Metabolic syndrome in children: algorithms of diagnostic and therapeutic and preventive measures

Abstract

There is an increase in the incidence of obesity and metabolic syndrome (MS) among children and adolescents. The purpose of the study: to improve the algorithms of diagnostic and therapeutic and preventive measures for MS in obese children. Materials and methods. A comprehensive examination of 483 children with exogenous constitutional obesity aged 6-17 years (285 boys and 198 girls) (SDS BMI ≥ 2.0) was conducted. Results. MS (IDF, 2007) was diagnosed in 49% of the examined children. Adolescents aged 12-17 prevailed (77%). Boys 61%, girls 39% (p<0.05). 61% of adolescents were obese for 5 years or more. 54% of children had a combination of abdominal obesity with two additional components (an incomplete version of MS), 33% - with three, 13% of adolescents had complete MS (a combination of all five components). The analysis of hereditary burden has established a high incidence of obesity, type 2 diabetes, diseases of the cardiovascular system in the mother and maternal grandmother. An increase in blood pressure was detected in 79% of children with MS, arterial hypertension of the I degree - in 34%, hypertension of the II degree - in 22%. Pronounced disorders of glucose metabolism were revealed in the form of a high frequency of IR (81%) and compensatory hyperinsulinemia (55%). Changes in the lipid profile were recorded in 77% of children with MS. An increase in the level of TG and a decrease in HDL cholesterol, which are components of MS, were in 48% and 55% of children, respectively, and their combination was in 27%. Non-alcoholic fatty liver disease was diagnosed in 70% of children with MS, signs of non-alcoholic steatohepatitis - in 13%. In 29%, cholesterosis of the gallbladder was detected, in 34% - biliary sludge, in 7% - gallstones. Conclusion. Based on a comprehensive examination, a diagnostic algorithm and a three-level MS prevention program have been developed, as well as a mathematical model for predicting MS based on the assessment of indicators such as the size of the pancreatic head, thyroid volume, serum alanine aminotransferase (ALT) level, fasting serum glucose level, increased liver echogenicity, according to which it is possible to predict the development of MS in children at the outpatient level at the early stages metabolic disorders.