Age, sex and weight loss predict bariatric surgery benefits in teens

Last Updated: 2018-01-08

By Marilynn Larkin

NEW YORK (Reuters Health) - Greater weight loss, female sex and younger age predict cardiovascular risk factor resolution in adolescents undergoing bariatric surgery, researchers say.

"Teen-LABS is the largest ongoing multicenter clinical outcomes study designed to evaluate the general safety and health effects of bariatric surgery in the adolescent population," Dr. Marc Michalsky of Nationwide Children's Hospital in Columbus, Ohio, said in an email to Reuters Health.

"The aim of the latest report," he said, "was to examine changes in baseline (preoperative) prevalence of specific biomarkers of cardiovascular disease risk."

Teen-LABS researchers enrolled 242 adolescents with a body-mass index (BMI) of at least 35 from 2007 through 2011. Data were collected at baseline (within 30 days before surgery); six months; and one, two and three years after surgery.

Participants' mean age at baseline was 17 (76% female; 72% white). A total of 161 underwent Roux-en-Y gastric bypass; 67, vertical sleeve gastrectomy; and 14, adjustable gastric banding, according to the Pediatrics report, online January 8.

BMI declined by 27% overall at three years (28% for RYGB, 26% for VSG and 8% for AGB).

Overall improvements were evident for mean systolic blood pressure (-6 mmHg), diastolic blood pressure (-5 mmHg), triglycerides (-42 mg/dL), and HDL-C (+15 mg/dL).

At baseline, 75% of patients had dyslipidemia, but that rate declined to 27% by one year postsurgery and was 29% at three years. The authors note that "increasing baseline age was independently associated with a lower likelihood of dyslipidemia remission."

Postsurgery normalization of elevated blood pressure was more likely in female than male participants (risk ratio, 1.41) and in white participants than in those of color (RR, 1.26).

For every 10% increase in weight loss, participants were 24%, 11%, 14%, 13%, and 19% more likely to achieve resolution of dyslipidemia, elevated blood pressure, hyperinsulinemia, diabetes, and elevated high-sensitivity C-reactive protein, respectively.

The CVD-RF (cardiovascular disease risk factors) total score was used to assess the multiplicity of comorbid disease. At baseline, 97% of participants had at least one CVD-RF, whereas fewer than half (48%) had CVD-RF multiplicity at three years.

"Approximately one third of study participants had three or more cardiovascular disease risk factors at baseline," Dr. Michalsky noted. "Three years after surgery however, the rate of multiple risk factors among the study population dropped to 5%, representing a significant reduction in the overall likelihood of developing a number of cardiovascular diseases later in life - e.g., heart failure, atherosclerosis and stroke."

"In addition to the overall changes observed in risk prevalence," he continued, "accompanying analysis identified several predictors of cardiovascular risk reduction during the postoperative study time period."

"Specifically, increased weight loss, female sex and younger age at time of surgery predicted an increased likelihood of normalization of certain measured risk factors," he noted.

"Younger participants at the time of surgery were more likely to experience improvements in dyslipidemia and elevated hs-CRP levels compared to older patients, and females were more likely than males to experience significant improvements in blood pressure," Dr. Michalsky said. These findings "are novel and offer new insights into long-term outcomes."

"Collectively, data from the current study offer new and compelling support for the use of bariatric surgery in the pediatric population," he stated.

"In addition," he concluded, "they may help to refine the selection criteria and treatment strategies for severely obese adolescents and young adults who are considering bariatric surgery by showing us that some of the important benefits of surgery were more commonly seen in those who underwent surgery earlier than later in teenage years."

Jon Schram, Medical Director, Bariatric Surgery at Spectrum Health in Michigan, told Reuters Health by email, "The study mirrors many of the same results that we see in adult metabolic/bariatric surgery."

"When we intervene surgically at an earlier stage in the disease process," he said, "we have a better chance at reversing or preventing serious comorbidities such as diabetes, hypertension, and hyperlipidemia - all of which increase cardiovascular disease risk - and we generally obtain better weight loss results."

"When dealing with morbidly obese adolescents or adults, early surgical intervention, in what has become a chronic disease without a cure, offers the best opportunity for successful treatment," Dr. Schram concluded.

SOURCE: http://bit.ly/2m9KX7U

Pediatrics 2018.