ADOLESCENT BARIATRICS ASSESSING HEALTH BENEFITS AND RISKS

这个子项目是许多利用资源的研究子项目之一 由NIH/NCRR资助的中心拨款提供。次级项目的主要支助 子项目的主要研究者可能是由其他来源提供的， 包括其它NIH来源。 为子项目列出的总成本可能 表示子项目使用的中心基础设施的估计数量， NCRR赠款不直接向子项目或子项目工作人员提供资金。 摘要 为了促进和加速减肥手术的研究，国家糖尿病与消化和肾脏疾病研究所（NIDDK）建立了减肥手术联盟（LABS）的纵向评估。LABS研究项目，按照最初的设想，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。Teen-LABS就是这样一个相关项目。这项观察性Teen-LABS研究的主要目的是收集正在接受减肥手术的青少年的基线特征和术后结局，以评估减肥手术的安全性和有效性。通过镜像LABS数据收集，Teen-LABS研究还将使我们能够估计与延迟手术相比，极端肥胖青年早期手术的相对优点。这种比较将导致更好地了解重要的医学和心理社会肥胖相关的合并症的可塑性。此外，这项研究将提供关键的科学信息，告知临床决策有关减肥手术的适当时机。 I. 假设 青春期严重肥胖与医疗和心理社会障碍有关，在青春期手术治疗可能比成年后更有效。 二. 具体目标 具体目标1：确定寻求减肥手术的青少年和成人之间的健康是否存在显著差异，从而确定在一生中早期而不是晚期进行减肥手术是否有潜在的年龄相关健康益处。 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：记录减肥手术前和手术后1年和2年极度肥胖的青少年和成人的心理社会状况。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：获取并储存生物标本（血清、血浆、全血和肝组织），用于与本研究目的相关的研究，并供本联盟和辅助研究将来用于研究肥胖症的病理生理学和遗传学以及肥胖症相关问题。 三. 背景和意义 减肥手术是治疗成人极度肥胖的有效方法，最常用于50岁以上的人群。随着越来越多的青少年发展为极度肥胖并寻求减肥手术，我们的长期目标是阐明青少年手术减肥的健康益处和风险。我们的中心假设是，青春期的严重肥胖与医疗和心理社会障碍有关，在青春期手术治疗可能比成年后更有效。这是基于我们的临床观察，即接受减肥手术的青少年1）表现出代谢疾病的临床隐匿表现，并且已经发展出可能恶化的显著健康和心理社会问题，2）减肥手术后体重显著减轻，以及3）许多严重肥胖相关疾病（如胰岛素抵抗，心肌肥大，高血压和阻塞性睡眠呼吸暂停、抑郁症状和生活质量。然而，青少年对处方药物治疗方案的依从性可能有限，因此可能会对青少年减肥手术的营养结果产生不利影响。因此，本研究的目的是首次阐明在青春期进行减肥手术的好处，并定义并发症相比，在成年期进行减肥手术的更标准的方法。我们的具体目标是：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著差异，并确定在一生中早期而不是晚期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预期的并发症; 3）记录肥胖症青少年和成人在减肥手术前后的心理社会状况。将从几个青少年肥胖治疗中心招募青少年，并从参与减肥手术纵向评估（LABS）的成人肥胖治疗中心招募成人对照队列。通过比较关键的人体测量特征、代谢特征、睡眠呼吸暂停指数、并发症、营养和心理社会状况，我们将开始了解使用肥胖持续时间作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，这些决策涉及美国人生命过程中的适当手术时机，这些美国人的健康日益受到极端肥胖的威胁。

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.