Teen-Longitudinal Assessment Of Bariatric Surgery Research Articles

Exposure to per- and polyfluoroalkyl substances and alterations in plasma microRNA profiles in children

BackgroundPer- and polyfluoroalkyl substances (PFAS) are synthetic chemicals that persist in the environment and can accumulate in humans, leading to adverse health effects. MicroRNAs (miRNAs) are emerging biomarkers that can advance the understanding of the mechanisms of PFAS effects on human health. However, little is known about the associations between PFAS exposures and miRNA alterations in humans. ObjectiveTo investigate associations between PFAS concentrations and miRNA levels in children. MethodsData from two distinct cohorts were utilized: 176 participants (average age 17.1 years; 75.6% female) from the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) cohort in the United States, and 64 participants (average age 6.5 years, 39.1% female) from the Rhea study, a mother-child cohort in Greece. PFAS concentrations and miRNA levels were assessed in plasma samples from both studies. Associations between individual PFAS and plasma miRNA levels were examined after adjusting for covariates. Additionally, the cumulative effects of PFAS mixtures were evaluated using an exposure burden score. Ingenuity Pathways Analysis was employed to identify potential disease functions of PFAS-associated miRNAs. ResultsPlasma PFAS concentrations were associated with alterations in 475 miRNAs in the Teen-LABs study and 5 miRNAs in the Rhea study (FDR p < 0.1). Specifically, plasma PFAS concentrations were consistently associated with decreased levels of miR-148b-3p and miR-29a-3p in both cohorts. Pathway analysis indicated that PFAS-related miRNAs were linked to numerous chronic disease pathways, including cardiovascular diseases, inflammatory conditions, and carcinogenesis. ConclusionThrough miRNA screenings in two independent cohorts, this study identified both known and novel miRNAs associated with PFAS exposure in children. Pathway analysis revealed the involvement of these miRNAs in several cancer and inflammation-related pathways. Further studies are warranted to enhance our understanding of the relationships between PFAS exposure and disease risks, with miRNA emerging as potential biomarkers and/or mediators in these complex pathways.

Changes in plasma concentrations of per- and Polyfluoroalkyl substances after bariatric surgery in adolescents from the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study

Exposure to per- and poly-fluoroalkyl substances (PFAS) is ubiquitous due to their persistence in the environment and in humans. Extreme weight loss has been shown to influence concentrations of circulating persistent organic pollutants (POPs). Using data from the multi-center perspective Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) cohort, we investigated changes in plasma-PFAS in adolescents after bariatric surgery. Adolescents (Mean age = 17.1 years, SD = 1.5 years) undergoing bariatric surgery were enrolled in the Teen-LABS study. Plasma-PFAS were measured at the time of surgery and then 6-, 12-, and 36 months post-surgery. Linear mixed effect models were used to evaluate longitudinal changes in plasma-PFAS after the time of bariatric surgery. This study included 214 adolescents with severe obesity who had available longitudinal measures of plasma-PFAS and underwent bariatric surgery between 2007 and 2012. Underlying effects related to undergoing bariatric surgery were found to be associated with an initial increase or plateau in concentrations of circulating PFAS up to 6 months after surgery followed by a persistent decline in concentrations of 36 months (p < 0.001 for all plasma-PFAS). Bariatric surgery in adolescents was associated with a decline in circulating PFAS concentrations. Initially following bariatric surgery (0–6 months) concentrations were static followed by decline from 6 to 36 months following surgery. This may have large public health implications as PFAS are known to be associated with numerous metabolic related diseases and the significant reduction in circulating PFAS in individuals who have undergone bariatric surgery may be related to the improvement of such metabolic related diseases following bariatric surgery.

Exposure to 4,4'-DDE in visceral adipose tissue and weight loss in adolescents from the Teen-LABS cohort.

