Surgery and Minimally Invasive Devices for the Treatment of Obesity in Children and Adolescents: A Systematic Review and Meta-Analysis.

IF 8 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Obesity Reviews Pub Date : 2025-06-22 DOI:10.1111/obr.13974
Francesco Maria Carrano, Eleonora Allocati, Rita Banzi, Eugenia Romano, Valeria Calcaterra, Giacomo Piatto, Alberto Sartori, Marco Inama, Maurizio De Luca, Nicola Di Lorenzo, Chiara Gerardi
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引用次数: 0

Abstract

Background: Childhood obesity is a global health challenge linked to metabolic, cardiovascular, and psychosocial complications. While lifestyle interventions represent the key strategy for obesity management, metabolic and bariatric surgery (MBS) has emerged as a therapeutic option for severe obesity. This systematic review with meta-analysis assessed the effectiveness and safety of MBS and weight management devices in children and adolescents.

Methods: We included randomized and prospective controlled cohort studies assessing MBS or weight management devices in children and adolescents with obesity, searching PubMed, Embase, Cochrane Library, ClinicalTrials.gov, and WHO International Clinical Trials Registry through January 2025. Critical outcomes included body mass index (BMI) and weight reduction, adverse events, and incidence or severity of obesity-related outcomes.

Results: Seven studies (three RCTs and four non-RCTs), all involving adolescents undergoing MBS, were included. No studies evaluated children or devices. Meta-analysis showed that compared with lifestyle intervention, MBS reduced BMI by 11.7 kg/m2 (95% CI: -13.2 to -10.1; two RCTs, n = 100) and 14.5 kg/m2 (95% CI: -15.7 to -13.3; three non-RCTs, n = 307), and weight by 20.9% (95% CI: -23.6 to -18.1; three RCTs, n = 152) and 31.2% (95% CI: -34.3 to -28.0; two non-RCTs, n = 173). Certainty of evidence was low. One non-RCT comparing Roux-en-Y gastric bypass and sleeve gastrectomy found similar outcomes. Both RCTs and non-RCTs reported improvements in obesity-related outcomes.

Conclusions: Although MBS leads to substantial weight loss and health benefits in adolescents, the risk of complications underscores the need for careful patient selection, surgical expertise, and comprehensive postoperative care.

Trial registration: PROSPERO registration: CRD42023438469.

手术和微创设备治疗儿童和青少年肥胖:系统回顾和荟萃分析。
背景:儿童肥胖是一个全球性的健康挑战,与代谢、心血管和社会心理并发症有关。虽然生活方式干预是肥胖管理的关键策略,但代谢和减肥手术(MBS)已成为严重肥胖的治疗选择。本系统综述与荟萃分析评估了MBS和体重管理装置在儿童和青少年中的有效性和安全性。方法:我们纳入了随机和前瞻性对照队列研究,评估肥胖儿童和青少年的MBS或体重管理装置,检索PubMed, Embase, Cochrane图书馆,ClinicalTrials.gov和WHO国际临床试验注册中心,截止2025年1月。关键结局包括体重指数(BMI)和体重减轻、不良事件以及肥胖相关结局的发生率或严重程度。结果:纳入了7项研究(3项随机对照试验和4项非随机对照试验),均涉及接受MBS的青少年。没有研究评估儿童或设备。荟萃分析显示,与生活方式干预相比,MBS使BMI降低了11.7 kg/m2 (95% CI: -13.2 ~ -10.1;2个rct, n = 100)和14.5 kg/m2 (95% CI: -15.7至-13.3;3个非rct, n = 307),体重降低20.9% (95% CI: -23.6 ~ -18.1;3个rct, n = 152)和31.2% (95% CI: -34.3至-28.0;2个非rct, n = 173)。证据的确定性很低。一项比较Roux-en-Y胃旁路术和袖式胃切除术的非随机对照试验发现了相似的结果。随机对照试验和非随机对照试验均报告了肥胖相关结果的改善。结论:尽管MBS对青少年有显著的体重减轻和健康益处,但并发症的风险强调了仔细选择患者、外科专业知识和全面的术后护理的必要性。试验注册:PROSPERO注册:CRD42023438469。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Obesity Reviews
Obesity Reviews 医学-内分泌学与代谢
CiteScore
19.30
自引率
1.10%
发文量
130
审稿时长
1 months
期刊介绍: Obesity Reviews is a monthly journal publishing reviews on all disciplines related to obesity and its comorbidities. This includes basic and behavioral sciences, clinical treatment and outcomes, epidemiology, prevention and public health. The journal should, therefore, appeal to all professionals with an interest in obesity and its comorbidities. Review types may include systematic narrative reviews, quantitative meta-analyses and narrative reviews but all must offer new insights, critical or novel perspectives that will enhance the state of knowledge in the field. The editorial policy is to publish high quality peer-reviewed manuscripts that provide needed new insight into all aspects of obesity and its related comorbidities while minimizing the period between submission and publication.
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