Treatment of metabolic syndrome in children

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.

Normalization of the diet includes a moderate restriction of the daily energy value (while it is not recommended below 1200 kcal!). The reduction in the energy value of the diet is due to the restriction of carbohydrates and fats of animal origin (lard, butter, fatty meats, etc.), and vegetable consumption should be increased to 50% of the total amount of fats.

It is necessary to limit the "carbohydrate" height to 150 g per day. When preparing a diet, you should take into account the glycemic index of products. The lower the product's "ability" to increase blood glucose, the more favorable its effect on the insular apparatus and the lower the risk of additional utilization of glucose in fat stores, and products with a high glycemic index increase this risk. However, it must be taken into account that in obese patients almost all carbohydrate products cause a greater increase in glucose level than in people with normal weight.

The amount of protein in diets should not be less than 0.9-1.0 g / kg of normal body weight. Less than 60 grams of protein per day do not recommend eating. Protein products (meat, fish, cottage cheese) should be included in your daily diet. Limit table salt (up to 5 grams per day) and water (up to 1.5 liters per day). It is necessary to use unloading days.

Physical stress in its importance in the prevention and treatment of obesity is rightfully ranked second after nutrition. Walking, playing sports, swimming, cycling, skis and skates, including roller ones, are good for training cardiovascular system. You can move and need to always and everywhere: sitting in the bathroom, watching TV, on the bus, at the school desk. We must walk, run, swim, ride a bicycle, do exercises, do shaping, etc. It should be remembered that exercise without diets is ineffective.

In recent years, program-targeted education of children with various chronic pathologies occupies a worthy place in an integrated approach to the treatment of these diseases and the prevention of their exacerbations. For children suffering from chronic pathology and their parents, it is very important not only to know as much as possible about this disease, but also to be able to control its course, having certain practical skills, using self-monitoring tools. Change of lifestyle is necessary not only for the child, but also for his parents. In the overwhelming majority of adult patients, overweight is recorded from childhood, which underscores the need for starting problem-targeted education from the school period - until serious complications of this chronic disease appear. Obesity can not be cured without the knowledge of a sick child. It can not be cured without active cooperation and mutual understanding between the doctor, the patient and his parents. With problem-targeted training of children and adolescents in terms of increasing their motivation to reduce body weight and compliance with the principles of self-control, it is important to carry out a differentiated psychological correction. In children with obesity and metabolic syndrome who have undergone problem-targeted training, in comparison with children who did not pass it, in dynamics (after 6 months), the best anthropometric parameters (significant decrease in BMI), record the tendency to normalize the revealed metabolic shifts (lipidogram, IRI, HOMA-R) and, ultimately, they improve the quality of life. Taking into account the results of the research, the time period from 6 to 12 months can be considered the optimal time for the repeated course of problem-targeted education of children with obesity and metabolic syndrome. It is in this range that the tendency towards a decrease in motivation and exactingness in relation to the fulfillment of the basic principles of non-drug therapy (rational nutrition and exercise) is noted against the backdrop of the still remaining regime of self-monitoring of the dynamics of anthropometric and laboratory indicators.

Medical treatment of obesity

• Means that affect food behavior and improve the tolerability of the diet (preparations of central action):
  • anorectics (central agonists of catecholamines) - amfepramone, chlorphentermine (desopimon), mazindol, phenylpropanolamine (trimecs), etc. In pediatrics are not used because of side effects;
  • dietary regulators: dexfenfluramine (insipan) is not used because of the negative effect on the valvular heart apparatus; fluoxetine (Prozac) is better known as an antidepressant, the positive effect is not always achieved; sibutramine (meridia) - inhibitor of the reuptake of norepinephrine and serotonin in brain structures (can be used in adolescents).
• Means that reduce insulin resistance and hyperinsulinaemia, which reduce absorption of nutrients from the digestive tract (peripheral drugs):
  • metformin (glucophage, syfor) is referred to the biguanide group, it increases the sensitivity of tissues to insulin, inhibits fat oxidation, has an antihypertensive effect; it is widely used at present with metabolic syndrome, including without impaired glucose tolerance; it can be used in the absence of contraindications in children of school age (from 10 years) and adolescents;
  • acarbose (glucobay) inhibits the absorption of monosaccharides from the intestine;
  • orlistat (xenical) - an inhibitor of pancreatic and intestinal lipase; It can be used in children and adolescents with complicated forms of obesity.
• Preparations of peripheral and central action:
  • thermogenic sympathomimetics;
  • a growth hormone;
  • androgens;
  • preparations of hormone replacement therapy or gestagen-estrogen preparations.

The medical treatment of obesity is prescribed by a doctor under strict medical conditions after a child's examination and clarification of the severity of metabolic and clinical disorders. In children and adolescents, the drug of choice for the treatment of obesity is metformin (allowed to be used from 10 years). Currently, multicenter randomized placebo-controlled studies have received positive data on the evaluation of the effectiveness of obesity treatment in adolescents (over 12-13 years of age) with sibutramine and orlistat.

Treatment of arterial hypertension and dyslipidemia

Non-drug treatment of hypertension and dyslipidemia includes:

• keeping a diary;
• teaching sick children and adolescents;
• diet, changing eating habits;
• physical exercises.

It should be remembered that to improve the clinical status of patients with obesity and hypertension, it is not necessary to reduce the body weight to ideal values, it is sufficient to reduce it only by 5-10% of the initial value.

Medicamental treatment should be prescribed only by a doctor (pediatrician or endocrinologist) and carried out under his control.

There are four stages in the treatment of hypertension in children and adolescents with obesity.

• I stage: a 10-15% reduction in body weight for 3-6 months, while following the principles of rational nutrition and restriction of table salt.
• II stage: in the absence of a positive effect on non-medicamentous measures in the treatment of hypertension of the first degree (without target organ damage), labile arterial hypertension (according to daily monitoring of blood pressure) for 6 months, pharmacotherapy is recommended. With arterial hypertension of the II degree (with signs of target organ damage), as well as stable arterial hypertension (according to daily monitoring of blood pressure), medical treatment is immediately prescribed.
• Stage III: pharmacological monotherapy - ACE inhibitors (enalapril (renitek, berlipril)); selective beta-adrenoblockers [nebivolol (nebilet), etc. In case of insufficient hypotensive effect, an increase in the dose of the drug or its replacement. With insufficient hypotensive effect - combined therapy.
• IV stage: combined treatment - ACE inhibitors and diuretics [indapamide (arifone)]; selective beta-blockers and ACE inhibitors.

Promising in the treatment of hypertension in metabolic syndrome, angiotensin II receptor antagonists (irbesartan).