Background: Severe obesity in childhood is associated with significant morbidity including systolic hypertension, fatty liver, obstructive sleep apnoea, dyslipidemia and type 2 diabetes. Evidence that even small changes in BMI SDS bring about significant clinical benefit is strong.
Objectives: To assess the impact of weight loss associated with intragastric balloon therapy supported by a life style programme on biomedical outcomes (glucose metabolism, blood pressure, lipid profiles) in severely obese adolescents and to observe anychanges in incretin, ghrelin and adipokine hormones.
Methodology: A 2-year cohort study of 12 adolescents (BMI >3.5 SD, Tanner stage >4) following 6 months intragastric balloon placement. Subjects underwent anthropometry, oral glucose tolerance test, measurement of basal and stimulated incretins and adipokines at 0, 6 and 24 months.
Results: Mean weight loss at 6 months was 7.1 kg ([CI −27,12.8], P value=0.005), (5% body weight) but weight loss was sustained in only 20% patients at 2-years. Insulin area under the curve following OGTT improved at 6 months (P<0.05).As individuals tended to regain weight following balloon removal HOMA scores and fasting insulin levels increased but Insulin AUC remained below pre intervention levels. There was also a fall in HBA1c at 6 months that was maintained despite weight regain (P<0.005). There was a significant increase in fasting GLP-1 over the 24 months (P=0.04). The area under the curve (AUC) for GLP-1 also improved at 24 months despite weight regain. The significant drop in GIP at 6 months (P<0.001) was not sustained at 24 months. We noted moderately strong inverse correlations between percentage weight loss and change in GLP-1 AUC (r=−0.45) and ghrelin (r=−0.51) at 6 months. Clinically relevant improvements were also seen in blood pressure, liver function at 6 months.
Conclusion: Short-term weight loss and clinically relevant improvement in obesity related complications were seen after 6 months of intragastric balloon therapy. Benefits were sustained in some patients but not the majority at 2 years.
23 - 25 Nov 2016
British Society for Paediatric Endocrinology and Diabetes