Metabolic syndrome in children

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

The prevalence of metabolic syndrome among the population over 30 years of age in industrially developed countries is from 10 to 30%. Data on the prevalence of metabolic syndrome among children and adolescents are practically absent and are limited only to information on 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

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

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

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

Symptoms of Metabolic Syndrome

Diagnostic criteria for metabolic syndrome

• Mandatory (large) markers (criteria):
  • abdominal-visceral (central) obesity;
  • insulin resistance and hyperinsulinemia or impaired carbohydrate metabolism (impaired fasting glucose, impaired glucose tolerance, type 2 diabetes mellitus).
• Additional markers (criteria):
  • dyslipidemia (increased concentration of LDL and triglycerides, decreased level of HDL), early atherosclerosis;
  • arterial hypertension, remodeling of the heart and blood vessels;
  • hemostasis disorders (fibrinogen, ITAP 1, etc.);
  • hyperuricemia;
  • microalbuminuria;
  • hyperandrogenism (in girls);
  • other hormonal-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, carbohydrate metabolism disorders, arterial hypertension, and dyslipidemia.

Lifestyle changes are the basis for successful treatment of this syndrome. The doctor's goal is to form a stable motivation in the patient aimed at long-term compliance with recommendations on nutrition, physical activity, and medication. The focus on success allows the patient to more easily endure the hardships that lifestyle changes require, which include: normalization of the regimen, diet; optimization of physical activity; psychotherapy; problem-based learning and self-control.

Treatment of metabolic syndrome

Issues of 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.

Assessment of children with metabolic syndrome

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