Dataset Information

Subclinical kidney injury before and 1 year after bariatric surgery among adolescents with severe obesity.

ABSTRACT: OBJECTIVE:To assess subclinical kidney injury in adolescents with severe obesity by measuring biomarkers of early kidney disease and to assess changes in the levels of these biomarkers following bariatric procedures. METHODS:Twenty-two adolescents undergoing bariatric surgery with no microalbuminuria and normal kidney function were selected. Urinary NGAL, IL-18, and KIM-1 were measured at baseline, 6 and 12 months postoperatively. Biomarker levels were compared to 44 age-gender-matched lean controls. RESULTS:Subjects with obesity had a mean baseline BMI of 48 kg/m(2) that decreased by 34% at 1-year follow-up. Urine NGAL, IL-18, and KIM-1 were significantly elevated in subjects with obesity compared to lean controls at baseline. The obese cohort had a further significant increase in NGAL and KIM-1 at 6 months, followed by decline at 1 year. The overall change in levels of all three biomarkers through 1 year after surgery, however, was not significant compared to baseline. CONCLUSIONS:Adolescent severe obesity is associated with increased urinary excretion of novel biomarkers of kidney injury, despite no microalbuminuria or decreased kidney function. This subclinical kidney injury persists 1 year after significant weight loss induced by bariatric surgery, suggesting that close, long-term follow-up of kidney status is warranted in these adolescents.

SUBMITTER: Xiao N

PROVIDER: S-EPMC4446189 | biostudies-literature | 2015 Jun

REPOSITORIES: biostudies-literature

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Subclinical kidney injury before and 1 year after bariatric surgery among adolescents with severe obesity.

Xiao Nianzhou N Devarajan Prasad P Inge Thomas H TH Jenkins Todd M TM Bennett Michael M Mitsnefes Mark M MM

Obesity (Silver Spring, Md.) 20150509 6

<h4>Objective</h4>To assess subclinical kidney injury in adolescents with severe obesity by measuring biomarkers of early kidney disease and to assess changes in the levels of these biomarkers following bariatric procedures.<h4>Methods</h4>Twenty-two adolescents undergoing bariatric surgery with no microalbuminuria and normal kidney function were selected. Urinary NGAL, IL-18, and KIM-1 were measured at baseline, 6 and 12 months postoperatively. Biomarker levels were compared to 44 age-gender-ma ...[more]

PMID: 25959555

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Project description:Inflammation, oxidative stress and dysregulation of adipokines are thought to be pathophysiological mechanisms linking obesity to the development of insulin resistance and atherosclerosis. In adults, bariatric surgery reduces inflammation and oxidative stress, and beneficially changes the levels of several adipokines, but little is known about the postsurgical changes among adolescents.In two separate longitudinal cohorts we evaluated change from baseline of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), monocyte chemo-attractant protein-1 (MCP-1), oxidized low-density lipoprotein cholesterol (oxLDL), adiponectin, leptin and resistin up to 12 months following elective laparoscopic Roux-en-Y gastric bypass (RYGB) or vertical sleeve gastrectomy (VSG) surgery in adolescents with severe obesity.In cohort 1, which consisted of 39 adolescents (mean age 16.5±1.6 years; 29 females) undergoing either RYGB or VSG, IL-6 (baseline: 2.3±3.4 pg ml(-1) vs 12 months: 0.8±0.6 pg ml(-1), P<0.01), leptin (baseline: 178±224 ng ml(-1) vs 12 months: 41.4±31.9 ng ml(-1), P<0.001) and oxLDL (baseline: 41.6±11.6 U l(-1) vs 12 months: 35.5±11.1 U l(-1), P=0.001) significantly decreased and adiponectin significantly increased (baseline: 5.4±2.4 μg ml(-1) vs 12 months: 13.5±8.9 μg ml(-1), P<0.001). In cohort 2, which consisted of 13 adolescents (mean age 16.5±1.6 years; 10 females) undergoing RYGB, results were similar: IL-6 (baseline: 1.7±0.9 pg ml(-1) vs 12 months: 0.4±0.9 pg ml(-1), P<0.05) and leptin (baseline: 92.9±31.3 ng ml(-1) vs 12 months: 37.3±33.4 ng ml(-1), P<0.001) significantly decreased and adiponectin significantly increased (baseline: 6.1±2.9 μg ml(-1) vs 12 months: 15.4±8.0 μg ml(-1), P<0.001). When the cohorts were combined to evaluate changes at 12 months, oxLDL also significantly decreased (baseline: 39.8±16.7 U l(-1) vs 12 months: 32.7±11.9 U l(-1), P=0.03).Bariatric surgery produced robust improvements in markers of inflammation, oxidative stress and several adipokines among adolescents with severe obesity, suggesting potential reductions in risk for type 2 diabetes and cardiovascular disease.

