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Research Project: Pediatric Clinical Nutrition

Location: Children's Nutrition Research Center

Title: Energetic adaptations persist after bariatric surgery in severely obese adolescents

item BUTTE, NANCY - Children'S Nutrition Research Center (CNRC)
item BRANDT, MARY - Baylor College Of Medicine
item WONG, WILLIAM - Children'S Nutrition Research Center (CNRC)
item LIU, YAN - Children'S Nutrition Research Center (CNRC)
item MEHTA, NITESH - Children'S Nutrition Research Center (CNRC)
item WILSON, THERESA - Children'S Nutrition Research Center (CNRC)
item ADOLPH, ANNE - Children'S Nutrition Research Center (CNRC)
item PUYAU, MAURICE - Children'S Nutrition Research Center (CNRC)
item VOHRA, FIROZ - Children'S Nutrition Research Center (CNRC)
item SHYPAILO, ROMAN - Children'S Nutrition Research Center (CNRC)
item ZAKERI, ISSA - Drexel University

Submitted to: Obesity
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 11/13/2014
Publication Date: 2/20/2015
Citation: Butte, N.F., Brandt, M.L., Wong, W.W., Liu, Y., Mehta, N.R., Wilson, T.A., Adolph, A.L., Puyau, M.R., Vohra, F.A., Shypailo, R.J., Zakeri, I.F. 2015. Energetic adaptations persist after bariatric surgery in severely obese adolescents. Obesity. 23:591-601.

Interpretive Summary: The substantial weight loss induced by Roux-en-Y-gastric bypass surgery (surgery where the stomach is reduced to the size of approximately an egg) in obese individuals elicits energetic adaptations in the body to promote conserving energy; however, it is uncertain how long these energetic adaptations last. In this study, we monitored energetic adaptations in extremely obese adolescents who had Roux-en-Y gastric bypass surgery for 12 months following surgery. We found that the fall in energy expenditure persisted until 12 months, and was associated with changes in hormones and sympathetic nervous system activity. The fall in energy expenditure can contribute to weight regain in patients undergoing Roux-en-Y gastric bypass surgery. This study aids scientists in obtaining fundamental knowledge of weight gain that may be used in other research.

Technical Abstract: Energetic adaptations induced by bariatric surgery have not been studied in adolescents or for extended periods postsurgery. Energetic, metabolic, and neuroendocrine responses to Roux-en-Y gastric bypass (RYGB) surgery were investigated in extremely obese adolescents. At baseline and at 1.5, 6, and 12 months post-baseline, 24-h room calorimetry, body composition, and fasting blood biochemistries were measured in 11 obese adolescents relative to five matched controls. In the RYGB group, mean weight loss was 44.6 ±19 kg at 12 months. Total energy expenditure (TEE), activity EE, basal metabolic rate (BMR), sleep EE, and walking EE significantly declined by 1.5 months (P < 0.001) and remained suppressed at 6 and 12 months. Adjusted for age, sex, fat-free mass, and fat mass, EE was still lower than baseline (P < 0.001). Decreases in serum insulin, leptin, and triiodothyronine (T3), gut hormones, and urinary norepinephrine (NE) paralleled the decline in EE. Adjusted changes in TEE, BMR, and/or sleep EE were associated with decreases in insulin, homeostatic model assessment, leptin, thyroid stimulating hormone, total T3, peptide YY3-36, glucagon-like peptide-2, and urinary NE and epinephrine (P < 0.001-0.05). Energetic adaptations in response to RYGB-induced weight loss are associated with changes in insulin, adipokines, thyroid hormones, gut hormones, and sympathetic nervous system activity and persists 12 months postsurgery.