Kamrul-Hasan A B M, Pappachan Joseph M, Nagendra Lakshmi, Ashraf Hamid, Dutta Deep, Bhattacharya Saptarshi, Kapoor Nitin
Department of Endocrinology, Mymensingh Medical College, Mymensingh, Bangladesh.
Faculty of Science, Manchester Metropolitan University, Manchester, UK.
Clin Obes. 2025 Aug;15(4):e70008. doi: 10.1111/cob.70008. Epub 2025 Mar 6.
Data from clinical trials evaluating the effectiveness and safety of metabolic and bariatric surgery (MBS) compared to lifestyle modifications (LSM) in children and adolescents with obesity are scarce. This systematic review and meta-analysis (SRM) sought to fill this knowledge gap. Randomised or non-randomised trials spanning at least one-year involving children and adolescents with severe obesity receiving any form of MBS in the intervention group and LSM for weight loss in the control group were systematically searched through electronic databases. This SRM adhered to the guidelines outlined in the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA checklists. The primary outcome of interest was the change in body weight from the baseline. Five trials (three randomised, open-label and two non-randomised) with 1-2 years follow-up durations were analysed, including 367 participants aged 10-19 years. MBS resulted in greater reductions in body weight (mean difference [MD] -25.83 kg, 95% confidence interval [CI] [-36.91, -14.75], p < .00001) and per cent body weight (MD -24.54%, 95% CI [-33.19, -15.89], p < .00001) compared to LSM. Furthermore, MBS outperformed LSM in reducing body mass index (BMI), BMI z-score, waist circumference, glycated haemoglobin, fasting plasma glucose, insulin resistance, triglycerides, alanine aminotransferase, high sensitivity C-reactive protein and an overall improvement of physical functioning and quality of life. The safety profile was comparable between the two groups; however, data was scarce. Larger, longer-term trials that include multinational and multiethnic representation are essential for making solid clinical practice recommendations regarding MBS for children with obesity.
与生活方式改变（LSM）相比，评估代谢和减重手术（MBS）对肥胖儿童和青少年有效性及安全性的临床试验数据稀缺。本系统评价和荟萃分析（SRM）旨在填补这一知识空白。通过电子数据库系统检索了至少为期一年的随机或非随机试验，试验涉及严重肥胖的儿童和青少年，干预组接受任何形式的MBS，对照组接受LSM以减轻体重。本SRM遵循《Cochrane干预措施系统评价手册》和PRISMA清单中概述的指南。主要关注的结局是体重相对于基线的变化。分析了5项随访时间为1 - 2年的试验（3项随机、开放标签试验和2项非随机试验），包括367名年龄在10 - 19岁的参与者。与LSM相比，MBS导致体重（平均差[MD] -25.83 kg，95%置信区间[CI][-36.91, -14.75]，p <.00001）和体重百分比（MD -24.54%，95% CI [-33.19, -15.89]，p <.00001）有更大幅度的降低。此外，在降低体重指数（BMI）及其z评分、腰围、糖化血红蛋白、空腹血糖、胰岛素抵抗、甘油三酯、丙氨酸氨基转移酶、高敏C反应蛋白以及总体身体功能和生活质量改善方面，MBS优于LSM。两组的安全性概况相当；然而，数据稀缺。纳入多国和多民族代表性的更大规模、长期试验对于就肥胖儿童的MBS制定可靠的临床实践建议至关重要。