Project description:BACKGROUND/OBJECTIVES:We hypothesized that physical activity (PA) improves insulin sensitivity in adolescents with severe obesity beyond that attributable to metabolic bariatric surgery (MBS). SUBJECTS/METHODS:StepWatchTM monitors objectively measured PA in 88 participants in the Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study. Primary outcomes included absolute change in fasting insulin, HOMA-IR, and fasting glucose from pre-surgery (baseline) to 6, 12, 24, and 36 months post-MBS. SAS PROC TRAJ generated activity trajectories based on probability and individual participant step count trajectories. Linear regression models were used, adjusted for baseline value, visit, surgical procedure, sex, and percent change in BMI. Additional models adjusted for percent change in iliac waist circumference (IWC) or percent body fat (BF), measured by bio-impedance. RESULTS:Two activity trajectories were identified: more active (MA, n = 13) and less active (LA, n = 75). MA baseline mean daily step count was >6000, increasing to >9000 at 2 years. LA mean daily step count remained at ~4000. Few participants recorded moderate step activity (cadence >80 steps/minute). Still, fasting insulin and HOMA-IR differed in association with activity trajectoy. MA was associated with a greater absolute decrease in fasting insulin (-7.8 ?U/ml [95% CI: (-11.8, -3.7)], p???0.001) and a greater decrease in HOMA-IR (-1.9 [95% CI: (-3.0, -0.7)], p = 0.001), when adjusted for percent change in BMI. The significant independent effect of MA remained when adjusted for percent change in IWC or percent BF. Clinically, 100% of MA trajectory participants normalized fasting insulin, HOMA-IR, and fasting glucose by 6 months and normalization remained throughout the 36 months follow up. In contrast, 76.3 and 65.8% of LA trajectory participants normalized fasting insulin and HOMA-IR, respectively, by 12 months with 28.6% of both remaining normalized at 36 months. CONCLUSIONS:PA is independently associated with improved insulin sensitivity beyond that attributable to MBS in adolescents with severe obesity.

Project description:BackgroundParental underestimation of the severity and risks of their child's obesity and parents' potential implicit weight bias contribute to the reluctance to consider bariatric surgery for their adolescent children with obesity. Despite evidence for safety and efficacy of bariatric surgery in adolescents, pediatric providers may be hesitant or uncomfortable to discuss the benefits and refer patients for surgical evaluation. Understanding these barriers is an essential step toward effective long-term care in this patient population.ObjectivesWe hypothesized that parental views on bariatric surgery are primarily influenced by personal experiences with bariatric surgery, their implicit bias, understanding of health risks of obesity, and counseling by pediatric providers.SettingData were collected and analyzed at an academic medical center in the United States.MethodsAfter a retrospective chart review of 192 adolescents with obesity, a telephone survey of patients' parents was conducted.ResultsParents of 71.4% of patients who received outpatient weight loss counseling had accurate recollection of that event. Only 12.8% of parents who were referred to lifestyle programs successfully enrolled. Neither prior personal exposure to bariatric surgery nor enrollment of the child in a lifestyle program increased parents' likelihood to consider bariatric surgery for their child (P = .10 and .70, respectively). Most parents (84.6%) who were counseled by their pediatric provider about bariatric surgery would consider it, compared with only 34.5% of the parents who did not receive counseling (P < .001).ConclusionsCounseling by pediatric providers, not involvement in lifestyle programs or exposure to bariatric surgery, increased parents' willingness to consider bariatric surgery for their child. Given the current recommendations to incorporate bariatric surgery as a treatment modality in severe adolescent obesity, earlier counseling about the role of surgery by pediatric providers is essential. More detailed provider education on the current state of bariatric surgery in the treatment of severe adolescent obesity is also necessary.

Dataset Information

Subclinical kidney injury before and 1 year after bariatric surgery among adolescents with severe obesity.

Publications

Subclinical kidney injury before and 1 year after bariatric surgery among adolescents with severe obesity.

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