudomonas colonization and lung function and CA 125 also with pancreatic insufficiency. The estimates of CA 19-9 are hampered by the influence of the Lewis histo-blood group system on the synthesis of CA 19-9.
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Affiliation(s)
- E Gronowitz
- West Swedish CF Centre, Department of Paediatrics, Göteborg University, Göteborg, Sweden
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Gronowitz E, Pitkänen S, Kjellmer I, Heikinheimo M, Strandvik B. Association between serum oncofetal antigens CA 19-9 and CA 125 and clinical status in patients with cystic fibrosis. Acta Paediatr 2004; 92:1267-71. [PMID: 14696845 DOI: 10.1080/08035250310006052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
UNLABELLED In cystic fibrosis (CF), mucus plugging in the airways and in the gastrointestinal tract leads to severe morbidity and mortality. The mucin-associated antigens CA 19-9 and CA 125 are markers of gastrointestinal malignancy, and CA 19-9 has also been reported in association with pulmonary function in CF. AIM To test whether these antigens might serve as markers for the severity of pulmonary and gastrointestinal disease in CF. METHODS In 99 patients, aged 1 to 48 y, serum levels of CA 19-9 and CA 125 were measured by RIA and ELISA and related to clinical data. RESULTS Patients with severe mutations had significantly increased serum levels of CA 125, indicating an association with a more severe CF phenotype. This was further supported by the association with lung function, chronic pulmonary colonization of Pseudomonas aeruginosa and pancreatic insufficiency. CA 19-9 was also shown to be associated with lung function and Ps. aeruginosa colonization. No gastrointestinal malignancy was found in our patients despite very high values of CA 19-9 in some patients. During a 5-y follow-up, the very high serum levels of CA 19-9 decreased along with improved general condition of the patients. CONCLUSION Increased serum levels of CA 125 in CF patients were associated with severe cystic fibrosis transmembrane conductance regulator mutations and a severe phenotype. Both antigens were associated with pseudomonas colonization and lung function and CA 125 also with pancreatic insufficiency. The estimates of CA 19-9 are hampered by the influence of the Lewis histo-blood group system on the synthesis of CA 19-9.
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Affiliation(s)
- E Gronowitz
- West Swedish CF Centre, Department of Paediatrics, Göteborg University, Göteborg, Sweden
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Abstract
AIM To study bone mineral density (BMD) in normal-growing patients with cystic fibrosis (CF) and its relation to clinical and biochemical markers of nutrition and lung function. METHODS Seventy consecutive patients aged 6-49 y with CF were investigated using dual X-ray absorptiometry and the findings related to anthropometric data. Energy intake was calculated and basal metabolic rate and serum values for calcium, phosphorus, calcitonin and 25(OH) calcidiol measured. Working capacity, lung function and pseudomonas colonization were determined as parameters of physical fitness and severity of pulmonary disease. RESULTS The average z-score of BMD was decreased in the lumbar spine in both children and adults, being -0.7 +/- 1.0 and -0.5 +/- 1.0, respectively, as was the femoral neck BMD z-score, being -0.3 +/- 0.9 and -1.1 +/- 1.0 for children and adults, respectively. BMD was correlated to lung function and working capacity, but not to anthropometric data at multiple regression analysis compensating for age and calcitonin. No correlation was found with energy intake, basal metabolic rate or biochemical markers, with the exception of calcitonin. CONCLUSION BMD z-scores were significantly lower than those in the normal population despite normal anthropometry. Osteoporosis was rare. The strongest correlation was found with lung function. Our data indicate that BMD at all ages might be a sensitive indicator of the general status of patients with CF.
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Affiliation(s)
- E Gronowitz
- Department of Paediatrics, Göteborg University, The Queen Silvia Children's Hospital, Göteborg, Sweden.
