Tonsillitis, tonsillectomy and weight disturbance

Conlon, Brendan J.; Donnelly, M.; McShane, O.P.

doi:10.1016/s0165-5876(97)00105-5

Cited by 34 publications

(33 citation statements)

References 13 publications

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“…Historically, underweight used to be a common problem in children undergoing adenotonsillectomy and, in studies published up to the early 1990s, increased weight gain was described as a beneficial effect [7,9,10,11,12]. In a study published in 1997 it was reported that children undergoing (adeno)tonsillectomy were heavier than their peers already at the time of surgery and that this discrepancy increased after surgery [13]. Later publications suggested that underweight was no longer a typical characteristic of children undergoing adenotonsillectomy and that accelerated weight gain also occurred in children who were not underweight before surgery.…”

Section: Discussionmentioning

confidence: 99%

Leptin and Ghrelin Levels in Children before and after Adenoidectomy or Adenotonsillectomy

Karalök

Akdağ²,

Turhan³

et al. 2013

Horm Res Paediatr

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Background and Aim: Accelerated weight gain after (adeno)tonsillectomy has been reported in a number of studies. Whether (adeno)tonsillectomy is also a risk factor for development of overweight is unknown. We investigated serum leptin and plasma ghrelin levels before and 1 year after (adeno)tonsillectomy operation in children. Materials and Methods: We studied 31 patients and 29 age- and sex-matched healthy control children. Auxologic evaluation and biochemical investigations were performed before surgery and 1 year later. Results: One year after surgery, height SDS (p = 0.001) and weight SDS (p = 0.004) were significantly increased in both groups. No changes in BMI SDS (p = 0.105) were observed. Preoperative leptin levels were significantly higher in patients than controls (p < 0.001). IGF-1, IGFBP-3, HOMA-IR and ghrelin values were not significantly different between the groups. One year after surgery, IGF-1 (p = 0.001) and IGFBP-3 (p = 0.001) were significantly increased, while ghrelin (p < 0.001) was significantly decreased. Postoperative leptin levels of patients were also significantly higher than preoperative values (p = 0.036). Conclusion: Significantly higher leptin levels in patients compared to control both before and 1 year after an obstruction-relieving surgery suggested that higher levels might be due to leptin resistance in these patients. Based on our findings we recommend measurement of leptin levels longitudinally for at least 5 years after adenotonsillectomy.

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Section: Discussionmentioning

confidence: 99%

Leptin and Ghrelin Levels in Children before and after Adenoidectomy or Adenotonsillectomy

Karalök

Akdağ²,

Turhan³

et al. 2013

Horm Res Paediatr

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“…Before T&A, the participants' weight was at the 73rd percentile, which corresponds to an average overweight of 32%. Barr et al 17 reported the median weight of 8.5-year-old children with OSDB was at the 55th percentile, whereas Conlon et al 40 reported that 7-year-old children with OSDB were 10% overweight. Studies have indicated that children with OSDB are overweight.…”

Section: Discussionmentioning

confidence: 99%

Increases in Overweight After Adenotonsillectomy in Overweight Children With Obstructive Sleep-Disordered Breathing Are Associated With Decreases in Motor Activity and Hyperactivity

et al. 2006

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OBJECTIVE. To examine the effect of adenotonsillectomy (T&A) in children with obstructive sleep-disordered breathing on growth, hyperactivity, and sleep and waking motor activity.METHODS. We studied 54 children who were aged 6 to 12 years and had adenotonsillar hypertrophy and an obstructive apnea-hypopnea index of Ն1 before and 12 months after they all received adenotonsillectomy (T&A). We measured their height, weight, percentage overweight (patient BMI Ϫ BMI at 50th percentile)/ BMI at 50th percentile * 100) and obtained a hyperactivity score from parent report on a standardized behavior questionnaire scale. A subset of 21 of these children were also studied for motor activity by wrist actigraphy for 7 consecutive days and nights before and 12 months after T&A.RESULTS. After T&A, mean obstructive apnea-hypopnea index decreased from 7.6 to 0.6. Height percentile did not change, but weight percentile increased; as a consequence, percentage overweight increased from 32.0% to 36.3%. Hyperactivity scores and total daily motor activity were reduced after T&A. From linear regression, the reduction in hyperactivity scores predicted an increase in percentage overweight. Reduced motor activity was correlated with increased percentage overweight.CONCLUSIONS. An increase in percentage overweight after T&A in children with obstructive sleep-disordered breathing is correlated to decreased child hyperactivity scores and to decreased measured motor activity in the subset studied. These associations suggest that the increase in overweight may be attributable to reductions in physical activity and fidgeting energy expenditure. (OSDB) occurs in ϳ3% of children. 1-3 Adenotonsillar hypertrophy is the most common cause of OSDB in young children, and adenotonsillectomy (T&A) is the primary treatment of obstructive sleep apnea in children. [4][5][6] OSDB in children has been associated with a variety of comorbidities, including hypertension, enuresis, poor scholastic performance, hyperactivity, and attentiondeficit/hyperactivity disorder, and these conditions are also ameliorated with successful treatment of OSDB via T&A. 7,8 OSDB has also been reported to influence somatic growth. Several studies have shown that OSDB is associated with reduced growth in height and weight 5,6,[9][10][11][12] and failure to thrive in infants. 13 These growth alterations have been related to a number of factors, including reduced secretion of growth hormone and insulinlike growth factor-I, 11,14,15 low energy intake as a result of difficulty swallowing, 16 and increased energy expenditure during sleep. 5,16 All of these factors are reported to improve after T&A. 6,11,[14][15][16] Other studies, however, have reported that growth in children with adenotonsillar hypertrophy and OSDB is normal or that these children are actually overweight before treatment. 4,17,18 After T&A, normal-weight and overweight children with or without OSDB rapidly gain weight. 17,18 Thus, although T&A has a beneficial effect on OSDB symptoms 4 and improves the other...

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“…Interestingly, around this same period, researchers began reporting that children undergoing tonsillectomy often weighed more than their peers rather than less, as was true in the past, when tonsillectomy was often performed for growth failure. 11 Conlon et al 11 suggested that the discrepancy in weight that was seen before surgery was exacerbated after surgery. In 1999, Soultan et al 12 found that even among obese children the BMI increased.…”

Section: Commentmentioning

confidence: 99%