From the Journals

Metabolic and bariatric surgery reduces CVD risk in severely obese adolescents

 

Key clinical point: Metabolic and bariatric surgery reduced the risk of cardiovascular disease in severely obese adolescents.

Major finding: With every 10% increase in weight loss, patients were 24%, 11%, 14%, 13%, and 19% more likely to resolve dyslipidemia, elevated BP, hyperinsulinemia, diabetes and elevated high-sensitivity C-reactive protein, respectively.

Study details: This study was a longitudinal, multicenter prospective study of 242 severely obese adolescents undergoing metabolic and bariatric surgery between February 28, 2007 and December 30, 2011.

Disclosures: Dr. Inge has worked as a consultant for Standard Bariatrics, UpToDate, and Independent Medical Expert Consulting Services; all of these companies are unrelated to this research. John B. Dixon, PhD, has received support for his research through a National Health and Medical Research Council research fellowship. Anita Courcoulas, MD, has received grants from various healthcare groups and companies. All other authors had no relevant financial disclosures. The study was funded by a variety of institutional grants and the National Institutes of Health.

Source: M Michalsky et al. Pediatrics. 2018 Jan 8. doi: 10.1542/peds.2017-2485


 

FROM PEDIATRICS

Weight loss caused by metabolic and bariatric surgery (MBS) independently predicts the normalization of dyslipidemia, elevated blood pressure (EPB), hyperinsulinemia, diabetes, and elevated high-sensitivity C-reactive protein (hs-CRP) in severely obese adolescents, according to results of a longitudinal, multicenter prospective study.

In the study of 242 severely obese adolescents undergoing MBS between Feb. 28, 2007, and Dec. 30, 2011, Marc Michalsky, MD, of Nationwide Children’s Hospital, Columbus, Ohio, and his colleagues found that with every 10% increase in weight loss, patients were 24%, 11%, 14%, 13%, and 19% more likely to resolve dyslipidemia, EBP, hyperinsulinemia, diabetes, and elevated hs-CRP, respectively.

obese child scale moodboard/thinkstockphotos
Lower body mass index levels were linked with significantly lower EPBs, compared with the higher BMI scores (BMI less than 50, 30% vs. BMI greater than or equal to 60, 63%; P less than .001). At a 3-year follow-up, the difference between EBP numbers was almost indistinguishable between low and high BMI groups (15% vs. 18%).

One of the most important facets of this study is the predictive nature of different patient risk factors on the future remission of cardiovascular disease symptoms.

For example, “the evidence suggests that better long-term outcomes may be anticipated among individuals undergoing MBS at lower BMI levels (i.e., less than 50),” they reported in the journal Pediatrics. “Increasing age at the time of MBS was associated with a reduced likelihood of dyslipidemia remission and normalization of hs-CRP,” which was true even in the narrow age range of this group of adolescents.

“The identification of specific predictors of CVD-RF [cardiovascular disease risk factors] normalization and/or remission on the basis of sex, race, preoperative BMI, and age at surgery may serve to improve future study design and insights regarding the optimization of treatment strategies,” wrote Dr. Michalsky and his colleagues. “Collectively, these data demonstrate a reduction in the risk for development of CVD in adulthood and offer additional, compelling support for MBS in adolescents.”

Dr. Inge has worked as a consultant for Standard Bariatrics, UpToDate, and Independent Medical Expert Consulting Services; all of these companies are unrelated to this research. John B. Dixon, PhD, has received support for his research through a National Health and Medical Research Council research fellowship. Anita Courcoulas, MD, has received grants from various health care groups and companies. All other authors had no relevant financial disclosures. The study was funded by a variety of institutional grants and the National Institutes of Health.

SOURCE: M Michalsky et al. Pediatrics. 2018 Jan 8. doi: 10.1542/peds.2017-2485.

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