Source:

Inge
TH
,
Courcoulas
AP
,
Jenkins
TM
, et al
.
Five-year outcomes of gastric bypass in adolescents as compared with adults
.
N Engl J Med.
2019
;
380
(
22
):
2136
2145
. doi:
https://doi.org/10.1056/NEJMoa1813909

Investigators from multiple institutions conducted parallel prospective studies to compare long-term outcomes after bariatric surgery for severe obesity in adolescents and adults. Adolescent participants, <19 years old, were enrolled in the Teen-Longitudinal Assessment of Bariatric Surgery (LABS) study at 1 of 5 centers between 2006 and 2012. Teen-LABS used the same design features and data collection forms as the adult LABS study. For the adult LABS study, individuals ≥18 years old were enrolled at 1 of 10 centers between 2006 and 2009. For the current analysis, only adults with a history of a BMI ≥30 at age 18 were included. Roux-en-Y gastric bypass surgery was performed in all study participants, and follow-ups were conducted at least annually for 5 years after enrollment. Data collected on study participants included demographics, weight, and BMI at enrollment and each follow-up; presence of diabetes and hypertension; and levels of micronutrients (up to 2 years after surgery), including ferritin, vitamin D, and vitamin B12. The primary outcomes were changes in weight and presence of diabetes and hypertension at the 5-year follow-up. Secondary outcomes included death and micronutrient status. Differences between those in the adolescent and adult cohorts were assessed with linear mixed and Poisson mixed models after adjusting for confounding variables.

Data were analyzed on 161 adolescents and 396 adults. At enrollment, mean (standard deviation) BMI was 54 (10) in the adolescents and 51 (8) in adults (P<.001). By the 5-year follow-up, the percentage of weight loss was −26% (95% CI, −29% to −23%) in adolescents and −29% (95% CI, −31% to −27%) in adults (P=.08). The prevalence of diabetes and hypertension at enrollment were 14% and 57%, respectively, in adolescents and 31% and 68%, respectively, in adults. By the 5-year follow-up, 86% of the adolescents and 53% of adults with diabetes at baseline had normal glycated hemoglobin levels, defined as <6.5% (relative risk [RR], 1.27; 95% CI, 1.03–1.57). Similarly, among those with hypertension at baseline, 68% of adolescents and 41% of adults no longer had hypertension, defined as systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg, (RR, 1.51; 95% CI, 1.21–1.88). Three adolescents (1.9%) and 7 adults (1.8%) died during the study period. At the 2-year follow-up, 48% of adolescents had low ferritin levels compared to 29% of adults (P=.004), vitamin B12 values were low in 4% of both cohorts, and vitamin D levels were low in 38% of adolescents and 24% of adults (P=.02).

The authors conclude that both adolescents and adults had marked weight loss after gastric bypass surgery, but remission rates for diabetes and hypertension were greater in adolescents than in adults.

Drs Wong and Armstrong have disclosed no financial relationship relevant...

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