Dichlorodiphenyldichloroethylene (DDE), an obesogen accumulating in adipose tissue, is released into circulation with weight loss, although its impact is underexplored among adolescents. We tested the association using an integrative translational approach of epidemiological analysis among adolescents with obesity and in vitro measures exploring the impact of DDE on adipogenesis via preadipocytes. We included 63 participants from the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) cohort. We assessed 4,4'-DDE in visceral adipose tissue at surgery and BMI and waist circumference at surgery and 0.5, 1, 3, and 5 years after. We conducted longitudinal analysis to estimate the interaction on weight loss between DDE and time since surgery. In vitro analysis quantified adipogenic differentiation in commercial human preadipocytes exposed to 4,4'-DDE via fluorescent staining and imaging. A dose-response relationship was observed, with the low-exposure group having a greater reduction in BMI during the first year compared to higher-exposure groups and showing smaller regains compared to higher-exposure groups after the first year. In vitro analysis of preadipocytes treated with 4,4'-DDE during adipogenic differentiation for 12 days showed a concentration-dependent increase in lipid accumulation. DDE could contribute to weight trajectory among adolescents undergoing bariatric surgery, potentially mediated via promoted adipogenesis in preadipocytes.

Paired Liver:Plasma PFAS Concentration Ratios from Adolescents in the Teen-LABS Study and Derivation of Empirical and Mass Balance Models to Predict and Explain Liver PFAS Accumulation.

Animal studies have pointed at the liver as a hotspot for per- and polyfluoroalkyl substances (PFAS) accumulation and toxicity; however, these findings have not been replicated in human populations. We measured concentrations of seven PFAS in matched liver and plasma samples collected at the time of bariatric surgery from 64 adolescents in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study. Liver:plasma concentration ratios were perfectly explained (r2 > 0.99) in a multilinear regression (MLR) model based on toxicokinetic (TK) descriptors consisting of binding to tissue constituents and membrane permeabilities. Of the seven matched plasma and liver PFAS concentrations compared in this study, the liver:plasma concentration ratio of perfluoroheptanoic acid (PFHpA) was considerably higher than the liver:plasma concentration ratio of other PFAS congeners. Comparing the MLR model with an equilibrium mass balance model (MBM) suggested that complex kinetic transport processes are driving the unexpectedly high liver:plasma concentration ratio of PFHpA. Intratissue MBM modeling pointed to membrane lipids as the tissue constituents that drive the liver accumulation of long-chain, hydrophobic PFAS, whereas albumin binding of hydrophobic PFAS dominated PFAS distribution in plasma. The liver:plasma concentration data set, empirical MLR model, and mechanistic MBM modeling allow the prediction of liver from plasma concentrations measured in human cohort studies. Our study demonstrates that combining biomonitoring data with mechanistic modeling can identify underlying mechanisms of internal distribution and specific target organ toxicity of PFAS in humans.

Exposure to DDE and BMI among adolescents in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Study

Exposure to DDE and BMI among adolescents in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Study

1101-P: Glycemia after Pediatric Bariatric Surgery—Outcomes and Predictors

Background: Metabolic and bariatric surgery (MBS) is a safe and efficacious treatment for children and adolescents with severe forms of obesity. However, there are few data on the effects of pre-surgical fasting insulin homeostasis measures on post-surgical weight loss or glycemia. Methods: We analyzed data from n=216/242 individuals with ≥ Class 2 obesity prospectively enrolled in the multi-center, Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study for up to eight years. Individuals who had type 1 diabetes, a gastric band procedure, or lacked baseline data for insulin homeostasis measurements were excluded, leaving 216 individuals for analysis. Body composition was assessed through bioelectrical impedance measurements. An analysis of fasting markers of insulin homeostasis using homeostatic model of insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), or HOMA-β and outcomes following MBS was performed. Results: Our cohort had a baseline mean age of 16.5 years, BMI of 52.7 kg/m2, and was 75.4% female. At 8-year follow up, participants had a mean BMI of 43.0 kg/m2. Pre-surgical measures of insulin homeostasis did not predict change in BMI or fat mass over eight years. However, larger improvements in HbA1c were positively associated with younger baseline age, higher baseline HOMA-IR and HOMA-β, and lower baseline HbA1c. Conclusion: Baseline markers of insulin homeostasis were not significantly associated with weight loss outcomes, but did predict glycemia 8 years after MBS. Disclosure S.Sisley: Speaker's Bureau; Rhythm Pharmaceuticals, Inc. A.S.Shah: None. K.J.Nadeau: None. M.M.Kelsey: Other Relationship; Boehringer Ingelheim Inc., Janssen Pharmaceuticals, Inc., Rhythm Pharmaceuticals, Inc., Lilly. T.Gu: None. M.Michalsky: Advisory Panel; Lilly, Other Relationship; Intuitive Surgical, Stock/Shareholder; Intuitive Surgical. T.M.Jenkins: None. T.Inge: None. Funding National Institutes of Health (U01DK072493); U.S. Department of Agriculture-Agricultural Research Service (3092-5100-065)

The association of sagittal abdominal diameter with metabolic syndrome risk before and after weight-loss surgery in adolescents.

