Marc P Michalsky1, Thomas H Inge2, Todd M Jenkins3, Changchun Xie4, Anita Courcoulas5, Michael Helmrath3, Mary L Brandt6, Carroll M Harmon7, Mike Chen8, John B Dixon9, Elaine M Urbina10. 1. Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; marc.michalsky@nationwidechildrens.org. 2. University of Colorado, Denver, Colorado and Children's Hospital Colorado, University of Colorado, Aurora, Colorado. 3. Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 4. University of Cincinnati, Cincinnati, Ohio. 5. University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 6. Texas Children's Hospital, College of Medicine, Baylor University, Houston, Texas. 7. Women and Children's Hospital of Buffalo, Buffalo, New York. 8. University of Alabama at Birmingham, Birmingham, Alabama. 9. Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; and. 10. Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, Ohio.
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.
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.
Authors: Olga van der Baan-Slootweg; Marc A Benninga; Anita Beelen; Job van der Palen; Christine Tamminga-Smeulders; Jan G P Tijssen; Wim M C van Aalderen Journal: JAMA Pediatr Date: 2014-09 Impact factor: 16.193
Authors: Pamela B Morris; Christie M Ballantyne; Kim K Birtcher; Steven P Dunn; Elaine M Urbina Journal: J Am Coll Cardiol Date: 2014-07-15 Impact factor: 24.094
Authors: Marc P Michalsky; Thomas H Inge; Mark Simmons; Todd M Jenkins; Ralph Buncher; Michael Helmrath; Mary L Brandt; Carroll M Harmon; Anita Courcoulas; Michael Chen; Mary Horlick; Stephen R Daniels; Elaine M Urbina Journal: JAMA Pediatr Date: 2015-05 Impact factor: 16.193
Authors: Steven H Belle; Paul D Berk; Anita P Courcoulas; David R Flum; Carolyn W Miles; James E Mitchell; Walter J Pories; Bruce M Wolfe; Susan Z Yanovski Journal: Surg Obes Relat Dis Date: 2007 Mar-Apr Impact factor: 4.734
Authors: Thomas H Inge; Anita P Courcoulas; Todd M Jenkins; Marc P Michalsky; Michael A Helmrath; Mary L Brandt; Carroll M Harmon; Meg H Zeller; Mike K Chen; Stavra A Xanthakos; Mary Horlick; C Ralph Buncher Journal: N Engl J Med Date: 2015-11-06 Impact factor: 91.245
Authors: Lindel C Dewberry; Anahita Jalivand; Resmi Gupta; Todd M Jenkins; Andrew Beamish; Thomas H Inge; Anita Courcoulas; Michael Helmrath; Mary L Brandt; Carroll M Harmon; Mike Chen; John B Dixon; Margaret Zeller; Marc P Michalsky Journal: Obes Surg Date: 2020-06 Impact factor: 4.129
Authors: Janey S A Pratt; Allen Browne; Nancy T Browne; Matias Bruzoni; Megan Cohen; Ashish Desai; Thomas Inge; Bradley C Linden; Samer G Mattar; Marc Michalsky; David Podkameni; Kirk W Reichard; Fatima Cody Stanford; Meg H Zeller; Jeffrey Zitsman Journal: Surg Obes Relat Dis Date: 2018-03-23 Impact factor: 4.734
Authors: Cornelia L Griggs; Numa P Perez; Robert N Goldstone; Cassandra M Kelleher; David C Chang; Fatima Cody Stanford; Janey S Pratt Journal: JAMA Pediatr Date: 2018-12-01 Impact factor: 16.193
Authors: Justin R Ryder; Peixin Xu; Thomas H Inge; Changchun Xie; Todd M Jenkins; Chin Hur; Minyi Lee; Jin Choi; Marc P Michalsky; Aaron S Kelly; Elaine M Urbina Journal: Obesity (Silver Spring) Date: 2020-02-05 Impact factor: 5.002
Authors: Janey S A Pratt; Sebastian S Roque; Ruben Valera; Kathryn S Czepiel; Deborah D Tsao; Fatima Cody Stanford Journal: Semin Pediatr Surg Date: 2020-01-20 Impact factor: 2.754
Authors: S Christopher Derderian; Luke Patten; Alexander M Kaizer; Jaime M Moore; Sarah Ogle; Todd M Jenkins; Marc P Michalsky; James E Mitchell; Petter Bjornstad; John B Dixon; Thomas H Inge Journal: Obesity (Silver Spring) Date: 2020-12 Impact factor: 5.002
Authors: Sarah B Ogle; Lindel C Dewberry; Todd M Jenkins; Thomas H Inge; Megan Kelsey; Matias Bruzoni; Janey S A Pratt Journal: Pediatrics Date: 2021-02-01 Impact factor: 7.124
Authors: Jaime M Moore; Jacqueline J Glover; Brian M Jackson; Curtis R Coughlin; Megan M Kelsey; Thomas H Inge; Richard E Boles Journal: Surg Obes Relat Dis Date: 2020-09-16 Impact factor: 4.734