Examination of children with metabolic syndrome

Detailed anamnestic information is important for including a child in a risk group, which helps to predict and explain the development of metabolic and regulatory disorders characteristic of metabolic syndrome.

Of interest from the family history data are data on the presence of obesity (abdominal, as the most unfavorable), chronic cardiovascular diseases (ischemic heart disease, atherosclerosis, arterial hypertension, early myocardial infarctions and strokes, thrombotic diseases) in close relatives, as well as disorders of carbohydrate (impaired glucose tolerance, type 2 diabetes mellitus), lipid (atherogenic hyperlipidemia), purine metabolism (hyperuricemia, gout). Particular attention to these diseases is dictated by their proven hereditary nature and the significant contribution they make to the development of metabolic syndrome in both the parents themselves and their children. It turns out that the level of education of parents is also important, which has an inverse relationship with the development of obesity in their children - an obligatory risk factor for metabolic syndrome. When assessing the anamnesis, one should also consider the provoking effects of environmental factors or behavioral factors, such as physical inactivity, bad habits, a high-calorie diet with the consumption of easily digestible carbohydrates and fats in excess of physiological needs (which often has a family-wide nature), stressful effects, as well as the process of urbanization, which contributes to the consolidation of this lifestyle.

When including a child in a risk group, special attention should be paid to the assessment of his genotype. Currently, a large number of gene polymorphism variants are known that are responsible for the formation and degree of expression of the signs that make up the metabolic syndrome. These signs include insulin resistance/hyperinsulinemia, obesity, including its abdominal form, dyslipidemia variants, arterial hypertension, hyperuricemia, and thrombophilia. Having information about the genetic polymorphism variant of a specific patient, with a certain degree of probability, it is possible to assume the possibility of developing metabolic syndrome components, especially in combination with favorable environmental conditions.

It is known that the period of intrauterine and early postnatal development of the child is of great importance for the formation of any characteristics of the body.

Given this, more and more attention is paid to the study of prenatal and postnatal factors that create the prerequisites for the development of disorders leading to the formation of metabolic syndrome components. Such factors include the pathological course of pregnancy, including a reduction in the gestation period, the development of gestational diabetes in the mother (which is accompanied by fetal hyperinsulinemia and entails macrosomia), and periods of intrauterine starvation. Of no less importance in assessing the predisposition to metabolic syndrome are the weight and height parameters of the newborn. Thus, according to the conducted studies, low or high birth weight (phenomena of intrauterine growth retardation and macrosomia with a weight of <2800 g and >4000 g, respectively, which act as prenatal markers and reflect the processes of insulin resistance and hyperinsulinemia) are considered to be a predictor of the development and persistence of obesity, arterial hypertension, dyslipidemia, impaired glucose tolerance/type 2 diabetes mellitus and hypercoagulation already at school age. The characteristics of the first year of a child's life are also of certain importance. These include the absence or short duration of the breastfeeding stage, the presence of fasting periods, accelerated growth and weight gain, as well as adverse effects at this age.

The criteria for inclusion in the risk group should also be those signs that directly or indirectly participate in the formation and development of the metabolic syndrome itself. One of the key components can be considered the presence of excess body weight in children and adolescents (BMI values from the 85th to 95th percentile by age, gender and height), which threatens the development of obesity (BMI> 95th percentile or body weight exceeding the 90th percentile by 10% or more), which persists into adulthood. The danger is not only the tendency toward abdominal obesity (WC>90th percentile for age and sex), which has a pronounced correlation with insulin resistance and hyperinsulinemia and acts as an independent risk factor for the early development of cardiovascular diseases, dyslipidemia, type 2 diabetes mellitus and metabolic syndrome not only in adults, but also such early clinical manifestations of metabolic syndrome as dyslipidemia (increased total cholesterol, triglycerides and LDL cholesterol, decreased HDL cholesterol), hyperuricemia and an increase in blood pressure to the borders of high (mean arterial pressure between the 90th and 95th percentile for age, sex and height), a tendency to hypercoagulation and initial manifestations of carbohydrate metabolism disorders in the form of impaired fasting glycemia or impaired glucose tolerance.

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Examination of children and adolescents with obesity and metabolic syndrome

Health group of children and adolescents with metabolic syndrome depending on the severity of clinical markers of the disease - III or IV, V. When choosing a profession, all types of intellectual work are recommended, as well as work as a laboratory assistant, draftsman, mechanic. It is forbidden to work with occupational hazards (noise and vibration), with prescribed work rates (conveyor belt), work in forced positions, on night shifts is not recommended. Work associated with stress and business trips is contraindicated.

In case of high blood pressure, it is necessary to exempt a sick teenager not only from transfer exams, but even from exams for a certificate of maturity, which is decided by a special commission upon application of the child's parents.

With III-IV degrees of obesity, stable arterial hypertension, diabetes mellitus type 2, a deferment from conscription is given. With a lower degree of obesity, the question of conscription is decided individually, taking into account the state of hemodynamics, tolerance to glucose, loads and stress. In each case, when conscripted into the army, a medical examination is carried out in an endocrinology hospital with the involvement of a cardiologist, ophthalmologist, neurologist.

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