ODP396 The Relationship Between Baseline Metabolic Factors and Post-surgical Weight Loss Outcomes in Adolescents Undergoing Laparoscopic Sleeve Gastrectomy
Authors: Burghard Anne Claire , Fisher* Anna Sonnett , Rahming Virginia L , Zitsman Jeffrey , Oberfield Sharon E , Fennoy Ilene 
Published: November 2022

Abstract
Introduction: There is a paucity of data exploring the effect of baseline metabolic factors on weight loss success following laparoscopic sleeve gastrectomy (LSG) in adolescents. This study aimed to identify if there is a relationship between abnormal baseline metabolic characteristics including Metabolic Syndrome (MeS), elevated Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), impaired glucose tolerance, and liver function in adolescents presenting for LSG and subsequent weight loss. METHODS: This was a retrospective study at the Center for Adolescent Bariatric Surgery. Subjects were recruited from 2010-2021. Patients with diabetes, identified by fasting blood glucose ≥ 125 mg/dl, 2-hour blood glucose ≥ 200 mg/dl, or HbA1c ≥ 6.5%, were excluded. Anthropometric measurements, fasting triglycerides, HDL, glucose, ALT, HbA1c, and oral glucose tolerance test results were collected pre-surgery and at 6 and/or 12 months post-surgery. Subjects were classified as having childhood MeS using de Ferranti et. al. [1] criteria. Successful weight loss was defined by a change in BMI of at least -11.49 kg/m 2 in the 6-month group and -13. 05 kg/m 2 in the 12-month group. ALT &gt; 22 mg/dl for females and &gt; 26 mg/dl for males, HbA1c ≥ 5.7%, and HOMA-IR &gt; 2.7 were considered abnormal. Chi-squared or Fisher's analyses were performed using RStudio [2], calculating the presence of a relationship between abnormal metabolic factors pre-surgery and subsequent weight loss at 6 and 12 months. A p-value of &lt;0. 05 was considered significant. RESULTS: 143 patients (6-month group: n = 122, 12-month group: n= 78) with a mean baseline age of 16 ± 1.82 years were included. The mean baseline BMI was 46.7 ± 7.9 kg/m 2 . At baseline, 45% of patients had MeS. A greater number of patients with baseline elevated systolic blood pressure (SBP) were in the successful weight loss group compared to the unsuccessful weight loss group at 6 (p = 0. 0163) and 12 (p = 0. 0315) months. Additionally, there were more patients with abnormal baseline HbA1c in the successful weight loss group at 6 months (p = 0. 0239), albeit this was not significant at 12 months. CONCLUSION: Our results suggest that patients with elevated versus normal HbA1c levels may have greater weight loss success after LSG surgery. Performing bariatric surgery in patients with prediabetes may therefore be a key to weight loss success in the adolescent population. Further analyses are needed to elucidate the relationship between glucose metabolism dysregulation and elevated SBP at baseline and weight loss success. REFERENCES: 1. de Ferranti SD, Gauvreau K, Ludwig DS, Neufeld EJ, Newburger JW, Rifai N. Prevalence of the metabolic syndrome in American adolescents: findings from the Third National Health and Nutrition Examination Survey. Circulation. 2004;110(16): 2494-7. 2. Holleran S, Ramakrishnan R (2021). cufunctions, a package to facilitate statistical analyses in R, http: //biomath. net/cufunctions.html"&gt; NOTES: *ACB and ASF are co-first authors.
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