Effect of laparoscopic adjustable gastric banding on modifiable cardiovascular risk factors in extremely obese adolescents.
ABSTRACT Recently, surgical intervention has gained increasing support in adolescents with extreme obesity. This study summarizes the analysis into the effect of laparoscopic adjustable gastric bands (LAGB) on cardiovascular risk factors in 14 extremely obese Portuguese adolescent patients. Data collected both pre- and postoperatively included age, gender, body mass index (BMI), percentage of excess weight loss, cardiovascular risk factors, and cardiovascular outcomes. Ten girls and four boys aged from 13.5 to 17.5 years underwent LABG. The mean preoperative weight and BMI were 127.4 kg and 46.1 kg/m(2), respectively. The average percentage of weight loss calculated was 32 % at 1 year, 38.8 % at 2 years, and 48.1 % at 3 years of follow-up. Simultaneously, blood pressure and insulin resistance index returned to normal, and there was an increase in high-density lipoprotein levels, 3 years after the LABG was fitted. LABG fitting is a safe and effective treatment strategy for the improvement of cardiovascular status following weight loss.
Article: Surgical treatment of obesity.[show abstract] [hide abstract]
ABSTRACT: More than half of the European population are overweight (body mass index (BMI) > 25 and < 30 kg/m2) and up to 30% are obese (BMI > or = 30 kg/m2). Being overweight and obesity are becoming endemic, particularly because of increasing nourishment and a decrease in physical exercise. Insulin resistance, type 2 diabetes, dyslipidemia, hypertension, cholelithiasis, certain forms of cancer, steatosis hepatis, gastroesophageal reflux, obstructive sleep apnea, degenerative joint disease, gout, lower back pain, and polycystic ovary syndrome are all associated with overweight and obesity. The endemic extent of overweight and obesity with its associated comorbidities has led to the development of therapies aimed at weight loss. The long-term effects of diet, exercise, and medical therapy on weight are relatively poor. With respect to durable weight reduction, bariatric surgery is the most effective long-term treatment for obesity with the greatest chances for amelioration and even resolution of obesity-associated complications. Recent evidence shows that bariatric surgery for severe obesity is associated with decreased overall mortality. However, serious complications can occur and therefore a careful selection of patients is of utmost importance. Bariatric surgery should at least be considered for all patients with a BMI of more than 40 kg/m2 and for those with a BMI of more than 35 kg/m2 with concomitant obesity-related conditions after failure of conventional treatment. The importance of weight loss and results of conventional treatment will be discussed first. Currently used operative treatments for obesity and their effectiveness and complications are described. Proposed criteria for bariatric surgery are given. Also, some attention is devoted to more basic insights that bariatric surgery has provided. Finally we deal with unsolved questions and future directions for research.European Journal of Endocrinology 03/2008; 158(2):135-45. · 3.14 Impact Factor
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ABSTRACT: Childhood obesity has contributed to an increased incidence of type 2 diabetes mellitus and metabolic syndrome (MS) among children. Intrauterine exposure to diabetes and size at birth are risk factors for type 2 diabetes mellitus, but their association with MS in childhood has not been demonstrated. We examined the development of MS among large-for-gestational-age (LGA) and appropriate-for-gestational age (AGA) children. The major components of MS (obesity, hypertension, dyslipidemia, and glucose intolerance) were evaluated in a longitudinal cohort study of children at age 6, 7, 9, and 11 years who were LGA (n = 84) or AGA (n = 95) offspring of mothers with or without gestational diabetes mellitus (GDM). The cohort consisted of 4 groups, ie, LGA offspring of control mothers, LGA offspring of mothers with GDM, AGA offspring of control mothers, and AGA offspring of mothers with GDM. Biometric and anthropometric measurements were obtained at 6, 7, 9, and 11 years. Biochemical testing included measurements of postprandial glucose and insulin levels and high-density lipoprotein (HDL) cholesterol levels at 6 and 7 years and of fasting glucose, insulin, triglyceride, and HDL cholesterol levels at 9 and 11 years. We defined the components of MS as (1) obesity (BMI >85th percentile for age), (2) diastolic or systolic blood pressure >95th percentile for age, (3) postprandial glucose level >140 mg/dL or fasting glucose level >110 mg/dL, (4) triglyceride level >95th percentile for age, and (5) HDL level <5th percentile for age. There were no differences in baseline characteristics (gender, race, socioeconomic status, and maternal weight gain during