Weight Loss and Health Status 3 Years after Bariatric Surgery in Adolescents.
Weight Loss and Health Status 3 Years after Bariatric Surgery in Adolescents.
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DOI：
10.1056/nejmoa1506699
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发表时间：
2016-01-14
期刊：
影响因子：
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通讯作者：
Teen-LABS Consortium
中科院分区：
文献类型：
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作者：
Inge TH;Courcoulas AP;Jenkins TM;Michalsky MP;Helmrath MA;Brandt ML;Harmon CM;Zeller MH;Chen MK;Xanthakos SA;Horlick M;Buncher CR;Teen-LABS Consortium
减肥手术越来越多地被考虑用于治疗重度肥胖的青少年，但很少有针对青少年的前瞻性研究来检验减肥手术的有效性和安全性，以支持临床决策。
我们前瞻性地招募了美国5个中心的242名接受减肥手术的青少年。接受胃旁路术（161名参与者）或袖状胃切除术（67名）的患者被纳入分析。在手术后的3年里，对体重变化、共存疾病、心脏代谢危险因素、与体重相关的生活质量以及术后并发症进行了评估。
参与者的平均（±标准差）基线年龄为17±1.6岁，平均体重指数（体重千克数除以身高米数的平方）为53；75%的参与者为女性，72%为白人。在手术后3年，整个队列的平均体重下降了27%（95%置信区间[CI]，25% - 29%），接受胃旁路术的参与者体重下降了28%（95%CI，25% - 30%），接受袖状胃切除术的参与者体重下降了26%（95%CI，22% - 30%）。到手术后3年，基线时有2型糖尿病的参与者中95%（95%CI，85% - 100%）病情缓解，肾功能异常缓解率为86%（95%CI，72% - 100%），糖尿病前期缓解率为76%（95%CI，56% - 97%），高血压缓解率为74%（95%CI，64% - 84%），血脂异常缓解率为66%（95%CI，57% - 74%）。与体重相关的生活质量也显著提高。然而，在减肥手术后3年，57%（95%CI，50% - 65%）的参与者出现低铁蛋白血症，13%（95%CI，9% - 18%）的参与者接受了一次或多次额外的腹腔内手术。
在这项针对青少年减肥手术的多中心前瞻性研究中，我们发现手术后3年体重、心脏代谢健康以及与体重相关的生活质量有显著改善。与手术相关的风险包括特定的微量营养素缺乏以及需要额外的腹部手术。（由美国国家糖尿病、消化和肾脏疾病研究所等资助；Teen - LABS ClinicalTrials.gov编号，NCT00474318）
Bariatric surgery is increasingly considered for the treatment of adolescents with severe obesity, but few prospective adolescent-specific studies examining the efficacy and safety of weight-loss surgery are available to support clinical decision making. We prospectively enrolled 242 adolescents undergoing weight-loss surgery at five U.S. centers. Patients undergoing Roux-en-Y gastric bypass (161 participants) or sleeve gastrectomy (67) were included in the analysis. Changes in body weight, coexisting conditions, cardiometabolic risk factors, and weight-related quality of life and postoperative complications were evaluated through 3 years after the procedure. The mean (±SD) baseline age of the participants was 17±1.6 years, and the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 53; 75% of the participants were female, and 72% were white. At 3 years after the procedure, the mean weight had decreased by 27% (95% confidence interval [CI], 25 to 29) in the total cohort, by 28% (95% CI, 25 to 30) among participants who underwent gastric bypass, and by 26% (95% CI, 22 to 30) among those who underwent sleeve gastrectomy. By 3 years after the procedure, remission of type 2 diabetes occurred in 95% (95% CI, 85 to 100) of participants who had had the condition at baseline, remission of abnormal kidney function occurred in 86% (95% CI, 72 to 100), remission of prediabetes in 76% (95% CI, 56 to 97), remission of elevated blood pressure in 74% (95% CI, 64 to 84), and remission of dyslipidemia in 66% (95% CI, 57 to 74). Weight-related quality of life also improved significantly. However, at 3 years after the bariatric procedure, hypoferritinemia was found in 57% (95% CI, 50 to 65) of the participants, and 13% (95% CI, 9 to 18) of the participants had undergone one or more additional intraabdominal procedures. In this multicenter, prospective study of bariatric surgery in adolescents, we found significant improvements in weight, cardiometabolic health, and weight-related quality of life at 3 years after the procedure. Risks associated with surgery included specific micro-nutrient deficiencies and the need for additional abdominal procedures. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; Teen-LABS ClinicalTrials.gov number, NCT00474318.)