Effects of bariatric surgery on glycemic and lipid metabolism, surgical complication and quality of life in adolescents with obesity: a systematic review and meta-analysis

Abstract

Background: Obesity in adolescents is associated with numerous health risks and co-morbidities, including type 2 diabetes and dyslipidemia. Bariatric surgery on adolescents induces weight loss, but little is known about metabolic effects of these operations.

Objective: To explore weight loss and metabolic effects of bariatric surgery on young people.

Setting: A systematic review and meta-analysis. University Hospital, China.

Methods: PubMed and EMBASE were searched for relevant studies up to July 2017. The related studies in adolescents after operation were included.

Results: A total of 49 studies with 3007 patients were included. The average preoperative age ranged from 13.9 to 19.9 years. Roux-en-Y gastric bypass (n = 1216), laparoscopic adjustable gastric banding (n = 1028), and laparoscopic sleeve gastrectomy (n = 665) were the most common bariatric surgeries performed. At the longest follow-up (range, 12-120 mo), bariatric surgery led to an overall 16.43 kg/m² (95% confidence interval [CI]: 14.84-18.01) and 31% (95% CI: 28%-34%) reduction in body mass index. There were significant improvements in glycemic and lipid profiles including glycosylated hemoglobin A1C, fasting blood insulin, fasting blood glucose, total cholesterol, triglyceride, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol, postoperatively at 12 months. The remission rate of dyslipidemia was 55% (95% CI: 34%-76%), 70% (95% CI: 55%-82%), and 95% (95% CI: 80%-100%) at 1, 3, and>5 years after surgery. Roux-en-Y gastric bypass produced better improvements than other surgical procedures.

Conclusion: Bariatric surgery in adolescents may achieve significant weight loss, and glycemic and lipid control. Further well-designed studies with longer follow-up are warranted to provide more reliable evidence.

Keywords: Adolescents with obesity; Bariatric surgery; Glycemic metabolism; Lipid metabolism; Meta-analysis; Remission; Type 2 diabetes.