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Bariatric surgery reduces CVD risk over time in adolescents
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Adolescents who underwent metabolic and bariatric surgery had improvements in various CVD risk factors, according to a study published in Pediatrics.
“This is the first large-scale analysis of predictors of change in cardiovascular disease risk factors among adolescents following bariatric surgery,” Marc P. Michalsky, MD, surgical director of the Center for Healthy Weight and Nutrition at Nationwide Children’s Hospital in Columbus, Ohio, said in a press release. “The study demonstrated early improvement and reduction of cardiometabolic risk factors, offering compelling support for bariatric surgery in adolescents.”
Researchers from the Teen-LABS study analyzed data from 242 adolescents (mean age, 17 years; 76% girls; median BMI, 50 kg/m2) who had class 2 obesity or higher, comorbid disease and underwent metabolic and bariatric surgery. Patients underwent vertical sleeve gastrectomy (n = 67), Roux-en-Y gastric bypass (n = 161) or adjustable gastric banding (n = 14).
Data were collected through research visits, telephone interviews and electronic communication less than 30 days before surgery and at 6 months and annually up to 3 years. Measurements included HDL, LDL, triglycerides, BP, fasting glucose, fasting insulin and the prevalence of diabetes.
At 3 years, reductions were seen in triglycerides (–42 mg/dL), systolic BP (–6 mm Hg), diastolic BP (–5 mm Hg) and HDL (15 mg/dL). The rate of elevated BP also improved at 3 years (from 44% to 15%). More boys had elevated BP at baseline (63%) compared with girls (37%; P = .001), which decreased to 31% and 10%, respectively (P = .002).
The rate of dyslipidemia decreased from 75% at baseline to 27% at 1 year and 29% at 3 years. Fewer patients had diabetes at 3 years (0.5%) than at baseline (13%). Hyperinsulinemia also improved from baseline (74%) to 3 years (21%). High-sensitivity C-reactive protein values of at least 0.3 mg/dL decreased from 75% at baseline to 25% at 3 years.
Patients were more likely to resolve their elevated BP (11%), dyslipidemia (24%), hyperinsulinemia (14%), elevated high-sensitivity CRP (19%) and diabetes (13%) with every 10% increase in weight loss.
Baseline age was independently linked to a lower possibility of dyslipidemia remission (RR = 0.93; 95% CI, 0.88-0.98). White patients (RR = 1.26; 95% CI, 1-1.58) and girls (RR = 1.41; 95% CI, 1.1-1.8) were more likely to normalize their elevated BP compared with black patients and boys.
“Our findings underscore the importance of long-term analysis to demonstrate whether the more beneficial responses of CVD [risk factors] in younger adolescents and children allow these individuals to enjoy even greater longitudinal health benefits than individuals undergoing [metabolic syndrome] later in adolescence,” Michalsky and colleagues wrote. – by Darlene Dobkowski
Disclosures: Michalsky reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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