Weight gain after Tonsillectomy

Adenoidectomy and Tonsillectomy Linked to Subsequent Overweight in Children
Laurie Barclay & Désirée Lie Medscape News

April 7, 2009 — Tonsillectomy with or without adenoidectomy, or (adeno)tonsillectomy, are linked to subsequent overweight in children, according to the results of a study reported in the April issue of Pediatrics.

"Studies among patients have shown accelerated weight gain after (adeno)tonsillectomy," write Alet H. Wijga, PhD, from the Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, Netherlands, and colleagues. "Whether (adeno)tonsillectomy is also a risk factor for the development of overweight is unknown. We investigated the association between (adeno)tonsillectomy and the subsequent development of overweight in the general population."

The study sample included 3963 children enrolled in the Dutch Prevention and Incidence of Asthma and Mite Allergy birth cohort. Annual questionnaires completed by the parents provided data on weight and height; adenoidectomy and tonsillectomy; and covariates including sex, birth weight, maternal education, maternal overweight, maternal smoking during pregnancy, breast-feeding, and smoking in the home. The investigators also measured the children's weight and height at 8 years of age.

Undergoing (adeno)tonsillectomy from birth to age 7 was significantly associated with overweight and obesity at 8 years of age. Being overweight at 2 years of age did not predict increased risk for (adeno)tonsillectomy at older ages, suggesting that preexisting overweight did not explain the association between (adeno)tonsillectomy and overweight.

"Longitudinal data on weight and height in the years before and after surgery suggest that (adeno)tonsillectomy forms a turning point between a period of growth faltering and a period of catch-up growth, which might explain the increased risk to develop overweight after the operation," the study authors write. "Children who undergo (adeno)tonsillectomy are at increased risk to develop overweight in the years after surgery."

Limitations of this study include loss to follow-up for the medical examination where weight and height were measured and that most data were parental reported.

"Dietary and lifestyle advice at the time of surgery and growth monitoring thereafter might help parents to keep their child's catch-up growth within healthy limits," the study authors conclude.

Pediatrics. 2009;123:1095–1101.

Clinical Context

Accelerated weight gain has been observed in several studies after adenoidectomy and tonsillectomy, but this has not been considered a risk factor for overweight and obesity in children. In the Netherlands, the rate of the procedures is higher than in the rest of Europe or the United States.

This is a follow-up study of a birth cohort in the Netherlands followed up from birth to age 8 years to examine the cumulative incidence of the procedures and the effect of either adenoidectomy alone or adenoidectomy and tonsillectomy from age 0 to 7 years on the risk for overweight and obesity at 8 years of age.

Pearls for Practice

•The cumulative incidence of adenoidectomy and (adeno)tonsillectomy to age 8 years are 12% and 15%, respectively, and 70% of those who undergo adenoidectomy and tonsillectomy have both procedures at the same age.
•(Adeno)tonsillectomy between 0 and 7 years are associated with a increased risk for overweight and obesity at 8 years.