Reversal of Type 2 Diabetes Mellitus and Improvements in Cardiovascular Risk Factors After Surgical Weight Loss in Adolescents

Inge, Thomas H.; Miyano, Go; Bean, Judy A.; Helmrath, Michael A.; Courcoulas, Anita P.; Harmon, Carroll M.; Chen, Mike K.; Wilson, Kimberly; Daniels, Stephen R.; Garcia, Victor F.; Brandt, Mary L.; Dolan, Lawrence M.

doi:10.1542/peds.2008-0522

Cited by 176 publications

(109 citation statements)

References 50 publications

(49 reference statements)

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“…However, the optimal age in adolescence for bariatric surgery is as yet undetermined [24] . Our findings, and those of others [26,27] indicate that bariatric surgery before adulthood can substantially reduce weight [10,25] and resolve comorbidities [25] . Moreover, earlier treatment of obesity may prevent later costs.…”

Section: Discussionsupporting

confidence: 83%

Effect of ethnicity on weight loss among adolescents 1 year after bariatric surgery

Messiah¹,

Lopez-Mitnik²,

Winegar³

et al. 2013

WJD

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AIM:To investigate whether or not bariatric surgery weight outcomes vary by ethnicity in a large, nationally representative sample of adolescents. METHODS:The Bariatric Outcomes Longitudinal Database was used for analysis and contains data on surgeries performed on adolescents from 2004 to 2010 from 423 surgeons at 360 facilities across the United States Adolescents (n = 827) between 11 and 19 years old who underwent either gastric bypass or adjustable gastric banding surgery were included in the analysis. Outcome measures included changes in anthropometric measurements [weight (kg) and body mass index] from baseline to 3 (n = 739), 6 (n = 512), and 12 (n = 247) mo after surgery. RESULTS:A year after patients underwent either gastric bypass (51%) or adjustable gastric banding (49%) surgery, mean estimated weight loss for all ethnic groups differed by a maximum of only 1.5 kg, being 34.3 kg (95%CI: 30.0-38.5 kg) for Hispanics, 33.8 kg (95%CI: 27.3-40.3 kg) for non-Hispanic blacks, and 32.8 kg (95%CI: 30.9-34.7 kg) for non-Hispanic whites. No overall pairwise group comparisons were significant, indicating that no ethnic group had better weight loss outcomes than did another. CONCLUSION:Bariatric surgery substantially reduces the weight of severely obese adolescents at 1 year post-procedure with little variation by ethnicity and/or gender. These results suggest that bariatric surgery is a safe and reasonable treatment for all severely obese adolescents with the appropriate indications. treatments for severe obesity. Among adults, outcomes of bariatric surgery differ by ethnicity. We tested whether this relationship is also true among adolescents. Outcome measures included changes in anthropometric measurements (weight and body mass index) from baseline (n = 827) to 1 year after surgery. Our results support the conclusion that bariatric surgery can substantially reduce weight in severely obese adolescents for at least 1 year, irrespective of their race or ethnicity. Ethnicity is a reasonable and safe treatment for all severely obese adolescents with the appropriate indications.

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Section: Discussionsupporting

confidence: 83%

Effect of ethnicity on weight loss among adolescents 1 year after bariatric surgery

Messiah¹,

Lopez-Mitnik²,

Winegar³

et al. 2013

WJD

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“…Bariatric surgery may be a feasible alternative, with one study demonstrating reversal of type 2 diabetes in ten of 11 adolescents [37]. However, our study demonstrates that, if adhered to, a VLED may be as effective and possibly safer for youth, in whom the long-term effects of bariatric surgery, both physical and mental, are largely unknown [38].…”

Section: Discussionmentioning

confidence: 77%

Reversal of type 2 diabetes in youth who adhere to a very-low-energy diet: a pilot study

et al. 2016

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Aims/hypothesis The aim of the study was to investigate whether a very-low-energy diet (VLED) is a feasible and acceptable treatment option for type 2 diabetes in children and adolescents, and whether adherence can lead to rapid weight loss, reversal of type 2 diabetes and reduced liver fat as seen in adult studies. Methods Eight participants with type 2 diabetes and obesity, aged 7-16 years, non-medicated (n = 1) or treated with metformin (n = 7) and in some cases insulin (n = 3), followed a VLED (<3360 kJ/day) for 8 weeks, then transitioned to a hypocaloric diet (∼6300 kJ/day) that they followed to 34 weeks. HbA 1c , fasting glucose and 2 h post-glucose load plasma glucose (2hG) were determined from fasting blood and an OGTT. Liver fat concentration was quantified using proton magnetic resonance spectroscopy. Adherence was defined as ≥5% weight loss during the 8 week VLED. Results Adherers (n = 5) and non-adherers (n = 3) had median weight loss of 7.5% and 0.5%, respectively, at 8 weeks. Only three out of eight participants met non-alcoholic fatty liver disease (NAFLD) criteria (≥5.5%) at 8 weeks, compared with eight out of eight at baseline. The three participants on insulin therapy at baseline were able to cease therapy during the 8 week VLED. At 34 weeks, adherers (n = 5) achieved 12.3% weight loss, none met NAFLD criteria and four did not meet American Diabetes Association criteria for type 2 diabetes.

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“…In a meta-analysis done by Black and colleagues, there was a significant change in the BMI at one year following bariatric surgery with the largest reduction in BMI noticed with RYGB (72). There is some evidence to suggest that bariatric surgery can lead to resolution of associated co-morbidities such as sleep apnea, type 2 diabetes and other cardiovascular risk factors (77,78). Bariatric surgery has also been reported to improve insulin sensitivity and secretion (79).…”

Section: Bariatric Surgerymentioning

confidence: 99%

Metabolic syndrome in children and adolescents

2017

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Prevalence of metabolic syndrome in children and adolescents is increasing, in parallel with the increasing trends in obesity rates. Varying definitions of this syndrome have hindered the development of a consensus for the diagnostic criteria in the pediatric population. While pathogenesis of metabolic syndrome is not completely understood, insulin resistance and subsequent inflammation are thought to be among its main mechanistic underpinnings. Overweight and obesity are cardinal features, along with abnormal glucose metabolism, dyslipidemia, and hypertension. Other disorders associated with metabolic syndrome include fatty liver, polycystic ovarian syndrome (PCOS), and pro-inflammatory states. Prevention and management of this condition can be accomplished with lifestyle modifications, behavioral interventions, pharmacological and surgical interventions as needed.

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Reversal of Type 2 Diabetes Mellitus and Improvements in Cardiovascular Risk Factors After Surgical Weight Loss in Adolescents

Cited by 176 publications

References 50 publications

Effect of ethnicity on weight loss among adolescents 1 year after bariatric surgery

Effect of ethnicity on weight loss among adolescents 1 year after bariatric surgery

Reversal of type 2 diabetes in youth who adhere to a very-low-energy diet: a pilot study

Metabolic syndrome in children and adolescents

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