What is the clinical evidence from this study?

Study design: Cohort. Population: Severe obesity with comorbid disease (n=242). Intervention: Metabolic and bariatric surgery vs. Baseline (pre-surgery). Primary outcome: Presence of ≥3 cardiovascular disease risk factors (p=<0.001).

January 8, 2018Open Access

Cardiovascular Risk Factors After Adolescent Bariatric Surgery

Q: What are the key findings of this study?

Metabolic and bariatric surgery in severely obese adolescents significantly reduced the prevalence of having ≥3 cardiovascular disease risk factors from 33% at baseline to 5% at 3 years.

Key Result

Metabolic and bariatric surgery in severely obese adolescents significantly reduced the prevalence of having ≥3 cardiovascular disease risk factors from 33% at baseline to 5% at 3 years.

Study Design

Type

Cohort (n=242)

Multicenter

Yes

Structured PICO

What are the predictors of change in cardiovascular disease risk factors 3 years after metabolic and bariatric surgery in severely obese adolescents?

Population

242 severely obese adolescents (mean age 17.1 years, 76% female) underwent metabolic and bariatric surgery and were followed for 3 years to assess changes in cardiovascular risk factors.

Exposure

Metabolic and bariatric surgery (Roux-en-Y gastric bypass and vertical sleeve gastrectomy)

Outcome

Change in cardiovascular disease risk factors (blood pressure, lipids, glucose homeostasis, and inflammation) 3 years after surgerysurrogate

In severely obese adolescents, metabolic and bariatric surgery improves cardiovascular risk factors at 3 years, with greater weight loss, younger age, and female sex predicting better resolution.

Main Result

Absolute Event Rate: 5% vs 33%

p-value: p=<0.001

Limitations

Findings are specific to the severely obese and not representative of the wider obese population due to the high BMI range.
Overrepresentation of girls, white people, and participants undergoing Roux-en-Y gastric bypass limits generalizability.
Use of categorical analysis based on age-dependent cardiovascular disease risk factor cutpoints may introduce bias.
Abnormal blood pressure measurements did not meet the strict definition of hypertension.
Analysis does not consider data beyond 3 years, limiting insights into weight loss durability and risk factor re-emergence.

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: = 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.

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