Department of Pediatrics, Center for Pediatric Obesity Medicine, University of Minnesota Medical School, University of Minnesota, Minneapolis, Minnesota, USA.
College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.
Obesity (Silver Spring). 2020 Mar;28(3):616-623. doi: 10.1002/oby.22725. Epub 2020 Feb 5.
Quantifying risk for cardiovascular disease (CVD) events among adolescents is difficult owing to the long latent period between risk factor development and disease outcomes. This study examined the 30-year CVD event risk among adolescents with severe obesity treated with and without metabolic and bariatric surgery (MBS), compared with youths with moderate obesity, overweight, or normal weight.
Cross-sectional and longitudinal comparisons of five frequency-matched (age and diabetes status) groups were performed: normal weight (n = 247), overweight (n = 54), obesity (n = 131), severe obesity without MBS (n = 302), and severe obesity undergoing MBS (n = 215). A 30-year CVD event score developed by the Framingham Heart Study was the primary outcome. Data are mean (SD) with differences between time points for MBS examined using linear mixed models.
Preoperatively, the likelihood of CVD events was higher among adolescents undergoing MBS (7.9% [6.7%]) compared with adolescents with severe obesity not referred for MBS (5.5% [4.0%]), obesity (3.9% [3.0%]), overweight (3.1% [2.4%]), and normal weight (1.8% [0.8%]; all P < 0.001). At 1 year after MBS, event risk was significantly reduced (7.9% [6.7%] to 4.0% [3.4%], P < 0.0001) and was sustained for up to 5 years after MBS (P < 0.0001, all years vs. baseline).
Adolescents with severe obesity are at elevated risk for future CVD events. Following MBS, the predicted risk of CVD events was substantially and sustainably reduced.
由于风险因素的发展与疾病结果之间存在较长的潜伏期，因此青少年心血管疾病（CVD）事件的风险难以量化。本研究比较了接受和未接受代谢和减重手术（MBS）治疗的严重肥胖青少年与超重、肥胖和正常体重青少年之间的 30 年 CVD 事件风险。
对五个频率匹配（年龄和糖尿病状态）组进行了横断面和纵向比较：正常体重（n=247）、超重（n=54）、肥胖（n=131）、无 MBS 的严重肥胖（n=302）和接受 MBS 的严重肥胖（n=215）。弗雷明汉心脏研究开发的 30 年 CVD 事件评分是主要结果。数据为平均值（标准差），使用线性混合模型比较 MBS 前后的时间点差异。
术前，接受 MBS 的青少年（7.9%[6.7%]）CVD 事件的可能性高于未被推荐接受 MBS 的严重肥胖青少年（5.5%[4.0%]）、肥胖青少年（3.9%[3.0%]）、超重青少年（3.1%[2.4%]）和正常体重青少年（1.8%[0.8%]；所有 P<0.001）。MBS 后 1 年，风险显著降低（7.9%[6.7%]至 4.0%[3.4%]，P<0.0001），并且在 MBS 后长达 5 年内持续降低（P<0.0001，所有年份与基线相比）。
严重肥胖的青少年未来发生 CVD 事件的风险较高。接受 MBS 后，CVD 事件的预测风险显著降低且持续降低。