Metabolic syndrome (MetS) affects ∼10% of U.S. adolescents. Abdominal obesity is the most prevalent component and may indicate MetS risk in adolescents undergoing weight loss surgery. Assess MetS risk/severity and its association with abdominal obesity (measured by sagittal abdominal diameter, SAD) before and after weight loss surgery in adolescents to determine whether SAD predicts MetS risk in this population. Data were collected in the Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study at 5 sites (U.S. children's hospitals) performing weight-loss surgery in adolescents. The current study is a secondary analysis of these data. We examined data collected presurgery through 5 years postsurgery. MetS risk/severity was defined using the MetS severity z score (MetS-z), and MetS prevalence was determined using age-appropriate criteria. Association between SAD and MetS-z was evaluated with an adjusted linear mixed model. Among 228 individuals (75% female, 72% White), mean age 16.5 years and body mass index (BMI) 53 kg/m2, 79% met MetS criteria pre-urgery. MetS-z (1.5) and SAD (32cm) were correlated (r = 0.6, P < .0001) presurgery, and both improved significantly at 6 months, 1, and 5 years postsurgery, remaining highly correlated at each timepoint. SAD predicted MetS-z (β = 0.118; 95% CI, 0.109, 0.127) after adjustment for age, visit, surgery type, and caregiver education. Abdominal obesity is a key MetS risk marker in youth undergoing weight loss surgery. Both SAD and Met-z measures may be useful for MetS risk assessment and tracking postsurgery changes in this population, but more research is needed to identify effective lifestyle interventions targeting abdominal obesity.

Plasma concentrations of Per- and Polyfluoroalkyl Substances and alanine aminotransferase among Adolescents with and without NAFLD from the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Study

Plasma concentrations of Per- and Polyfluoroalkyl Substances and alanine aminotransferase among Adolescents with and without NAFLD from the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Study

Liver and Plasma concentrations of Per- and Polyfluoroalkyl Substances in Adolescents from the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Study

Liver and Plasma concentrations of Per- and Polyfluoroalkyl Substances in Adolescents from the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Study

High prevalence of subnormal testosterone in obese adolescent males: reversal with bariatric surgery.

Obesity in adolescent males is associated with the lowering of total and free testosterone concentrations. Weight loss may increase testosterone concentrations. We evaluated the changes in sex hormones following bariatric surgery in 34 males (age range: 14.6-19.8 years) with obesity. These participants were part of a prospective multicenter study, Teen-Longitudinal Assessment of Bariatric Surgery. The participants were followed up for 5 years after surgery. Total testosterone, total estradiol, luteinizing hormone, follicle-stimulating hormone, sex hormone-binding globulin, C-reactive protein, insulin and glucose were measured at baseline, 6 months and annually thereafter. Free testosterone, free estradiol and HOMA2-IR were calculated. Study participants lost one-third of their body weight after bariatric surgery, with maximum weight loss achieved at 24 months for most participants. Free testosterone increased from 0.17 (95% CI: 0.13 to 0.20) at baseline to 0.34 (95% CI: 0.30 to 0.38) and 0.27 nmol/L (95% CI: 0.23 to 0.32) at 2 and 5 years (P < 0.001 for both), respectively. Total testosterone increased from 6.7 (95% CI: 4.7 to 8.8) at baseline to 17.6 (95% CI: 15.3 to 19.9) and 13.8 (95% CI: 11.0 to 16.5) nmol/L at 2 and 5 years (P < 0.001), respectively. Prior to surgery, 73% of the participants had subnormal free testosterone (<0.23 nmol/L). After 2 and 5 years, only 20 and 33%, respectively, had subnormal free testosterone concentrations. Weight regain was related to a fall in free testosterone concentrations. Bariatric surgery led to a robust increase in testosterone concentrations in adolescent males with severe obesity. Participants who regained weight had a decline in their testosterone concentrations.

