title: Patterns of surgical weight loss and resolution of metabolic abnormalities in superobese bariatric adolescents.
abstract: OBJECTIVE
  The aim of the study was to compare the baseline and the 18-month follow-up for weight and metabolic characteristics of superobese (SO) (body mass index [BMI] ≥50 kg/m(2)) and morbidly obese (MO) (BMI <50 kg/m(2)) adolescents who participated in a prospective longitudinal study of gastric banding delivered in an adolescent multidisciplinary treatment program.
  
  
  METHODS
  Clinical information was extracted from an institutional review board-approved database of bariatric adolescents. Fasting cytokine and acute phase protein serum levels were analyzed by enzyme-linked immunosorbent assay. Liver histopathologies were assessed using the Kleiner's classification score.
  
  
  RESULTS
  Other than BMI, MO (n = 11) and SO (n = 7) patients have similar degree of insulin resistance, dyslipidemia, and nonalcoholic fatty liver disease. Serum C-reactive protein (10.2 ± 5.6 SO vs 4 ± 3.9 μg/mL MO [P < .02]) and leptin (71 ± 31 SO vs 45 ± 28 MO ng/mL [P = .04]) were more elevated in SO patients. Although weight loss is similar (30 ± 19 kg MO vs 28 ± 12 kg SO, P = .8 at 18 months; mean percent change in BMI, 22.8% ± 11.6% vs 20.5% ± 10.3% SO, P = .2), SO patients has less resolution of insulin resistance and dyslipidemia but experienced significantly improved health-related quality of life.
  
  
  CONCLUSIONS
  The SO adolescents demonstrate equivalent short-term weight loss and improved quality of life but delayed metabolic response to a gastric banding-based weight loss treatment program compared with MO patients, illustrating the importance of early referral for timely intervention of MO patients.
authors.affiliation: Department of Surgery/Division of Pediatric Surgery, University of Illinois College of Medicine at Peoria, Peoria, IL 61603. aixuan.l.holterman@osfhealthcare.org
authors.forename: Ai-Xuan L
authors.initials: AX
authors.lastname: Holterman
authors.forename: Mark
authors.initials: M
authors.lastname: Holterman
authors.forename: Allen
authors.initials: A
authors.lastname: Browne
authors.forename: Steve
authors.initials: S
authors.lastname: Henriques
authors.forename: Grace
authors.initials: G
authors.lastname: Guzman
authors.forename: Giamila
authors.initials: G
authors.lastname: Fantuzzi
mesh_terms: D000209:Acute-Phase Proteins / Q000378:metabolism; D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D016207:Cytokines / Q000097:blood; D050171:Dyslipidemias / Q000150:complications; D004797:Enzyme-Linked Immunosorbent Assay; D005234:Fatty Liver / Q000150:complications; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000379:methods; D006801:Humans; D007333:Insulin Resistance; D010535:Laparoscopy; D020738:Leptin / Q000097:blood; D024821:Metabolic Syndrome / Q000097:blood / Q000150:complications / Q000601:surgery*; D065626:Non-alcoholic Fatty Liver Disease; D009767:Obesity, Morbid / Q000097:blood / Q000150:complications / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome; D015431:Weight Loss; D061217:Weight Reduction Programs
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; D016207:Cytokines; D020738:Leptin