Коморбідні стани при ожирінні у дітей

Abstract

Background. The unfavorable demographic situation in Ukraine is due to the spread of diseases of civilization (obesity, diabetes mellitus (DM), dyslipidemia, arterial hypertension, metabolically associated fatty liver disease) and requires early diagnosis, personalized treatment, and improvement of ways to prevent these diseases especially in childhood. About 15 million people die from non-communicable diseases every year. The mortality rate caused by the diseases of civilization is increased in a certain category of people who are included in the group of "high risk" regarding metabolic disorders. The aim of the study: to identify the contribution of comorbid conditions (impaired fasting glycemia/car-bohydrate tolerance, dyslipidemia, metabolically-associated fatty liver disease (MAFLD), arterial hypertension) to the development of meta-bolically unhealthy obesity (MUO) in children. Materials and methods. 210 obese children aged 6-18 years were examined. The main group (n = 128) were children with MUO according to the criteria of IDEFICS 2014. The control group (n = 82) were children with metabolically healthy obesity (metabolically healthy obesity — MHO). All children underwent a general clinical, immunobiochemical examination with electroche-miluminescence detection, enzymatic colorimetric method in the certified laboratory "Synevo" (Dnipro, Ukraine), sonographic and bioimped-ance examination. Static analysis included variational analysis with calculation of Student’s test (t); sequential Wald analysis with calculation of relative risk (RR); Spearman’s correlation analysis by calculating the Spearman’s rank correlation coefficient (ρ). The critical value of the level of statistical significance (p) for all types of analysis was accepted at the level of p < 0.05 (5 %). Results: In patients with MUO, violations of tolerance to carbohydrates are registered in 26.7 %, dyslipidemia — in 53.3 %, metabolic-associated fatty liver disease — in 66.6 %, arteri-al hypertension — in 46.6 % of cases. Whereas among patients with MHO, metabolic-associated fatty liver disease is diagnosed in 10 % and dyslipidemia in 5 % of cases. The relative risk of developing MUO is most associated with basal hyperinsulinemia (9,33); sonographic criteria of heterogeneity of liver tissue according to Saverymuttu (6.33); extreme obesity (6); ALT/AST ratio ≥ 1 (3.56); sonographic criteria of hep-atomegaly (3.33); an increase in diastolic (3.07) and systolic blood pressure (2.27) and a decrease in high-density lipoproteins. Conclusions: The metabolic-associated fatty liver disease is the most frequent comorbid condition found in various phenotypes of obesity in children.Keywords: metabolically unhealthy obesity, metabolically healthy obesity, impaired carbohydrate tolerance, arterial hypertension, dyslipidemia, metabolically associated fatty liver disease.