Associations between liver PFAS concentrations and plasma extracellular miRNAs in a cohort of adolescents undergoing bariatric surgery

BACKGROUND AND AIM: Perfluoroalkyl substances (PFAS), the “forever chemicals”, accumulate mainly in the liver and have various adverse health effects. Little is known about the mechanistic pathways of PFAS toxicity, but one likely mechanism is alteration of microRNA (miRNA) profiles that regulate post-transcription gene expression. This study aimed to explore relationships between hepatic PFAS concentrations and extracellular miRNAs in adolescents with severy obesity undergoing bariatric surgery. METHODS: PFAS concentrations (PFOS, PFOA, PFHxS, PFNA, PFDA, PFUdA, PFHpA, 8:2 FTS, 6:2 FTS, and NMeFOSAA) were assessed in liver biopsy samples (LOD0.01 ng/g tissue) collected at the time of bariatric surgery from 63 participants (mean [SD] age: 16.3 [1.7] years; 73% female) of the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) cohort. HTG EdgeSeq quantified plasma extracellular miRNAs, of which 803 had a coefficient of variation 25% among the control replicates and were used for analysis. Linear regression was performed to examine the pairwise associations between each liver PFAS concentration and each miRNA after adjusting for age, sex, race, pre-surgery weight loss, and BMI. KEGG pathway analysis was used to identify putative biological functions of PFAS-associated miRNAs. RESULTS:Median (IQR) hepatic PFAS concentrations ranged from 0.9 (0.08-0.13) ng/g liver for 6:2FTS to 6.57 (4.79-9.55) ng/g liver for PFOS. The greatest extent of associations with the expression of individual miRNAs was observed among PFOS and PFHxS, with PFOS being associated with upregulation of 9 miRNAs and PFHxS with downregulation of 15 miRNAs. Putative targets of dysregulated miRNAs associated with PFAS included pathways involved in cell cycle and cancer (e.g., TGF-beta signaling, Wnt signaling, p53 signaling, MAPK signaling), lipid metabolism (e.g., fatty acid biosynthesis, glycerophospholipid metabolism) and glucose metabolism (e.g., insulin signaling). CONCLUSIONS:Altered miRNA expression might be a mode of action of PFAS toxicity. Findings of this study offer new avenues to explore the mechanistic link between PFAS and disease. KEYWORDS: liver tissue, PFAS, extracellular miRNAs, adolescents

Outcomes of Bariatric Surgery in Older Versus Younger Adolescents.

In this report, we compare weight loss, comorbidity resolution, nutritional abnormalities, and quality of life between younger and older adolescents after metabolic and bariatric surgery. From March 2007 to December 2011, 242 adolescents (≤19 years of age) who underwent bariatric surgery at 5 clinical centers in the United States were enrolled in the prospective, multicenter, long-term outcome study Teen-Longitudinal Assessment of Bariatric Surgery. Outcome data from younger (13-15 years; n = 66) and older (16-19 years; n = 162) study participants were compared. Outcomes included percent BMI change, comorbidity outcomes (hypertension, dyslipidemia, and type 2 diabetes mellitus), nutritional abnormalities, and quality of life over 5 years post surgery. Baseline characteristics, except for age, between the 2 cohorts were similar. No significant differences in frequency of remission of hypertension (P = .84) or dyslipidemia (P = .74) were observed between age groups. Remission of type 2 diabetes mellitus was high in both groups, although statistically higher in older adolescents (relative risk 0.86; P = .046). Weight loss and quality of life were similar in the 2 age groups. Younger adolescents were less likely to develop elevated transferrin (prevalence ratio 0.52; P = .048) and low vitamin D levels (prevalence ratio 0.8; P = .034). The differences in outcome of metabolic and bariatric surgery between younger and older adolescents were few. These data suggest that younger adolescents with severe obesity should not be denied consideration for surgical therapy on the basis of age alone and that providers should consider adolescents of all ages for surgical therapy for obesity when clinically indicated.

Influence of Weight Loss on Obesity-Associated Complications After Metabolic and Bariatric Surgery in Adolescents.

