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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 6  |  Issue : 2  |  Page : 31-33

Tonsillectomy and weight gain in children: A prospective study


1 Department of Surgery, College of Medicine, Taif University, Taif, Saudi Arabia
2 Department of Pediatric, College of Medicine, Taif University, Taif, Saudi Arabia

Date of Web Publication29-May-2018

Correspondence Address:
Dr. Sami A Al Kindy
Department of Surgery, College of Medicine, Taif University, Taif, P.O. Box 888, Taif, 21974
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ssj.ssj_22_17

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  Abstract 

Aim: The aim of this study is to demonstrate the relation between tonsillectomy and weight gain in children, we hypothesize tonsillectomy may cause increase body weight in children.
Methods and Materials: It is a comparative prospective study conducted in King Abdul Aziz Specialist Hospital, Taif, Saudia Arabia, between January 2013 and December 2015 between study group (tonsillectomy with or without adenoidectomy) and control (grommets insertion, adenoidectomy, turbinate reduction, evaluation under anesthesia nasal cavity). Patients were randomly selected, weight before and after the procedure, and reviewed 6-week postoperatively. Incomplete data, failure to follow up, and more than 60-days follow-up were excluded from the study.
Results: A total of 96 patients were involved in the study, of whom 14 not fulfilling the criteria, were excluded. test group were 54 (65.8%) (male 44 [81.5%] and 18 females [22.7%]) and control group 28 (34.15%). Minimal and maximum ages were 1.11 and 12.4 years, respectively. The minimum and maximum follow-ups were 16 and 58 days, respectively, an average of 43.8 days. Weight gain calculated (< 0.5 kg, 0.5 – 1 kg, >1 kg) in study group was 14,4%, 24.3%, and 24.3% while the control group 7.6%, 12.7%, and 12.7%, respectively. The total accumulated Weight gain in the test group was 49.6 kg, Whereas in control group 33.4 kg. There was no difference noted between the two, however, both gained weight above the norm.
Conclusion: Weight gain post tonsillectomy cannot be proven to be a sequence in children; however, both groups gained weight above the normal, further studies are require to exclude other factors.

Keywords: Children, complications, post tonsillectomy, weight gain


How to cite this article:
Al Kindy SA, Alzahrani AK. Tonsillectomy and weight gain in children: A prospective study. Saudi Surg J 2018;6:31-3

How to cite this URL:
Al Kindy SA, Alzahrani AK. Tonsillectomy and weight gain in children: A prospective study. Saudi Surg J [serial online] 2018 [cited 2018 Dec 11];6:31-3. Available from: http://www.saudisurgj.org/text.asp?2018/6/2/31/233488


  Introduction Top


Tonsillectomy with or without adenoidectomy is a common surgical procedure in children, besides its known complications,[1] it has been reported to cause overweight/obesity, in children,[2],[3] adolescent, and young adults alike, especially when indicated for obstructive symptoms and chronic tonsillitis.[4],[5],[6],[7] However, others reported no difference.[8] Our prospective study, both groups gained weight, however, above the expected normal.


  Methods and Materials Top


A comparative prospective study conducted in King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia, between January 2013 and December 2014 of pediatric patients were randomly selected and divided into two groups, a test (tonsillectomy with or without adenoidectomy) and a control (adenoidectomy, grommet insertion, turbinate reduction, evaluation of the nose under anesthesia) group.

Patient was weight before and after the procedure and reviewed postoperative.

Incomplete data, failure to show, and more than 60-day follow-up were excluded from the study. SPSS version 22 (IBM Corporation, Armonk, New York 10504-1722, USA) was used to analyze the data.


  Results Top


A total of 96 patients were included, of whom 14 excluded (not fulfilling the criteria) from the study, test group were 54 (65.8%) (male 44 [81.5%] and 18 females [22.7%]) and control group 28 (34.15%). The minimum 1.11 and maximum 12.4 age in years, respectively, an average of 5.8 years. Follow-up in days ranged between 57 and 16, an average of 43.8 days. Weight gain calculated (< 0.5 kg, 0.5 – 1 kg, >1 kg) in study group was 14.4%, 24.3%, and 24.3%, whereas control group was 7.6%, 12.7%, and 12.7% kg, respectively. Test group (postoperative), total difference of weight in children below 6 years was 37 kg, while the expected 22.17 kg with a difference of 14.8 kg (one child had no change in weight while another lost 1 kg) a balance of 13.8 kg, in comparison to control where the total difference of weight was 17.1 kg, the expected 13.2 kg, with a balance of 3.3 kg, (one had no change in weight, the other lost 0.3 kg), respectively, while children above 6 years, the test group had a total total difference in weight postoperative was 12.6 kg, expected 3.9 kg with a balance of 5.4 kg (four lost weight (3.3 kg) while two had no change) in comparison to control, where the weight difference was 16.3, expected 2.6 kg and the balance 13.7 kg (one had no change in weight)[Figure 1].
Figure 1: Comparative chart

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The accumulated weight gain in test group 49.6 kg, expected 26.1 kg and the balance 19.2 kg, while control group 33.4 kg, 15.8 kg, and 17 kg respectively [Table 1].
Table 1: Comparative table between the two groups in kg

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There was no difference in the total weight gain of both groups (χ2(2) =0.59, P > 0.75). However, both groups had above the norm weight increase. SPSS (IBM Corporation, Armonk, New York, United States) Version 23 was used to analyze the results.

Method of calculating weight

Weight of children <6 years of age was calculated from average growth and caloric requirements table “Nelson textbook of Pediatrics (20th Edition), Vol. 1”[9] while >6 up to 12 years, was calculated by weight gain (2–3 kg/year)[10] with the average gain per day 0.0151 and 0.0057 kg, respectively, multiplied by the number of follow-up days.


