Cardiovascular Risk Factors After Adolescent Bariatric Surgery

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

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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Age Factors
  • Bariatric Surgery*
  • C-Reactive Protein / analysis
  • Cardiovascular Diseases / epidemiology*
  • Female
  • Glycated Hemoglobin A / analysis
  • Humans
  • Lipids / blood
  • Male
  • Obesity, Morbid / blood
  • Obesity, Morbid / complications
  • Obesity, Morbid / surgery*
  • Pediatric Obesity / blood
  • Pediatric Obesity / complications
  • Pediatric Obesity / surgery*
  • Risk Factors
  • Sex Factors
  • Weight Loss
  • Young Adult

Substances

  • Glycated Hemoglobin A
  • Lipids
  • hemoglobin A1c protein, human
  • C-Reactive Protein

Associated data

  • ClinicalTrials.gov/NCT00474318