Metabolic syndrome in children

Metabolic syndrome is a symptomatic complex of metabolic, hormonal and psychosomatic disorders, based on abdominal-visceral (central) obesity with insulin resistance and compensatory hyperinsulinemia.

The prevalence of the metabolic syndrome among the population over 30 in the industrialized countries ranges from 10 to 30%. Data on the prevalence of metabolic syndrome among children and adolescents are practically absent and limited only to information about the frequency of occurrence of one of its main manifestations - obesity. According to existing domestic and foreign data, the prevalence of overweight and obesity in school-age children is 10-17.5%.

Symptoms of Metabolic Syndrome

Violations, united by the metabolic syndrome, for a long time are asymptomatic, often begin to form in adolescence and adolescence, long before the clinical manifestation of type 2 diabetes, arterial hypertension and atherosclerotic vascular lesions. The earliest manifestations of the metabolic syndrome are dyslipidemia and hypertension. Often not all components of this syndrome occur simultaneously. What phenotype it will manifest depends on the interaction of genetic factors and environmental factors in ontogenesis.

Metabolic syndrome combines a group of metabolic and clinical signs (markers), which can be considered in its framework only in the presence of insulin resistance. Virtually all components of this syndrome are established risk factors for the development of cardiovascular diseases:

• abdominal obesity (the deposition of fat in the abdominal cavity, the anterior abdominal wall, trunk, neck and face - android type of obesity);
• insulin resistance (low sensitivity of cells to insulin);
• hyperinsulinemia;
• a violation of glucose tolerance or type 2 diabetes mellitus;
• arterial hypertension;
• dyslipidemia;
• hyperandrogenia in girls;
• violation of hemostasis (decreased fibrinolytic activity of the blood);
• hyperuricemia;
• microalbuminuria.

Symptoms of Metabolic Syndrome

Criteria for diagnosis of metabolic syndrome

• Mandatory (large) markers (criteria):
  • abdominal-visceral (central) obesity;
  • insulin resistance and hyperinsulinemia or violation of carbohydrate metabolism (impaired fasting glycemia, impaired glucose tolerance, type 2 diabetes mellitus).
• Additional markers (criteria):
  • dyslipidemia (increased LDL and triglyceride concentrations, lower HDL cholesterol), early atherosclerosis;
  • arterial hypertension, cardiac and vascular remodeling;
  • disorders of hemostasis (fibrinogen, ITAP 1, etc.);
  • hyperuricemia;
  • microalbuminuria;
  • hyperandrogenia (in girls);
  • other hormone-metabolic markers of cardiovascular risk (hyperhomocysteinemia, C-reactive protein and others) may correspond to the "platinum standard" for determining additional metabolic factors;
  • anxiety-depressive state.

Diagnosis of Metabolic Syndrome

Treatment of metabolic syndrome

Complex treatment of metabolic syndrome includes lifestyle changes, treatment of obesity, disorders of carbohydrate metabolism, arterial hypertension, dyslipidemia.

Changing the way of life underlies the successful treatment of this syndrome. The goal of the doctor is to form a stable motivation for the patient, aimed at long-term implementation of recommendations on nutrition, physical activity, medication intake. Setting for success allows the patient to easily transfer those deprivations that lifestyle changes require, and it involves: normalizing the regimen, dieting; optimization of physical activity; psychotherapy; problem-oriented training and self-control.

Treatment of metabolic syndrome

Questions of examination of children and adolescents with obesity and metabolic syndrome

Group of health in children and adolescents with metabolic syndrome, depending on the degree of severity of clinical markers of the disease - III or IV, V. When choosing a profession, all types of intellectual work, as well as work as a laboratory assistant, draftsman, fitter. You can not work with occupational hazards (noise and vibration), with the prescribed pace of work (conveyor), do not show work in forced positions, at night shifts. Contraindicated work associated with stress and business trips.

At high arterial pressure, it is necessary to release a sick teenager not only from transfer examinations, but even from examinations for a matriculation certificate, which is decided by a special commission upon the application of the child's parents.

At III-IV degrees of adiposity, stable arterial hypertension, type 2 diabetes mellitus give a respite from conscription into the army. With a lower degree of obesity, the issue of conscription is decided individually, taking into account the state of hemodynamics, glucose tolerance, stress and stress. In each case, when enlisting in the army, a medical examination is carried out in the endocrinological hospital with the involvement of a cardiologist, ophthalmologist, neurologist.

Examination of children with metabolic syndrome

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