  Discussion Top


The prevalence of obesity/overweight in childhood worldwide is a serious health problem and considered to be a global pandemic,[11],[12] it has been associated with a fall in life expectancy and disability-adjusted life years as a sequence of the associated health risks (hypertension, diabetes mellitus, respiratory, and orthopedic conditions), especially in growing years.[13]

A number of factors has been implicated including, diet, sedentary life, socioeconomic, sex, high altitude,[14] and tonsillectomy. Myth or otherwise, the latter an uncommon and unique sequence of a surgical procedure,[15] whereas the mechanism is not quite clear, has been reported to increase weight in under developing a child.[16],[17] These reports, however, suggest revision of tonsillectomy criteria [7] as well as the informed consent.

In contrast to other, retrospective researches, our prospective study, showed otherwise, in fact few showed no change in weight (1 [3.6%] in the control, and 2 [3.7%] in test group), moreover, others lost weight (1 [3.6%] from control and 5 [9.26%] from test [with the average of 0.77 kg]) groups, while majority in both groups weight increase was noted.

The no gain or loss of weight, though small in number, cannot be explained, in contrast to weight increases. Sex differences in body mass index are small during childhood and are established in late adolescence,[10] which was considered here in calculating the weight.

Follow-up was one of the problems faced here, where patient compliance and data recording were compromised, we felt 6 weeks were reasonable, as so as late and long appointments may be missed, especially, if outcome of the procedure was satisfactory.

Limitation of our study included consideration of diet, family history, socioeconomic, racial factors as well as high altitude residency.

Error of measurements, a factor that cannot be completely ruled out, however, was minimized by repeated revision and exclusion of incomplete or suspicious data.


  Conclusion Top


Tonsillectomy with or without adenoidectomy has been implicated in weight gain, this could not be proven in our study. However, the weight above the norm gained by both groups requires further studies, to exclude other factors.

Acknowledgment

The authors would like to thank Dr. Adel Al Shareef, Dr. A. Mastan, Dr. Satish Kunju, and Ms Amal Al Jaeed for their valuable contributions in collecting the data required.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Randall DA. Taste impairment following tonsillectomy and adenoidectomy: An unusual complication. Ear Nose Throat J 2010;89:E15-8.  Back to cited text no. 1
[PUBMED]    
2.
Levi J, Leoniak S, Schmidt R. Evaluating tonsillectomy as a risk factor for childhood obesity. Arch Otolaryngol Head Neck Surg 2012;138:897-901.  Back to cited text no. 2
    
3.
Barr GS, Osborne J. Weight gain in children following tonsillectomy. J Laryngol Otol 1988;102:595-7.  Back to cited text no. 3
    
4.
Bonuck KA, Freeman K, Henderson J. Growth and biomarker changes after adenotonsillectomy: Systemic review and meta-analysis. Arch Dis Child 2009;94:83-91.  Back to cited text no. 4
    
5.
Pisarev VF. Tonsillectomy effects on physical development of young men. Vestn Otolaryngol 2000;2:41-2.  Back to cited text no. 5
    
6.
Camilleri AE, MacKenzie K, Gatehouse S. The effect of recurrent tonsillitis and tonsillectomy on growth in childhood. Clin Otolaryngol Allied Sci 1995;20:153-7.  Back to cited text no. 6
    
7.
Koycu A, Aydin E, Tulgar Kinik S. Changes in body composition and growth pattern after adenotonsillectomy in prepubertal children. Int J Pediatr Otorhinolaryngol 2016;81:46-50.  Back to cited text no. 7
    
8.
Rozycki S, Gessler EM. Posttonsillectomy weight loss in adults. Otolaryngol Head Neck Surg 2015;152:1035-8.  Back to cited text no. 8
    
9.
Keane VA. Nelson Text Book of Pediatric. 20th ed., Vol. 1. Philadelphia, PA: Elsevier; 2016.  Back to cited text no. 9
    
10.
Malina R. Normal weight gain in growing children. Healthy Weight J 1999;13:13.  Back to cited text no. 10
    
11.
Abalkhail B. Overweight and obesity among Saudi Arabian children and adolescents between 1994 and 2000. East Mediterr Health J 2002;8:470-9.  Back to cited text no. 11
    
12.
Gaskin PS, Walker SP. Obesity in a cohort of black Jamaican children as estimated by BMI and other indices of adiposity. Eur J Clin Nutr 2003;57:420-6.  Back to cited text no. 12
    
13.
Lobstein T, Baur L, Uauy R; IASO International Obesity TaskForce. Obesity in children and young people: A crisis in public health. Obes Rev 2004;5 Suppl 1:4-104.  Back to cited text no. 13
    
14.
Khalid Mel-H. Is high-altitude environment a risk factor for childhood overweight and obesity in Saudi Arabia? Wilderness Environ Med 2008;19:157-63.  Back to cited text no. 14
    
15.
Wei JL. Weight gain after tonsillectomy: Myth or reality? Interpreting research responsibly. Otolaryngol Head Neck Surg 2011;144:855-7.  Back to cited text no. 15
    
16.
Williams EF 3rd, Woo P, Miller R, Kellman RM. The effects of adenotonsillectomy on growth in young children. Otolaryngol Head Neck Surg 1991;104:509-16.  Back to cited text no. 16
    
17.
Fernandes AA, Alcântara TA, D'Avila DV, D'Avila JS. Study of weight and height development in children after adenotonsillectomy. Braz J Otorhinolaryngol 2008;74:391-4.  Back to cited text no. 17
    


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