title: Bariatric surgery: is it reasonable before the age of 16?
abstract: to assess the severity of obesity in children and adolescents through the presence of comorbidities and the potential indication of bariatric surgery.
  we conducted a cross-sectional study with clinical and laboratory data of the first consultation of patients at the childhood obesity clinic at a tertiary hospital from 2005 to 2013. We divided the patients into groups with or without potential indication for surgery, and recorded age, gender, birth weight, age of obesity onset, BMI Z score, presence of acanthosis nigricans, blood pressure, total cholesterol and fractions, triglycerides, blood glucose and fasting insulin, HOMA1-IR, CRP and ESR. The group with potential indication for surgery included: BMI > 40 or between 35-40 with comorbidities (Triglycerides >130mg/dl, glucose levels >100mg/dl, HOMA1-IR >3.16, Total Cholesterol >200mg/dl, LDL >130mg/dl and HDL <45mg/dl), regardless of age, epiphysis consolidation and previous treatment.
  of the 296 patients included in the study, 282 (95.3%) were younger than 16 years. The most frequent change was the HDL (63.2%), followed by HOMA1-IR (37.5%). Of the group of 66 patients with potential indication for surgery (22.3%), only ten (15.1%) had more than 16 years. Acanthosis nigricans, the average HOMA1-IR, insulin, CRP, ESR, age, BMI Z score and systolic and diastolic blood pressure were significant in the group with potential surgical indication.
  bariatric surgery might be indicated by BMI and comorbidities in children and adolescents under 16 years.
  avaliar a gravidade da obesidade em crianças e adolescentes pela presença de comorbidades e pela potencial indicação de cirurgia bariátrica.
  estudo transversal com dados clínicos e laboratoriais da primeira consulta de pacientes do ambulatório de obesidade infantil em um hospital terciário no período de 2005 a 2013. Os pacientes foram divididos em grupos com ou sem potencial indicação cirúrgica, e associados com idade, sexo, peso de nascimento, idade de início da obesidade, escore z de IMC, presença de acantose nigricans, pressão arterial, colesterol total e frações, triglicérides, glicemia e insulina de jejum, HOMA1-IR, PCR e VHS. O grupo com potencial indicação cirúrgica incluiu: IMC >40 ou IMC entre 35-40 com comorbidades (Triglicérides >130mg/dl, Glicemia >100mg/dl, HOMA1-IR >3,16, Colesterol total >200mg/dl, LDL >130mg/dl e HDL <45mg/dl), independente da idade, consolidação das epífises e tratamento prévio.
  de 296 pacientes incluídos no estudo, 282 (95,3%) tinham menos de 16 anos. A alteração mais frequente foi a do HDL (63,2%), seguido do HOMA1-IR (37,5%). Do grupo de 66 pacientes com potencial indicação cirúrgica (22,3%), apenas dez (15,1%) tinham mais de 16 anos. Acantose nigricans, as médias de HOMA1-IR, insulina, PCR, VHS, idade, escore z de IMC e pressões sistólica e diastólica foram significantes no grupo com potencial indicação cirúrgica.
  os resultados sugerem que a cirurgia bariátrica, poderia estar indicada pelo IMC e presença de comorbidades, em crianças e adolescentes com menos de 16 anos.
authors.affiliation: Department of Pediatrics, Faculty of Medical Sciences, University of Campinas (Unicamp), Campinas, Sao Paulo State, Brazil.
authors.forename: Lilian Helena Polak
authors.initials: LH
authors.lastname: Massabki
authors.affiliation: Department of Pediatrics, Faculty of Medical Sciences, University of Campinas (Unicamp), Campinas, Sao Paulo State, Brazil.
authors.forename: Letícia Esposito
authors.initials: LE
authors.lastname: Sewaybricker
authors.affiliation: Department of Pediatrics, Faculty of Medical Sciences, University of Campinas (Unicamp), Campinas, Sao Paulo State, Brazil.
authors.forename: Keila Hayashi
authors.initials: KH
authors.lastname: Nakamura
authors.affiliation: Department of Pediatrics, Faculty of Medical Sciences, University of Campinas (Unicamp), Campinas, Sao Paulo State, Brazil.
authors.forename: Roberto Teixeira
authors.initials: RT
authors.lastname: Mendes
authors.affiliation: Department of Pediatrics, Faculty of Medical Sciences, University of Campinas (Unicamp), Campinas, Sao Paulo State, Brazil.
authors.forename: Antonio DE Azevedo
authors.initials: AA
authors.lastname: Barros
authors.affiliation: Department of Pediatrics, Faculty of Medical Sciences, University of Campinas (Unicamp), Campinas, Sao Paulo State, Brazil.
authors.forename: Maria Ângela Reis DE Góes Monteiro
authors.initials: MÂ
authors.lastname: Antonio
authors.affiliation: Department of Pediatrics, Faculty of Medical Sciences, University of Campinas (Unicamp), Campinas, Sao Paulo State, Brazil.
authors.forename: Mariana Porto
authors.initials: MP
authors.lastname: Zambon
mesh_terms: D000293:Adolescent; D000367:Age Factors; D050110:Bariatric Surgery; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D063766:Pediatric Obesity / Q000150:complications / Q000601:surgery*; D012720:Severity of Illness Index