Cardiovascular Risk Factors in Severely Obese Adolescents: The Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Study.
OBJECTIVE
Severe obesity is increasingly common in the adolescent population but, as of yet, very little information exists regarding cardiovascular disease (CVD) risks in this group.


OBJECTIVE
To assess the baseline prevalence and predictors of CVD risks among severely obese adolescents undergoing weight-loss surgery.


METHODS
A prospective cohort study was conducted from February 28, 2007, to December 30, 2011, at the following 5 adolescent weight-loss surgery centers in the United States: Nationwide Children's Hospital in Columbus, Ohio; Cincinnati Children's Hospital Medical Center in Cincinnati, Ohio; Texas Children's Hospital in Houston; University of Pittsburgh Medical Center in Pittsburgh, Pennsylvania; and Children's Hospital of Alabama in Birmingham. Consecutive patients aged 19 years or younger were offered enrollment in a long-term outcome study; the final analysis cohort consisted of 242 participants.


METHODS
This report examined the preoperative prevalence of CVD risk factors (ie, fasting hyperinsulinemia, elevated high-sensitivity C-reactive protein levels, impaired fasting glucose levels, dyslipidemia, elevated blood pressure, and diabetes mellitus) and associations between risk factors and body mass index (calculated as weight in kilograms divided by height in meters squared), age, sex, and race/ethnicity. Preoperative data were collected within 30 days preceding bariatric surgery.


RESULTS
The mean (SD) age was 17 (1.6) years and median body mass index was 50.5. Cardiovascular disease risk factor prevalence was fasting hyperinsulinemia (74%), elevated high-sensitivity C-reactive protein levels (75%), dyslipidemia (50%), elevated blood pressure (49%), impaired fasting glucose levels (26%), and diabetes mellitus (14%). The risk of impaired fasting glucose levels, elevated blood pressure, and elevated high-sensitivity C-reactive protein levels increased by 15%, 10%, and 6%, respectively, per 5-unit increase in body mass index (P < .01). Dyslipidemia (adjusted relative risk = 1.60 [95% CI, 1.26-2.03]; P < .01) and elevated blood pressure (adjusted relative risk = 1.48 [95% CI, 1.16-1.89]; P < .01) were more likely in adolescent boys compared with adolescent girls. White individuals were at greater risk of having elevated triglyceride levels (adjusted relative risk = 1.76 [95% CI, 1.14-2.72]; P = .01) but were less likely to have impaired fasting glucose levels (adjusted relative risk = 0.58 [95% CI, 0.38-0.89]; P = .01).


CONCLUSIONS
Numerous CVD risk factors are apparent in adolescents undergoing weight-loss surgery. Increasing body mass index and male sex increase the relative risk of specific CVD risk factors. These data suggest that even among severely obese adolescents, recognition and treatment of CVD risk factors is important to help limit further progression of disease.
Nationwide Children's Hospital, Columbus, Ohio.
Marc P
MP
Michalsky
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Thomas H
TH
Inge
University of Cincinnati, Cincinnati, Ohio.
Mark
M
Simmons
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Todd M
TM
Jenkins
University of Cincinnati, Cincinnati, Ohio.
Ralph
R
Buncher
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Michael
M
Helmrath
Texas Children's Hospital, Baylor College of Medicine, Houston.
Mary L
ML
Brandt
University of Buffalo, Buffalo, New York.
Carroll M
CM
Harmon
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Anita
A
Courcoulas
University of Alabama at Birmingham.
Michael
M
Chen
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland.
Mary
M
Horlick
Denver Children's Hospital, Denver, Colorado.
Stephen R
SR
Daniels
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Elaine M
EM
Urbina
D000293:Adolescent; D050110:Bariatric Surgery; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000209:etiology*; D048909:Diabetes Complications; D005260:Female; D005544:Forecasting; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D063766:Pediatric Obesity / Q000601:surgery*; D044469:Racial Groups; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
D001786:Blood Glucose