pregnancy) for the 4 groups except for birth weight, but there was a trend toward a higher prevalence of maternal obesity before pregnancy in the LGA/GDM group. Obesity (BMI >85th percentile) at 11 years was present in 25% to 35% of the children, but rates were not different between LGA and AGA offspring. There was a trend toward a higher incidence of insulin resistance, defined as a fasting glucose/insulin ratio of <7, in the LGA/GDM group at 11 years. Analysis of insulin resistance at 11 years in a multivariate logistic regression revealed that childhood obesity and the combination of LGA status and maternal GDM were associated with insulin resistance, with odds ratios of 4.3 (95% confidence interval [CI]: 1.5-11.9) and 10.4 (95% CI: 1.5-74.4), respectively. The prevalence at any time of > or =2 components of MS was 50% for the LGA/GDM group, which was significantly higher than values for the LGA/control group (29%), AGA/GDM group (21%), and AGA/control group (18%). The prevalence of > or =3 components of MS at age 11 was 15% for the LGA/GDM group, compared with 3.0% to 5.3% for the other groups. Cox regression analysis was performed to determine the independent hazard (risk) of developing MS attributable to birth weight, gender, maternal prepregnancy obesity, and GDM. For Cox analyses, we defined MS as > or =2 of the following 4 components: obesity, hypertension (systolic or diastolic), glucose intolerance, and dyslipidemia (elevated triglyceride levels or low HDL levels). LGA status and maternal obesity increased the risk of MS approximately twofold, with hazard ratios of 2.19 (95% CI: 1.25-3.82) and 1.81 (95% CI: 1.03-3.19), respectively. GDM and gender were not independently significant. To determine the cumulative hazard of developing MS with time, we plotted the risk according to LGA or AGA category for the control and GDM groups from 6 years to 11 years, with Cox regression analyses. The risk of developing MS with time was not significantly different between LGA and AGA offspring in the control group but was significantly different between LGA and AGA offspring in the GDM group, with a 3.6-fold greater risk among LGA children by 11 years. We showed that LGA offspring of diabetic mothers were at significant risk of developing MS in childhood. The prevalence of MS in the other groups was similar to the prevalence (4.8%) among white adolescents in the 1988-1994 National Health and Nutrition Examination Survey. This effect of LGA with maternal GDM on childhood MS was previously demonstrated for Pima Indian children but not the general population. We also found that children exposed to maternal obesity were at increased risk of developing MS, which suggests that obese mothers who do not fulfill the clinical criteria for GDM may still have metabolic factors that affect fetal growth and postnatal outcomes. Children who are LGA at birth and exposed to an intrauterine environment of either diabetes or maternal obesity are at increased risk of developing MS. Given the increased obesity prevalence, these findings have implications for perpetuating the cycle of obesity, insulin resistance, and their consequences in subsequent generations.PEDIATRICS 04/2005; 115(3):e290-6. · 4.47 Impact Factor
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ABSTRACT: To identify risk factors for overweight and obesity in Portuguese children. A cross-sectional study of children 7 to 9.5 y old was performed between October 2002 and June 2003. A total of 2,274 girls and 2,237 boys were observed. Weight and height were measured, and parents filled out a questionnaire about family characteristics. Overweight and obesity, using age- and sex-specific body mass index (BMI) cut-off points as defined by the International Obesity Taskforce, were used. After adjustment for age and sex, the odds ratio for childhood obesity increased by television viewing (reference 0-2 h; 2-3 h: 1.51; 3-4 h: 1.72; 4 h: 1.63), paternal obesity (reference <18.5 kg/m(2); 25.0-29.9: 3.06; 30.0: 7.09), maternal obesity (reference <18.5 kg/m(2); 25.0-29.9: 9.06; 30.0: 18.13) and birthweight (reference <2,500 g; 2,500-3,000 g: 1.55; 3,000-3,500 g: 1.87; 3,500-4,000 g: 2.13; 4,000 g: 2.74), and decreased by sleeping duration (reference 8 h/d; 9-10 h/d: 0.44; 11 h/d: 0.39), paternal education (reference primary school; secondary: 0.91; university: 0.42), maternal education (reference primary school; secondary: 1.13; university: 0.56), being a single child (reference yes; no: 0.56) and family size (reference one child; two children: 0.59; three children: 0.44; more than four children: 0.37). Our data support the perspective that education about energy intake and energy expenditure should be used much earlier in those families with high-risk children, namely those with high parental BMI or high birthweight. Protective factors were parental education and family size.Acta Paediatrica 11/2005; 94(11):1550-7. · 1.97 Impact Factor