Improvement in BMI z-score following adenotonsillectomy in adolescents aged 12–18 years: a retrospective cohort study

Abstract

Background Characteristics of obstructive sleep apnea (OSA) changes with age. Infants, toddlers and prepubertal children with OSA are usually underweight and may suffer from failure to thrive (FTT). Adenotonsillectomy (T&A) is the first line of treatment for OSA in childhood. In adults OSA is commonly associated with obesity and the metabolic syndrome. The change in body mass index (BMI) in adolescents with OSA following T&A was only sporadically studied. Thus, we peruse to examine the BMI z-score change following T&A in adolescents. Methods Clalit Health Services is the largest health care organization in Israel with the largest patient registry (more than 50% of the population). Two hundred and forty two adolescents aged 12–18 who underwent T&A between 2006 and 2015 were identified in the Clalit registry and their characteristics including height and weight were retrieved. The BMI z-score of these adolescents at baseline (up to 3 months prior to T&A) and during the consecutive 3 years after T&A were analyzed and compared. Results Changes in BMI Z-score were observed to all directions following T&A with overall small increase, not statistically significant (P = 0.26) from a median of 0.79 prior to T&A to a median of 0.835 after it. There was a minimal trend toward BMI z-score reduction in overweight children (n = 74) from 1.508 to 1.48 following T&A (p = NS), and in obese children (n = 33) from 2.288 to 2.000 (P = 0.06, 2 tailed). Interestingly thin individuals (n = 6) increased their BMI z-score following T&A from − 2.4 to − 0.59 (p = 0.046). Conclusions Adolescents show variable changes in their BMI z-score following T&A. In this aspect their BMI z-score change is closer to the change seen in adults treated for OSA and not that of young children. The changes observed show a trend toward normalization of the BMI z-score such that overweight children tend to decrease their BMI z-score while thin individuals tend to increase it.

Impact of OSA treatment success on changes in hypertension and obesity: A retrospective cohort study

“…The non-significant impact of surgical success for pediatric OSA is consistent with the findings of previous retrospective and prospective studies on weight changes in obese children after an adenotonsillectomy, a common surgical option for OSA. Most retrospective studies did not find any significant effect of an adenotonsillectomy on weight gain 13 , BMI 16 , BMI z-score 17 , or BMI range 18 in obese children. One retrospective study that did find a significant effect of adenotonsillectomy on BMI in obese children was limited by a small sample size and only included 7 obese children.…”

Adenotonsillectomy: the good, the bad and the unknown

“…In particular, 10.2% of normal-weight children became overweight, whereas 14.9% of overweight participants became obese and 13.5% became normal-weight. However, a comparison group without adenotonsillectomy was not included to ascertain that these changes could be attributed to adenotonsillectomy [17].…”

Comparable Studies of Financial Bankruptcy Prediction Using Advanced Hybrid Intelligent Classification Models to Provide Early Warning in the Electronics Industry

“…Applying the well-known Altman Z-score model [43][44][45][46][47][48] by financial economist Altman [49] allows observing US bankrupt and non-bankrupt companies using 22 financial ratios and mathematical statistics method to establish the Z-score model with five financial variables. In particular, the approach of the Z-score model is well designed, and this model has been widely applied in various fields, such as for studying obesity risk [43], learning disabilities [44], BMI [45], insolvency risk [46], and coronary artery disease [47].…”

“…Applying the well-known Altman Z-score model [43][44][45][46][47][48] by financial economist Altman [49] allows observing US bankrupt and non-bankrupt companies using 22 financial ratios and mathematical statistics method to establish the Z-score model with five financial variables. In particular, the approach of the Z-score model is well designed, and this model has been widely applied in various fields, such as for studying obesity risk [43], learning disabilities [44], BMI [45], insolvency risk [46], and coronary artery disease [47]. Based on the five main variables required by the Z-score model [48,49], its definition mainly includes 10 financial ratios: working capital, total assets, working capital, statutory surplus reserve, undistributed earnings, earnings before interest and taxes (EBIT), common stock market value at the end of the quarter, total liabilities, and net operating income, and different calculations are given to construct similar regression equations to distinguish functions, so as to confirm whether the company is facing financial bankruptcy.…”