Following metabolic and bariatric surgery (MBS), most adolescents experience weight loss and improvement of many obesity-associated complications (OACs). The relationship between weight loss and remission of OACs after MBS in adolescents has not been well described. The Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) is a multi-institutional prospective observational study of adolescents who underwent MBS between 2007 and 2012. Lower-weight-loss responders (LWLRs) were defined as having <20% total body weight loss (TBWL) and higher-weight-loss responders (HWLRs) were defined as having ≥20% TBWL at 5 years after MBS. The prevalence of OACs was compared at baseline and 5 years after MBS. Both LWLRs (n = 114) and HWLRs (n = 78) lost significant weight within the first year following MBS; however, the TBWL at 5 years for the LWLRs was 8.6% ± 9.5% compared with 33.8% ± 9.2% for the HWLRs. Those in the HWLR group were more likely to experience durable remission of composite dyslipidemia at 5 years, whereas there were no differences between groups in remission rates of all other OACs. Greater weight loss after MBS in adolescents was associated with greater remission of composite dyslipidemia; however, remission of other OACs was not dependent on major sustained weight loss.

Effect of surgical versus medical therapy on estimated cardiovascular event risk among adolescents with type 2 diabetes and severe obesity.

Cardiovascular disease (CVD) remains the leading cause of mortality in type 2 diabetes (T2D). Better interventions are needed to mitigate the high lifetime risk for CVD in youth T2D. To compare 30-year risk for CVD events in 2 cohorts of adolescents with T2D and severe obesity undergoing medical or surgical treatment of T2D. Longitudinal multicenter studies at University hospitals. A secondary analysis of data collected from the participants with T2D enrolled in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS, n = 30) and participants of similar age and racial distribution from the Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY, n = 63) studies was performed. Teen-LABS participants underwent metabolic bariatric surgery (MBS). TODAY participants were randomized to metformin alone or in combination with rosiglitazone or intensive lifestyle intervention, with insulin therapy given for glycemic progression. A 30-year CVD event score developed by the Framingham Heart Study was the primary outcome, assessed at baseline (preoperatively for Teen-LABS), 1 year, and 5 years of follow-up. Participants with T2D from Teen-LABS (n = 30; mean ± SD age = 16.9 ± 1.3 yr; 70% female; 60% white; body mass index (BMI) = 54.4 ± 9.5 kg/m2) and TODAY (n = 63; 15.3 ± 1.3 yr; 56% female; 71% white; BMI 40.5 ± 4.9 kg/m2) were compared. The likelihood of CVD events was higher in Teen-LABS versus TODAY at baseline (17.66 [1.59] versus 12.11 [.79]%, adjusted P = .002). One year after MBS, event risk was significantly lower in Teen-LABS versus TODAY (6.79 [1.33] versus 13.64 [0.96]%, adjusted P < .0001), and sustained at 5 years follow-up (adjusted P < .0001). Despite higher pretreatment risk for CVD events, treatment with MBS resulted in a reduction in estimated CVD event risks, whereas medical therapy associated with an increase inrisk among adolescents with T2D and severe obesity.

Physical activity impacts insulin sensitivity post metabolic bariatric surgery in adolescents with severe obesity.

Background/Objectives:We hypothesized that physical activity (PA) improves insulin sensitivity in adolescents with severe obesity beyond that attributable to metabolic bariatric surgery (MBS).Subjects/Methods:StepWatch™ monitors objectively measured PA in 88 participants in the Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study. Primary outcomes included absolute change in fasting insulin, HOMA-IR, and fasting glucose from pre-surgery (baseline) to 6, 12, 24, and 36 months post-MBS. SAS PROC TRAJ generated activity trajectories based on probability and individual participant step count trajectories. Linear regression models were used, adjusted for baseline value, visit, surgical procedure, sex, and percent change in BMI. Additional models adjusted for percent change in iliac waist circumference (IWC) or percent body fat (BF), measured by bio-impedance.Results:Two activity trajectories were identified: more active (MA, n=13) and less active (LA, n=75). MA baseline mean daily step count was >6 000, increasing to > 9 000 at 2 years. LA mean daily step count remained at approximately 4 000. Few participants recorded moderate step activity (cadence >80 steps/minute). Still, fasting insulin and HOMA-IR differed in association with activity trajectory. MA was associated with a greater absolute decrease in fasting insulin (−7.8μU/ml [95% CI: (−11.8, −3.7)], p =<0.001) and a greater decrease in HOMA- IR (−1.9 [95% CI: (−3.0, −0.7)], p = 0.001), when adjusted for percent change in BMI. The significant independent effect of MA remained when adjusted for percent change in IWC or percent BF. Clinically, 100% of MA trajectory participants normalized fasting insulin, HOMA-IR and fasting glucose by 6 months and normalization remained throughout the 36 month follow up. In contrast, 76.3% and 65.8% of LA trajectory participants normalized fasting insulin and HOMA-IR, respectively, by 12 months with 28.6% of both remaining normalized at 36 months.Conclusion:PA is independently associated with improved insulin sensitivity beyond that attributable to MBS in adolescents with severe obesity.

