AMOS study (Adolescent Morbidity Obesity Surgery)

Transkript

1 --9 AMOS study (Adolescent Morbidity Obesity Surgery) Inclusion -9 Prospective controlled nonrandomized Stockholm, Gothenburg, Malmö Surgery at Sahlgrenska, Gothenburg Gothenburg Malmö Stockholm Inclusion criteria -8 years age BMI > or > with co-morbidity Failure conservative treatment (> y) Tanner > Exclusion criteria Monogenic obesity Syndromal obesity Obesity secondary to brain injury Severe or uncontrolled psychiatric diseases RYGB adolescents Control adolescents RYGB adults RYGB adolescents Control adolescents RYGB adults Enrolment: Assessed: (n=9) Exclusions: Identified: BORIS registry Identified: SOReg registry Enrolment: Assessed: (n=9) Exclusions: Identified: BORIS registry Identified: SOReg registry Allocation: Included: (n=8) Declined Declined (day of surg) Allocation: Included: (n=8) Declined Declined (day of surg) Intervention: Follow-Up: yr yr Surgery: LRYGB n= Declined Lost Intensive medical: (n=9) Surgery: LRYGB Intervention: Follow-Up: yr yr Surgery: LRYGB n= Declined Lost Intensive medical: (n=9) Surgery: LRYGB yr (n=8) ( oustanding) (n=7) ( surgery) (n=7) ( death, 9 lost) yr (n=8) ( oustanding) (n=7) ( surgery) 8% opererade! (n=7) ( death, 9 lost) yr yr

2 BMI Cell Mean Mean SF- Score --9 Two year results of Swedish GB study in 8 obese adolescents the AMOS study 8 8 (Olberst T et al IJO ) Adol surg Adol contr Adults surg Mean (9% CI) for major biochemical data in 8 adolescents operated with GBP at baseline, and years follow up a), insulin glucos HbA C b) triglycerides LDL HDL * c) 9 Lpk Hs CRP d) 8 7 syst bp diastolic bp, 8 8 BMI Before BMIår year BMIår years, bl yr yr bl yr yr bl yr yr bl yr yr bl yr yr SF- QoL in 8 sdolescents after gastric bypass. PF RP BP GH VT SF RE MH Weight regain during the second year after surgery the AMOS study 8 Estimated postsurgery values are expected means from the linear mixed-effects models; a score of represents worst possible health and represents best possible health. PF = physical functioning; RP = role limitations due to physical health problems; BP = bodily pain; GH = generl health perceptions; VT = vitality; SF = social functioning; RE = role limitations due to emotional problems; MH = general menthal health; SF- = Short Form- Health Survey;

3 --9 Weight regain during the second year after surgery the AMOS study Weight regain during the second year after surgery the AMOS study % weight gain in adolescents >kg weight gain, % in adolescents 7% in adults WR was not associated with: gender, initial weight loss or BMI WR was not associated with: gender, initial weight loss or BMI 9 Weight regain year two 9 Weight loss year two 9 Weight regain year two 9 Weight loss year two 7 kg 7 7 kg 7 Non WR group: Higher BMI (p=.) at baseline Lower BMI (p=.) year post surgery m /f m/f m /f m/f

4 Weight (kg) Number Axelrubrik --9 Psychiatric and neuropsychiatric diagnoses at baseline % 9% 8% 7% % % % % % % % P=... No weight Reg. Weight Regain diagnoses no no diagnoses Metabolic consequences of weight regain after two years Kroppssammansättning (n=8): Non-WR förlorade mer fett (,7kg) än WR (,kg, p<.) år efter operationen Non-WR hade lägre fett procent percentage (,%) än WR (,%) år efter operationen Insulinkänslighet (n=8): Insulinkänsligheten ökade i non-wr gruppen och minskade i WR gruppen under andra året efter operationen Insulinkänsligheten var lägre i WR gruppen år efter operationen (p=,) Weight change, baseline to years, in AMOS, preliminary data Preliminary AMOS year data: Weight loss: n=7 adult gbp adolescent gbp adolescent controls 8 baseline yr yr yr Weight loss in kg

5 Number --9 Preliminary AMOS year data: Weight loss: n=7 8 % failures based on poor weight loss Definitions of surgery failure (Elnahas AI et al ) Total weight loss less than kg BMI > after surgery Weight loss less than % of initial excess weight Weight loss in kg Obesity surgery among young Swedes år år Neovius / Socialstyrelsen --8 Bariatric surgery is now a treatment provided for selected patients from years of age Conclusions (): Gastric Bypass förefaller nästan lika effektivt för ungdomar som för vuxna Behandlingen fungerar väl med måttliga biverkningar God viktnedgång för flertalet patienter Förbättrad metabol hälsa Trots kvarstående psykosociala problem har manga en förbättrad livskvalitet Claude Marcus

6 --9 Conclusions (): Fetmakirurgi är det bästa vi har men inte tillräckligt bra! Bristande effekt av fetmakirurgi är vanligare bland tonåringar -% av tonåringarna har begränsad effekt av kirurgin (dålig viktnedgång sekundär viktuppgång) Sekundär viktuppgångär associerat med sänkt insulinkänslighet Nya kombinationer av fetmakirurgi och beteendestöd behöver testas Kan man förebygga sekundär viktuppgång med beteendestöd? Sambandet mellan psykosociala problem och sekundärviktuppgång tyder på att det inte är ett kirurgiskt/endokrint problem primärt Intensivt beteendestöd efter gastric banding kunde förebygga sekundär viktuppgång (Steffen R et al Obesity Surg 9) KBT behandling av hetsätning förbättrade effekten av gastric bypass (Ashton K et al SOARD ) Claude Marcus Thank You! Claude Marcus