ADOLESCENT BARIATRICS ASSESSING HEALTH BENEFITS AND RISKS

青少年肥胖症患者评估健康益处和风险

• 批准号: 8356702
• 负责人: MARY L BRANDT
• 金额: $ 2.1万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-12-01 至 2011-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8356702
• 关键词: Adolescence; Adolescent; Adult; Affect; American; Ancillary Study; Bariatrics; Benefits and Risks; Body Weight decreased; Characteristics; Clinical; Clinical Research; Comorbidity; Data Collection; Eating Behavior; Functional disorder; Funding; Future; Genetic; Goals; Grant; Health; Health Benefit; Hypertriglyceridemia; Hypertrophy; Impairment; Insulin Resistance; Lead; Life; Life Cycle Stages; Liver; Medical; Mental Health; Metabolic; Metabolic Diseases; Morbid Obesity; Myocardial; National Center for Research Resources; National Institute of Diabetes and Digestive and Kidney Diseases; Nutritional; Obesity; Obstructive Sleep Apnea; Operative Surgical Procedures; Outcome; Plasma; Postoperative Period; Principal Investigator; Quality of life; Recruitment Activity; Regimen; Relative (related person); Research; Research Infrastructure; Research Project Grants; Resources; Risk; Safety; Sleep Apnea Syndromes; Source; Teenagers; Time; Tissues; United States National Institutes of Health; Weight; Whole Blood; Youth; age related; bariatric surgery; base; clinical decision-making; cohort; cost; depressive symptoms; experience; indexing; psychosocial

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. Primary support for the subproject and the subproject's principal investigator may have been provided by other sources, including other NIH sources. The Total Cost listed for the subproject likely represents the estimated amount of Center infrastructure utilized by the subproject, not direct funding provided by the NCRR grant to the subproject or subproject staff. ABSTRACT To facilitate and accelerate research in Bariatric Surgery, the National Institute of Diabetes & Digestive, and Kidney Diseases (NIDDK) established the Longitudinal Assessment of Bariatric Surgery consortium (LABS). The LABS research project, as originally conceived, focused only on adult subjects undergoing bariatric surgery. However, an ancillary studies mechanism was also established to support other related research projects. Teen-LABS is one such related project. The primary goal of this observational Teen-LABS study is to collect baseline characteristics and postoperative outcomes of adolescents who are undergoing bariatric surgery in an effort to assess safety and efficacy of bariatric surgery. By mirroring LABS data collection, the Teen-LABS study will also allow us to estimate the relative merits of early surgery compared to delayed surgery for extremely obese youth. This comparison will lead to a better understanding of the plasticity of important medical and psychosocial obesity-related comorbidities. Moreover, this study will provide critical scientific information to inform clinical decision-making regarding appropriate timing of bariatric surgery. I. HYPOTHESIS Severe obesity in adolescence is associated with medical and psychosocial impairments which may be more effectively treated with surgery during adolescence rather than later in adulthood. II. SPECIFIC AIMS Specific Aim 1: To determine whether health significantly differs between adolescents and adults seeking bariatric surgery and thereby determine whether there are potential age-related health benefits in performing bariatric surgery earlier rather than later in the lifetime. Specific Aim 2: To identify early (30 day) and intermediate term (1-2 year) health risks for adolescents and adults undergoing bariatric surgery. Specific Aim 3: To document the psychosocial status of adolescents and adults with extreme obesity before bariatric surgery and 1 and 2 years after surgery. Psychosocial status will be examined in three major domains: depressive symptoms, eating behaviors, and quality of life. Specific Aim 4: To obtain and store biospecimens (serum, plasma, whole blood, and liver tissue) for research related to the aims of this study, and for future use by this consortium and ancillary studies for research into the pathophysiology and genetics of obesity and obesity related issues. III. BACKGROUND AND SIGNIFICANCE Bariatric surgery is effective in treating extreme obesity in adults, and is most commonly used in the 5th decade of life. As more adolescents develop extreme obesity and seek bariatric surgery, our long term goal is to elucidate the health benefits and risks of surgical weight loss for adolescents. Our central hypothesis is that severe obesity in adolescence is associated with medical and psychosocial impairments which may be more effectively treated with surgery during adolescence rather than later in adulthood. This is based on our clinical observations that adolescents undergoing bariatric surgery 1) present with clinically occult manifestations of metabolic disease and have already developed significant health and psychosocial problems which are likely to worsen, 2) lose significant weight following bariatric surgery, and 3) experience significant improvement of a number of serious obesity-related conditions such as insulin resistance, myocardial hypertrophy, hypertriglyceridemia, and obstructive sleep apnea, depressive symptoms, and quality of life. However, compliance by adolescents with prescribed medical regimens may be limited and thus may adversely affect nutritional outcomes of bariatric surgery performed in adolescence. Thus, the purpose of this study is to elucidate for the first time the benefits and define complications for bariatric surgery performed in adolescence compared to the more standard approach of performing bariatric surgery in adulthood. Our Specific Aims are: 1) To determine whether health significantly differs between adolescents and adults seeking bariatric surgery and determine whether there is an age-related health benefit in performing bariatric surgery earlier rather than later in the lifetime; 2) To identify complications to be expected for adolescents and adults undergoing bariatric surgery; 3) To document the psychosocial status of adolescents and adults with extreme obesity before and after bariatric surgery. Adolescents will be recruited from several adolescent bariatric centers and a comparison cohort of adults will be recruited from adult bariatric centers participating in the Longitudinal Assessment of Bariatric Surgery (LABS). By comparison of key anthropometric features, metabolic features, sleep apnea indices, complications, nutritional and psychosocial status, we will begin to understand medical and psychological health outcomes of bariatric surgery using obesity duration as a moderating variable. This information will scientifically inform clinical decision-making regarding appropriate timing of surgery in the life-course of Americans whose health is increasingly threatened by extreme obesity.

