Gastric bypass in adolescents shows greater benefits in diabetes and hypertension remission than the surgery does in adults.
Many previous studies have discussed the health benefits of gastric bypass surgery. An Adams et al study, “Health benefits of gastric bypass surgery after 6 years,” has examined the association of bypass surgery with weight loss, diabetes mellitus and other health risks, 6 years after surgery. The results concluded that surgery was associated with higher rates of diabetes remission and lower risk of cardiovascular outcomes over 6 years.
The benefits of bypass surgeries in people with obesity are well defined. What was previously unclear was whether the health improvement outcomes differ according to the age of the patient at the time of surgery. Some evidence suggests that adults seeking gastric bypass who have severe obesity, and have had it from adolescence to adulthood, are more likely to present with diabetes, hypertension, and many other health implications, more than those adults seeking gastric bypass who did not have obesity during adolescence. Thus, should adolescents with excess weight seeking gastric bypass wait until adulthood? Or should the surgery be performed at a younger age to increase the likelihood of remission of diabetes and other coexisting conditions? A very recently published article (May 2019) by Inge et al, compares five-year outcomes of gastric bypass in adolescents compared with adults.
The study evaluated health effects of Roux-en-Y gastric bypass in 2 cohorts: one which consisted of 161 adolescents enrolled from 2006 through 2012, and the second a cohort of 396 adults enrolled from 2006 through 2009 (adults also categorized their body weight at age 18, which helped with the selection of adults with a BMI of 30 or more at age 18). Outcomes were compared with regard to weight and coexisting conditions between the cohorts 5 years after surgery.
Five years after surgery, no significant difference was found in the mean percent weight change between adults and adolescents ([-26%; 95% CI, -29 to -23] vs. [-29%; 95% CI, -31 to -27] P=0.08); 60% of adolescents and 76% of adults maintained a weight reduction of at least 20% (P=0.02), 4% of adolescents and 1% of adults maintained a weight reduction <5% (P=0.005), and 4% of adolescent and 1% of adults exceeded their baseline weight 5 years after surgery.
There was no significant difference found between groups in terms of improvements in LDL, HDL, and TG levels over the 5-year period. The prevalence of diabetes at baseline was 14% and 31% in adolescents and adults respectively and declined in both groups by year 1. By 5 years after surgery, the prevalence of diabetes in adolescents was 2% and 12% among adults. In addition to that, by year 5, the percentage of adolescents receiving diabetes medications reduced from 88% (before surgery) to zero. In contrast, in adults, 79% receiving diabetes medications before surgery decreased to 26% after surgery. Furthermore, 86% of adolescents and 53% of adults had remission of diabetes 5 years after surgery. In adjusted analysis, adolescents were 27% more likely than adults to have remission of diabetes after the surgery. In addition, the study findings reported that adolescents were more likely to achieve glycemic control irrespective of medication use after surgery.
Benefits of hypertension reduction were also observed to be higher in adolescents vs. adults, where 57% of adolescents before surgery receiving antihypertensive medications were decreased to 11%, compared with 68% of adults receiving antihypertensive medications before surgery, reduced to 33% of adults by year 5. Among participants with hypertension at baseline, 68% of adolescents and 41% of adults were in remission by year 5. In adjusted analysis, adolescents were 51% more likely to have remission of hypertension compared to adults.1.9% of adolescents and 1.8% of adults died in the 5 years after surgery; abdominal reoperations were found to be higher in adolescents vs. adults (19 vs 10 reoperations/500 person-years), and more adolescents had low ferritin levels (48% vs. 29%).
In a nutshell, weight loss benefits were found to be similar in both adolescents’ and adults’ cohorts. Adolescents were more likely to have remission of both diabetes and hypertension with an increase in risk for abdominal reoperations and short-term nutritional deficiencies by year 5 after surgery, with a similar rate of deaths.
- Study findings report that adolescents were 27% more likely than adults to have remission of diabetes after the surgery.
- Adolescents were 51% more likely to have remission of hypertension compared to adults.
- Weight loss benefits were similar in both cohorts; however, abdominal reoperations and risk of low ferritin levels were higher in adolescents compared with adults.
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;380:2136-45. DOI: 10.1056/NEJMoa1813909
Adams TD, Davidson LE, Litwin SE, et al. Health benefits of gastric bypass surgery after 6 years. JAMA. 2012 Sep 19;308(11):1122-31
Marian Ayad, BSPharm, BCPS, PharmD candidate, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences