“Childhood obesity is a major public health issue that has grown in the last 10 years,” said lead researcher Miriam Bredella, Ph.D., professor of radiology at Harvard Medical School in Boston, Massachusetts, and vice president of general hospital radiology at Massachusetts in Boston. “Sleeve gastrectomy is the most common bariatric surgery performed on children and adults.”
In a sleeve gastrectomy, approximately 75% of the stomach is removed to limit food intake and cause weight loss. Resulting in a typically rounded abdomen that takes the form of a tube or sleeve. The number of sleeve gastrectomy procedures performed on adolescents increased 100-fold from 2005 to 2014.
“In adults, bariatric surgery can have long-term effects on bones, leading to a higher risk of fractures,” said Dr Bredella. “We wanted to determine the effects of sleeve gastrectomy performed on adolescents in the crucial years when bone mass is collected.
The study examined 52 adolescents with moderate to severe obesity, 26 of whom underwent sleeve gastrectomy. The other 26 were in the control group. The median age was 17.5 years, and the mean body mass index (BMI) was 45. A BMI of 30 or above is considered obese. Thirty-eight participants in the study were girls. Before and 12 months after sleeve gastrectomy (or without surgery), patients underwent quantitative CT of the lumbar spine to measure the volumetric mineral density in the bones. Quantitative CT is a highly accurate technique for detecting changes in the volumetric mineral density of bones after extreme weight loss.
Recent studies have shown that bone marrow fat responds to dietary changes and can serve as a biomarker for bone quality. Therefore, patients underwent proton MR spectroscopy to measure bone marrow fat in the lumbar spine.
One year after surgery, adolescents who underwent sleeve gastrectomy lost 34 (+/- 13) kg, or 75 (+/- 28) pounds, while there was no significant change in weight in the control group. Compared to controls, patients with sleeve gastrectomy have a significant increase in bone marrow fat and a decrease in lumbar bone density.
“Adolescents who underwent sleeve gastrectomy had bone loss and increased bone marrow fat, despite marked loss of body fat,” said Dr. Bredella. “Although weight loss surgery is successful in losing weight and improving metabolic disorders, it has adverse effects on bones.
Dr Bredella said he was expected to lose bone density after a sleeve gastrectomy, as heavier weights could strengthen bones. In addition to losing bone density, other effects of weight loss surgery include disruption of hormones and nutrients important to bone health.
“We need to identify mechanisms that will help prevent bone loss in these patients and make obese adolescents more aware of bone health,” she said. “Adolescence is a critical time for calculating bone mass, and any process that interferes with calculating bone at this time can have dire consequences later in life.
Co-authors are Vibha Singal, Ph.D., Nazanin Hajir Karzar, Ph.D., Abisayo Animashaun, BS, Amita Boze, B.S. and Madhusmita Misra, M.D.
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