这个子项目是利用资源的许多研究子项目之一。 由NIH/NCRR资助的中心拨款提供。对子项目的主要支持 子项目的首席调查员可能是由其他来源提供的， 包括美国国立卫生研究院的其他来源。为子项目列出的总成本可能 表示该子项目使用的中心基础设施的估计数量， 不是由NCRR赠款提供给次级项目或次级项目工作人员的直接资金。 摘要 为了促进和加速减肥外科的研究，美国国家糖尿病、消化和肾脏疾病研究所(NIDDK)成立了减肥外科纵向评估联盟(LABS)。按照最初的设想，实验室的研究项目只关注接受减肥手术的成年受试者。然而，还设立了一个辅助研究机制，以支持其他相关的研究项目。青少年实验室就是这样一个相关的项目。这项观察性青少年实验室研究的主要目标是收集正在接受减肥手术的青少年的基线特征和术后结果，以努力评估减肥手术的安全性和有效性。通过反映实验室收集的数据，青少年实验室的研究还将使我们能够评估对于极度肥胖的年轻人来说，早期手术与延迟手术相比的相对优点。这种比较将有助于更好地理解与肥胖相关的重要医学和心理社会并发症的可塑性。此外，这项研究将提供关键的科学信息，为临床决策提供适当的减肥手术时机。 一、假说 青春期的严重肥胖与医学和心理社会障碍有关，青春期的手术治疗可能比成年后的手术更有效。 二、具体目标 具体目标1：确定寻求减肥手术的青少年和成年人之间的健康是否有显着差异，从而确定在一生中较早而不是较晚进行减肥手术是否有潜在的与年龄相关的健康益处。 具体目标2：确定接受减肥手术的青少年和成人的早期(30天)和中期(1-2年)健康风险。 具体目标3：记录青少年和成人极端肥胖患者在减肥手术前以及手术后1年和2年的心理社会状况。心理社会状况将在三个主要领域进行检查：抑郁症状、饮食行为和生活质量。 具体目标4：获取和存储生物标本(血清、血浆、全血和肝组织)，用于与本研究目标相关的研究，并供该联盟和辅助研究将来用于肥胖和肥胖相关问题的病理生理学和遗传学研究。 三、背景和意义 减肥手术在治疗成人极端肥胖方面是有效的，并且在人生的第五个十年中最常用。随着越来越多的青少年发展为极端肥胖并寻求减肥手术，我们的长期目标是阐明手术减肥对青少年的健康益处和风险。我们的中心假设是，青春期的严重肥胖与医学和心理社会障碍有关，而青春期的手术治疗可能比成年后的手术更有效。这基于我们的临床观察，接受减肥手术的青少年1)出现临床上隐蔽的代谢性疾病表现，并已出现严重的健康和心理社会问题，可能会恶化，2)减肥手术后体重显著减轻，3)一些与肥胖相关的严重状况显著改善，如胰岛素抵抗、心肌肥厚、高甘油三酯血症、阻塞性睡眠呼吸暂停、抑郁症状和生活质量。然而，青少年对处方医疗方案的依从性可能是有限的，因此可能对青春期进行的减肥手术的营养结果产生不利影响。因此，这项研究的目的是首次阐明在青春期进行减肥手术与在成年进行更标准的减肥手术相比的益处和并发症。我们的具体目标是：1)确定寻求减肥手术的青少年和成人之间的健康是否存在显著差异，并确定在一生中较早而不是较晚地进行减肥手术是否有与年龄相关的健康益处；2)确定接受减肥手术的青少年和成年人可能出现的并发症；3)记录极端肥胖的青少年和成年人在减肥手术前后的心理社会状况。青少年将从几个青少年减肥中心招募，成人对照队列将从参与减肥手术纵向评估(实验室)的成人减肥中心招募。通过比较主要人体测量学特征、代谢特征、睡眠呼吸暂停指数、并发症、营养和心理社会状况，我们将开始了解以肥胖持续时间为调节变量的减肥手术的医疗和心理健康结果。这些信息将为临床决策提供科学依据，为那些健康日益受到极端肥胖威胁的美国人的生命过程中适当的手术时机提供信息。