Resting energy expenditure declined in adolescents 12 months after undergoing bariatric surgery, and metabolic adaptation was also negative from baseline, which may predispose some patients to weight regain, according to study findings published in The Journal of Clinical Endocrinology & Metabolism.

The pediatric literature on resting energy expenditure following bariatric surgery is more limited than it is for adults, and theoretically stage of puberty could have an impact on energy expenditure through differences in substrate metabolism. However, the researchers pointed out that they are not aware of any published papers reporting metabolic adaptation or adaptive thermogenesis in children or adolescents compared with adults. In this study, they examined changes in resting energy expenditure and metabolic adaptation in a population of 20 adolescents at 12 months following bariatric surgery.

All patients underwent Roux-en-Y gastric bypass (n = 11) or sleeve gastrectomy (n = 9) at a single facility and were followed-up at 12 months after the procedure. At the time of surgery, the median age and body mass index were 17.2 ± 0.8 years and 48.7 ± 7.4 kg/m2, respectively. The results showed that resting energy expenditure decreased by 548 kcal/day at 12 months after surgery (P <.001), and metabolic adaptation was negative and significantly different from what it was at baseline (P <.05). When the patients were stratified by type of surgery, changes in resting energy expenditure at 12 months postsurgery did not differ significantly (Roux-en-Y gastric bypass: -494.0 ± 260.9 kcal/day vs sleeve gastrectomy: -614.6 ± 344.4 kcal/day; P =.384). For all patients regardless of surgery type, predicted resting energy expenditure was 19% lower at 12 months and measured resting energy expenditure was 25% lower.

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“Future investigations to elucidate the factors and mechanisms related to changes in [resting energy expenditure] and metabolic adaptation would be beneficial for optimizing nutritional and lifestyle counseling,” wrote the researchers.

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Chu L, Steinberg A, Mehta M, et al. Resting energy expenditure and metabolic adaptation in adolescents at 12 months following bariatric surgery [published online February 11, 2019]. J Clin Endocrinol Metab. doi:10.1210/jc.2018-02244