The effects of metabolic and bariatric surgery treatment on adolescent severe obesity:a Meta-analysis
Objective To evaluate systematically the clinical efficacy of three most common surgical interventions on severe obesity in adolescents,namely adjustable gastric banding(AGB),roux-en-y gastric bypass(RYGB),and sleeve gastrectomy(SG),and provide the scientific evidence for the selection of clinical treatment schemes.Methods The computerized search was conducted in databases including China National Knowledge Infrastructure(CNKI),VIP Database for Chinese Technical Periodicals(VIP),WanFang Data,China Biology Medicine disc(CBM),PubMed,Cochrane Library,Web of Science for identifying the studies on metabolic and bariatric surgery(MBS)treatment of severe obesity in adolescents up to April 30,2023.The literature was assessed using the Jadad scale,MINORS scale,and NOS scale.Outcome indicators included body mass index(BMI),morbidity of hypertension,fasting blood glucose,fasting insulin,triglycerides,and high-density lipoprotein cholesterol levels.Meta-analysis was performed using Stata 17.0 software.Results A total of 41 studies meeting the inclusion and exclusion criteria were identify,the total sample size was 2 092 individuals.The results of the meta-analysis showed that a significant reduction of BMI in severe obese adolescents after MBS(MD=13.47).After AGB,RYGB,and SG,BMI reduced significantly(MD values were 11.07,14.24 and 14.93,respectively),P＜0.01.The weight loss effect of SG was significantly better than that of AGB(P＜0.01).The weight loss outcome after MBS in adolescents with preoperative BMI 45.0 to＜50.0 kg/m2 was significantly better than that in adolescents with preoperative BMI 32.5 to＜45.0 kg/m2(t=3.06,P＜0.05).There was no significant difference in weight loss outcomes between the two groups with average following-up times of 10-24 months and＞24 months(F=0.01,P＞0.05).MBS also might reduce the morbidity of hypertension(OR=0.19,95％CI:0.14-0.26)in severe obese adolescents,and decreased fasting blood glucose(MD=-0.50),fasting insulin(MD=-21.30),and triglycerides(MD=-0.53),while increasing high-density lipoprotein cholesterol levels(MD=0.30),P＜0.01.Conclusion MBS can sustainably and effectively reduce BMI in severe obese adolescents,relieve the obesity-related complications.SG surgery is more effective as compared with AGB.It is suggested that severe obese adolescents after meeting the indications of surgery should undergo early operation for getting better metabolic weight loss outcomes.
AdolescentsObesityMetabolic and bariatric surgeryAdjustable gastric bandingRoux-en-y gastric bypassSleeve gastrectomyMeta-analysis
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