Comparison of Short and Long-Term Outcomes of Metabolic and Bariatric Surgery in Adolescents and Adults.

Fatima Cody Stanford,Karen J Campoverde Reyes,Tasnim Mushannen,Janey S Pratt,Denise W Gee,Vibha Singhal,Miriam A Bredella,Paul A Boepple,Priscilla Cortez,Madhusmita Misra,Hang Lee

doi:10.3389/fendo.2020.00157

Abstract

Objective: We sought to compare the short and long-term outcomes of MBS in adolescents vs. adults who have undergone a Roux-en-Y gastric bypass (RYGB) or Sleeve gastrectomy (SG).Design: Retrospective cohort study.Setting: Single tertiary care academic referral center.Participants: One hundred fifty adolescent (≤ 21-years) and adult (>21-years) subjects with severe obesity between 15 and 70 years of age who underwent RYGB or SG.Outcomes: Metabolic parameters, weight and height measures were obtained pre-and post-surgery (at 3 and 6 months, and then annually for 4 years).Results: Median pre-surgical body mass index (BMI) was higher in adolescents (n = 76) vs. adults (n = 74): 50 (45–57) vs. 44 (40–51) kg/m2 (p < 0.0001). However, obesity related complications were greater in adults vs. adolescents: 66 vs. 21% had hypertension, 68 vs. 28% had dyslipidemia, and 42 vs. 21% had type 2 diabetes mellitus (all p < 0.010). % BMI reduction and % weight loss (WL) were greater in adolescents vs. adults at all time points (p < 0.050). %WL was higher in adolescents who underwent SG at each time point (p < 0.050), and trended higher among adolescents who underwent RYGB (p = 0.060), compared to adults with the respective procedure. Follow-up data showed greater resolution of type 2 diabetes and hypertension in adolescents than adults (87.5 vs. 54.8%; p = 0.04, and 68.7 vs. 35.4%; p = 0.040).Conclusion: Adolescents compared to adults had greater reductions in BMI and weight, even at 4 years, and greater resolution of type 2 diabetes and hypertension. Earlier intervention in the treatment of severe obesity with MBS may lead to better outcomes.

Highlights

Obesity, defined as a body mass index (BMI) ≥ 30 kg/m2 in adults and BMI ≥ 95th percentile in children and adolescents of the same age and sex, is a pandemic complex multifactorial chronic disease
We conducted a retrospective review of adults (> 21 years) and adolescents (≤ 21 years) with obesity (BMI ≥ 30) who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2001 and 2014 at a single institution
The clinical and laboratory parameters included in this study were systolic and diastolic blood pressures, hemoglobin A1C (HbA1c), lipids, liver enzymes [aspartate aminotransferase (AST), alanine-aminotransferase (ALT)], iron and vitamin studies [iron, ferritin, total iron binding capacity (TIBC), vitamin B12] and 25hydroxy vitamin D (25-OHD) levels

Summary

Introduction

Obesity, defined as a body mass index (BMI) ≥ 30 kg/m2 in adults and BMI ≥ 95th percentile in children and adolescents of the same age and sex, is a pandemic complex multifactorial chronic disease. One weight loss medication, orlistat, is FDA approved in children and contributes to ∼3% total body weight loss, insufficient in severe obesity. A recent study showed greater resolution of T2D and HTN in adolescents as compared to adults after Roux-en-Y gastric bypass (RYGB) suggesting a benefit of early intervention [17]. Data comparing long-term outcomes following sleeve gastrectomy (SG), the most commonly performed MBS is not available [18]. Data comparing outcomes of RYGB and SG across age are lacking

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Results

Conclusion