Nutritional Risks in Adolescents After Bariatric Surgery

Little is known about prevalence and risk factors for nutritional deficiencies in adolescents after metabolic bariatric surgery. We performed a 5-year prospective cohort study of these. Adolescents who had Roux-en-Y gastric bypass (RYGB, n= 161) or vertical sleeve gastrectomy (VSG, n= 67) were enrolled at 5 tertiary-care centers from March 2007 through February 2012. The final analysis cohort included 226 participants (161 who had RYGB and 65 who had VSG). We measured serum levels of ferritin; red blood cell folate; vitamins A, D, B1, B12; and parathyroid hormone at baseline and annually for 5 years. General linear mixed models were used to examine changes over time and identify factors associated with nutritional deficiencies. The participants were 75% female and 72% white, with a mean age of 16.5 ± 1.6 years and mean body mass index of 52.7 ± 9.4 kg/m2 at surgery. Mean body mass index decreased 23% at 5 years, and did not differ significantly between procedures. After RYGB, but not VSG, serum concentrations of vitamin B12 significantly decreased whereas serum levels of transferrin andparathyroid hormone increased. Ferritin levels decreased significantly after both procedures. Hypo-ferritinemia was observed in 2.5% of patients before RYGB and 71% at 5 y after RYGB (P < .0001), and 11% of patients before VSG and 45% 5 y after VSG (P= .002). No significant changes in serum levels of folate or vitamins A, B1, or D were found between baseline and 5 y after either procedure. By 5 y, 59% of RYGB and 27% of VSG recipients had 2 or more nutritional deficiencies. Risk factors associated with specific deficiencies included surgery type, female sex, black race, supplementation intake, weight regain, and for females, pregnancy. In a prospective study of adolescents who underwent RYGB or VSG, we observed nutritional deficiencies by 5 y after the procedures-particularly in iron and B12 after RYGB. Ongoing nutrient monitoring and supplementation are recommended for all patients, but surgery type, supplementation intake, sex, and race might affect risk. (Clinical trial registration: Adolescent Bariatrics: Assessing Health Benefits and Risk [also known as Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS)], NCT00474318.).

Body contouring in adolescents after bariatric surgery.

Bariatric surgery leads to sustained weight loss and resolution of obesity-associated co-morbidities in severely obese adolescents. However, one consequence of massive weight loss is excess skin and soft tissue. Many details regarding the timing, outcomes, and barriers associated with body contouring surgery (BCS) in youth who have undergone bariatric surgery are unknown. Describe the incidence and effect of BCS following bariatric surgery among adolescents. University Hospitals. Teen-Longitudinal Assessment of Bariatric Surgery is a prospective multi-institutional study of 242 adolescents who underwent bariatric surgery from 2007 to 2012. Utilization of BCS was analyzed in this population with comparison of anthropometrics and excess skin-related symptoms between those who did and those who did not undergo BCS. Among the 198 study participants with BCS data available, 25 (12.6%) underwent 41 body contouring procedures after bariatric surgery. The most common BCS was panniculectomy (n = 23). Presence of pannus-related symptoms at baseline and the magnitude of weight loss within the first year after bariatric surgery were independently associated with subsequent panniculectomy (P=.04 and P = .03, respectively). All adolescents who underwent panniculectomy experienced resolution of pannus-related symptoms. At 5 years after bariatric surgery, 74% of those who did not undergo panniculectomy reported an interest in the procedure, and 58% indicated that cost/insurance coverage was the barrier to obtaining BCS. Few adolescents who underwent bariatric surgery later underwent BCS procedures. Panniculectomy effectively treated pannus-related symptoms. Disparities in access to surgical care for adolescents who desire BCS warrants further investigation.

