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Pediatrics. 2018 Feb;141(2). pii: e20172485. doi: 10.1542/peds.2017-2485. Epub 2018 Jan 8.

Cardiovascular Risk Factors After Adolescent Bariatric Surgery.

Author information

1
Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; marc.michalsky@nationwidechildrens.org.
2
University of Colorado, Denver, Colorado and Children's Hospital Colorado, University of Colorado, Aurora, Colorado.
3
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
4
University of Cincinnati, Cincinnati, Ohio.
5
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
6
Texas Children's Hospital, College of Medicine, Baylor University, Houston, Texas.
7
Women and Children's Hospital of Buffalo, Buffalo, New York.
8
University of Alabama at Birmingham, Birmingham, Alabama.
9
Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; and.
10
Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, Ohio.

Abstract

BACKGROUND AND OBJECTIVES:

Severely obese adolescents harbor numerous cardiovascular disease risk factors (CVD-RFs), which improve after metabolic and bariatric surgery (MBS). However, predictors of change in CVD-RFs among adolescents have not yet been reported.

METHODS:

The Teen-Longitudinal Assessment of Bariatric Surgery study (NCT00474318) prospectively collected anthropometric and health status data on 242 adolescents undergoing MBS at 5 centers. Predictors of change in CVD-RFs (blood pressure, lipids, glucose homeostasis, and inflammation) 3 years after Roux-en-Y gastric bypass and vertical sleeve gastrectomy were examined.

RESULTS:

The mean (±SD) age of participants at baseline was 17 ± 1.6 years; 76% were girls, and 72% were white, with a median BMI of 51. Participants underwent Roux-en-Y gastric bypass (n = 161), vertical sleeve gastrectomy (n = 67), or adjustable gastric banding (n = 14). Increasing weight loss was an independent predictor of normalization in dyslipidemia, elevated blood pressure (EBP), hyperinsulinemia, diabetes, and elevated high-sensitivity C-reactive protein. Older participants at time of surgery were less likely to resolve dyslipidemia compared with younger participants, whereas girls were more likely than boys to demonstrate improvements in EBP. Even those participants without frank dyslipidemia or EBP at baseline showed significant improvements in lipid and blood pressure values over time.

CONCLUSIONS:

Numerous CVD-RFs improve among adolescents undergoing MBS. Increased weight loss, female sex, and younger age predict a higher probability of resolution of specific CVD-RFs. The elucidation of predictors of change in CVD-RFs may lead to refinements in patient selection and optimal timing of adolescent bariatric surgery designed to improve clinical outcomes.

PMID:
29311357
PMCID:
PMC5810605
[Available on 2019-02-01]
DOI:
10.1542/peds.2017-2485
[Indexed for MEDLINE]

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Dr Inge serves as a consultant for Standard Bariatrics, UpToDate Inc, and Independent Medical Expert Consulting Services, all of which are unrelated to this project. Dr Harmon served on an advisory panel for the Stryker Corporation from 1998 to 2015, which was unrelated to this project. Dr Dixon has consulted for Apollo Endosurgery, Medtronic Minimally Invasive Therapies (formerly Covidien), Bariatric Advantage, Nestle Health Science, Inova, and Novo Nordisk; the other authors have indicated they have no potential conflicts of interest to disclose.

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