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Strandvik B, Björck E, Fallström M, Gronowitz E, Thountzouris J, Lindblad A, Markiewicz D, Wahlström J, Tsui LC, Zielenski J. Spectrum of mutations in the CFTR gene of patients with classical and atypical forms of cystic fibrosis from southwestern Sweden: identification of 12 novel mutations. Genet Test 2002; 5:235-42. [PMID: 11788090 DOI: 10.1089/10906570152742290] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Cystic fibrosis (CF) is caused by mutations in the CFTR gene. The spectrum of CFTR mutations varies between populations and depends on different factors, such as ethnic background and geographical location. The extensive CFTR mutation screening of 129 patients with classical or atypical CF from the south-western region of Sweden revealed the presence of 37 CFTR mutations, including 12 novel alleles. The overall mutation detection rate in this study population was 92%, the highest among all tested regions in Sweden. Eight mutations with a frequency above 1% (DeltaF508, 394delTT, R117C, 3659delC, E60X, 1112delT, R764X, and 621 + 1G --> T) accounted for 78% of CF chromosomes and have been recommended for inclusion in the CFTR mutation screening panel for molecular diagnosis of CF in this region. The multiple occurrence of specific CFTR alleles less common than the predominant DeltaF508 mutation (394delTT, R117C, 3659delC) allowed for genotype-phenotype comparisons and revealed consistent relationships between these mutations and disease severity.
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Affiliation(s)
- B Strandvik
- Department of Pediatrics, Institute for the Health of Women and Children, Göteborg University, Göteborg, Sweden
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Abstract
OBJECTIVE To determine if the serum phospholipid fatty acid pattern in patients with cystic fibrosis (CF) was related to the major cystic fibrosis transmembrane conductance regulator gene mutations. METHODS Patients with CF (n = 110) aged 3 months to 56 years were studied. Serum samples were analyzed for phospholipid fatty acid with gas-liquid chromatography, and cystic fibrosis transmembrane conductance regulator mutations were determined with standard methods. RESULTS Patients with CF had significantly lower molar percentages of linoleic acid and docosahexaenoic acid in the serum phospholipid than healthy controls (mean +/- standard deviation, 20.3 +/- 4.5 and 2.6 +/- 0.9 vs 22.4 +/- 2.2 and 3.1 +/- 0.7, respectively; P <.001). Palmitoleic and oleic acids were significantly increased (P <.001) but arachidonic acid was not different from controls. Homozygotes for DeltaF508 and heterozygotes/homozygotes for 394delTT showed significantly lower concentrations of linoleic acid and docosahexaenoic acid than the other groups. Low values were not correlated to anthropometric data or lung function. Patients with pancreatic insufficiency showed similar differences to those with sufficient pancreatic function, reflecting the different genotypes. CONCLUSION Serum concentrations of linoleic acid and docosahexaenoic acid were significantly lower in patients with severe cystic fibrosis transmembrane conductance regulator mutations, suggesting an association between the basic defect and abnormal essential fatty acid metabolism in CF patients.
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Affiliation(s)
- B Strandvik
- Department of Pediatrics and Clinical Genetics, Faculty of Medicine, Göteborg University, Göteborg, Sweden
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Soltani-Frisk S, Gronowitz E, Andersson H, Strandvik B. Water-miscible tocopherol is not superior to fat-soluble preparation for vitamin E absorption in cystic fibrosis. Acta Paediatr 2001; 90:1112-5. [PMID: 11697419 DOI: 10.1080/080352501317061486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
UNLABELLED Vitamin E deficiency is a major problem in cystic fibrosis. Modern pancreatic enzymes may improve the absorption of fat-soluble vitamins to make water dispersion less important. In order to compare the absorption of fat-soluble (F) and water-miscible (W) tocopheryl acetate, equivalent amounts (10 mg/kg body weight) were given to five patients with cystic fibrosis (CF) and five age- and sex-matched healthy controls. Serum was analysed for vitamin E using HPLC before and 1, 2, 3, 4, 6, 8, 10, 24 and 28 h after the oral intake. The median peak concentrations in the sera of controls were 41.9 micromol/L after F and 39.8 micromol/L after W preparations, corresponding values in CF patients being 21.3 and 26.8 micromol/L, and corresponding means +/- SD were 41.6+/-6.7 and 38.4+/-3.3, and 27.1+/-14.5 and 28.8+/-8.3, respectively. Although the area under the curve was lower for W than F preparations in both CF patients and controls, these differences were not significant. CONCLUSION The results in our study are consistent with those of an earlier study using the same preparation and suggest that it is not necessary to use water-miscible preparation of alpha-tocopheryl acetate in CF patients receiving modern pancreatic enzyme supplementation.
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Affiliation(s)
- S Soltani-Frisk
- Department of Pediatrics, Faculty of Medicine, Göteborg University, Sweden
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