Gastric Bypass for Teens Versus Adults

Research Article| September 01 2019 Gastric Bypass for Teens Versus Adults AAP Grand Rounds (2019) 42 (3): 31. https://doi.org/10.1542/gr.42-3-31 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Gastric Bypass for Teens Versus Adults. AAP Grand Rounds September 2019; 42 (3): 31. https://doi.org/10.1542/gr.42-3-31 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: gastric bypass, bariatric surgery, obesity, hypertension and diabetes Source: Inge TH, Courcoulas AP, Jenkins TM, et al. Five-year outcomes of gastric bypass in adolescents as compared with adults. N Engl J Med. 2019; 380(22): 2136– 2145. doi: https://doi.org/10.1056/NEJMoa1813909Google Scholar Investigators from multiple institutions conducted parallel prospective studies to compare long-term outcomes after bariatric surgery for severe obesity in adolescents and adults. Adolescent participants, <19 years old, were enrolled in the Teen-Longitudinal Assessment of Bariatric Surgery (LABS) study at 1 of 5 centers between 2006 and 2012. Teen-LABS used the same design features and data collection forms as the adult LABS study. For the adult LABS study, individuals ≥18 years old were enrolled at 1 of 10 centers between 2006 and 2009. For the current analysis, only adults with a history of a BMI ≥30 at age 18 were included. Roux-en-Y gastric bypass surgery was performed in all study participants, and follow-ups were conducted at least annually for 5 years after enrollment. Data collected on study participants included demographics, weight, and BMI at enrollment and each follow-up; presence of diabetes and hypertension; and levels of micronutrients (up to 2 years after surgery), including ferritin, vitamin D, and vitamin B12. The primary outcomes were changes in weight and presence of diabetes and hypertension at the 5-year follow-up. Secondary outcomes included death and micronutrient status. Differences between those in the adolescent and adult cohorts were assessed with linear mixed and Poisson mixed models after adjusting for confounding variables. Data were analyzed on 161 adolescents and 396 adults. At enrollment, mean (standard deviation) BMI was 54 (10) in the adolescents and 51 (8) in adults (P<.001). By the 5-year follow-up, the percentage of weight loss was −26% (95% CI, −29% to −23%) in adolescents and −29% (95% CI, −31% to −27%) in adults (P=.08). The prevalence of diabetes and hypertension at enrollment were 14% and 57%, respectively, in adolescents and 31% and 68%, respectively, in adults. By the 5-year follow-up, 86% of the adolescents and 53% of adults with diabetes at baseline had normal glycated hemoglobin levels, defined as <6.5% (relative risk [RR], 1.27; 95% CI, 1.03–1.57). Similarly, among those with hypertension at baseline, 68% of adolescents and 41% of adults no longer had hypertension, defined as systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg, (RR, 1.51; 95% CI, 1.21–1.88). Three adolescents (1.9%) and 7 adults (1.8%) died during the study period. At the 2-year follow-up, 48% of adolescents had low ferritin levels compared to 29% of adults (P=.004), vitamin B12 values were low in 4% of both cohorts, and vitamin D levels were low in 38% of adolescents and 24% of adults (P=.02). The authors conclude that both adolescents and adults had marked weight loss after gastric bypass surgery, but remission rates for diabetes and hypertension were greater in adolescents than in adults. Drs Wong and Armstrong have disclosed no financial relationship relevant... You do not currently have access to this content.

