Baseline BMI is a strong predictor of nadir BMI after adolescent gastric bypass.
Baseline BMI is a strong predictor of nadir BMI after adolescent gastric bypass.
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DOI：
10.1016/j.jpeds.2009.07.028
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发表时间：
2010-01
影响因子：
5.1
通讯作者：
Xanthakos, Stavra A.
中科院分区：
文献类型：
--
作者：
Inge, Thomas H.;Jenkins, Todd M.;Zeller, Meg;Dolan, Lawrence;Daniels, Stephen R.;Garcia, Victor F.;Brandt, Mary L.;Bean, Judy;Gamm, Kimberlee;Xanthakos, Stavra A.
极度肥胖的手术治疗可能适合某些青少年。我们假设手术减肥结果可能因术前极度肥胖程度（体重指数 [BMI] ≥99%）而异。对 2002 年至 2007 年在一个儿科中心接受腹腔镜 Roux-en-Y 胃绕道手术的 61 名青少年的临床特征进行了纵向评估。患者被分为 3 个术前 BMI 组中的 1 个：第 1 组，BMI = 40.0 至 54.9 (n = 23)；第 1 组，BMI = 40.0 至 54.9 (n = 23)；第 2 组，BMI = 55.0 至 64.9 (n = 21)；第 3 组，BMI = 65.0 至 95.0 (n = 17)。使用重复测量混合线性模型评估基线和第一年之间体重指数和心血管危险因素的变化。手术后 1 年，整个队列的基线 BMI (60.2 ± 11 kg/m2) 下降了 37.4% (P < .001)。术前 BMI 组的 BMI 变化百分比变化不大（第 1、2 和 3 组分别为 -37.2%、-36.8% 和 -37.7%；P = .8762）。绝对 BMI 单位的变化率因术前 BMI 类别而异（组 × 时间交互作用，P < .0001），第 1、2 和 3 组的 1 年最低 BMI 值分别降至 31 ± 4 kg/m2、38 ± 5 kg/m2 和 47 ± 9 kg/m2。手术一年后，只有 17% 的患者达到非肥胖体重指数 (<30 kg/m2)。无论基线 BMI 等级如何，术后收缩压和舒张压 (P < .0001)、空腹胰岛素 (P < .0001)、总胆固醇 (P = .0007) 和甘油三酯水平 (P < .0001) 均出现显着改善。尽管热量限制和体重减轻，但平均白蛋白水平仍保持正常。腹腔镜胃绕道手术改善或逆转了心血管危险因素，并使所有患者的 BMI 下降了约 37%，无论手术后 1 年的起始 BMI 是多少。青少年极度肥胖症的手术时机是一个重要的考虑因素，因为在 BMI 值最高时“晚”转诊进行减肥手术可能会妨碍肥胖的逆转。
Surgical treatment of extreme obesity may be appropriate for some adolescents. We hypothesized that surgical weight loss outcomes may differ by preoperative level of extreme obesity (body mass index [BMI] ≥99th percentile). A longitudinal assessment of clinical characteristics from 61 adolescents who underwent laparoscopic Roux-en-Y gastric bypass at a single pediatric center from 2002 until 2007 was performed. Patients were categorized into 1 of 3 preoperative BMI groups: group 1, BMI = 40.0 to 54.9 (n = 23); group 2, BMI = 55.0 to 64.9 (n = 21); group 3, BMI = 65.0 to 95.0 (n = 17). Changes in BMI and cardiovascular risk factors between baseline and year 1 were evaluated using repeated-measures mixed linear modeling. BMI in the overall cohort at baseline (60.2 ± 11 kg/m2) decreased by 37.4% at 1 year after surgery (P < .001). Percent BMI change varied little by preoperative BMI groups (−37.2%, −36.8%, and −37.7% for groups 1, 2, and 3 respectively; P = .8762). The rate of change in absolute BMI units significantly varied by preoperative BMI class (group × time interaction, P < .0001), with 1-year nadir BMI values for groups 1, 2, and 3 falling to 31 ± 4 kg/m2, 38 ± 5 kg/m2, and 47 ± 9 kg/m2, respectively. One year after surgery, only 17% of patients achieved a nonobese BMI (<30 kg/m2). Significant improvements in systolic and diastolic blood pressure (P < .0001), fasting insulin (P < .0001), total cholesterol (P = .0007), and triglyceride levels (P < .0001) were seen after surgery irrespective of baseline BMI class. Mean albumin levels remained normal despite significant caloric restriction and weight loss. Laparoscopic gastric bypass resulted in improvement or reversal of cardiovascular risk factors and resulted in a decrease in BMI of approximately 37% in all patients, regardless of starting BMI, 1 year after surgery. The timing of surgery for adolescent extreme obesity is an important consideration, because “late” referral for bariatric surgery at the highest of BMI values may preclude reversal of obesity.
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影响因子：
2.9
作者：
Czupryniak, Leszek;Pawlowski, Maciej;Strzelczyk, Janusz
通讯作者：
Strzelczyk, Janusz
影响因子：
2.9
作者：
Ma, Yunsheng;Pagoto, Sherry L.;Kelly, John J.
通讯作者：
Kelly, John J.
影响因子：
8
作者：
Inge, Thomas H.;Miyano, Go;Dolan, Lawrence M.
通讯作者：
Dolan, Lawrence M.
影响因子：
5.1
作者：
PinhasHamiel, O;Dolan, LM;Zeitler, P
通讯作者：
Zeitler, P
DOI：
10.2106/00004623-199308000-00003
发表时间：
1993-08-01
影响因子：
5.3
作者：
LODER, RT;ARONSON, DD;GREENFIELD, ML
通讯作者：
GREENFIELD, ML