123-OR: Effect of Surgical vs. Medical Therapy on Diabetic Kidney Disease (DKD) in Severely Obese Adolescents with Type 2 Diabetes (T2D)

To compare DKD rates over 5-years of follow-up in two cohorts of severely obese adolescents with T2D undergoing medical vs. surgical interventions. A secondary analysis of data collected by the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) and Treatment Options of type 2 diabetes in Adolescents and Youth (TODAY) studies was performed. Teen-LABS participants underwent bariatric surgery; TODAY participants were randomized to metformin alone or in combination with rosiglitazone or intensive lifestyle intervention, and insulin therapy was given when there was loss of glycemic control. TODAY participants (irrespective of treatment group assignment) were frequency matched to the 30 Teen-LABS participants with T2D by baseline age (13-18 years), ethnicity, sex, and baseline BMI (&amp;gt;35 kg/m2). Urinary albumin excretion (UAE), estimated glomerular filtration rate (eGFR) by creatinine and cystatin C equation, and prevalence of elevated UAE (≥ 30mg/g) and hyperfiltration (eGFR ≥ 135ml/min/1.73m2) were assessed. Thirty Teen-LABS participants with T2D (mean±SD age, 16.9±1.3 years; 70% female; 66% white; BMI 54.4 kg/m2) and 63 TODAY participants (15.3±1.3 years; 44% female; 71% white; BMI 40.5 kg/m2) were compared. During 5-years of follow-up, hyperfiltration decreased from 20% to 13% in Teen-LABS and increased from 5% to 37% in TODAY. Elevated UAE decreased from 27% to 5% in Teen-LABS and increased from 21% to 43% in TODAY. Adjusting for baseline age, sex, BMI and HbA1c, Teen-LABS participants had 15-fold lower odds of hyperfiltration (OR: 0.06, 95% CI 0.01-0.38) and 27-fold lower odds of elevated UAE (OR: 0.04, 95% 0.01-0.20) at 5-years of follow-up. Decreases in HbA1c and BMI showed the strongest associations with attenuation of hyperfiltration and elevated UAE, respectively. Compared with medical treatment, bariatric surgery of severely obese youth with T2D was associated with significantly lower odds of DKD over 5-years of follow-up. Disclosure P. Bjornstad: Advisory Panel; Self; Horizon, XORTX. Consultant; Self; Bayer US, Boehringer Ingelheim International GmbH, Bristol-Myers Squibb Company. K.S. Hughan: None. M.M. Kelsey: None. A. Shah: None. J.L. Lynch: Board Member; Self; American Academy of Pediatrics. Consultant; Self; Novo Nordisk Inc. Research Support; Self; Daiichi Sankyo Company, Limited, National Institutes of Health, Novo Nordisk Inc., Pediatric Diabetes Consortium. E. Nehus: Other Relationship; Self; Certara. M. Mitsnefes: None. T.M. Jenkins: None. P. Xu: None. C. Xie: None. T.H. Inge: Other Relationship; Self; Independent Medical Expert Consulting Services, Standard Bariatrics, UpToDate. K.J. Nadeau: None. Funding National Institutes of Health; National Institute of Diabetes and Digestive and Kidney Diseases

Physical Activity Improves Lipid and Weight-Loss Outcomes After Metabolic Bariatric Surgery in Adolescents with Severe Obesity.

Objective:To test the hypothesis that Physical Activity (PA) improves cardiovascular disease (CVD)-related lipids beyond that associated with weight loss in adolescents with severe obesity, post-metabolic bariatric surgery (MBS).Methods:We used objective StepWatch™ PA data from 108 participants of the Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study from baseline to 3 years post-MBS. Primary outcomes included absolute change in low density lipoprotein (LDL-C) and non-high density lipoprotein (non-HDL-C) from baseline. We adjusted for baseline measurement, visit, surgical procedure, and percent change in iliac waist circumference (IWC) or body mass index (BMI) from baseline in linear regression models using generalized estimating equations. PROC TRAJ in SAS generated optimal activity trajectories based on individual step count.Results:Despite low step counts and slow cadence, differences by activity trajectory were found. Greater absolute decreases in LDL-C and non-HDL-C (−15 mg/dL [95% CI: (−28, −2)], p =0.026 and −15 mg/dL [95% CI: (−28, −1)], p = 0.035), respectively, were associated with more activity (MA). MA was associated with greater resolution of triglycerides, LDL-C and non-HDL-C dyslipidemia and with greater weight loss 3 years post-MBS.Conclusion:More activity in adolescents was associated with improvements in CVD-related lipid measures and weight loss, post-MBS.