Examination of children with metabolic syndrome

To include a child in the risk group, detailed anamnestic information is important that helps to anticipate and explain the development of metabolic and metabolic syndrome disorders.

From the data of the family history, information on the presence of obesity (abdominal as more unfavorable), chronic cardiovascular diseases (coronary heart disease, atherosclerosis, arterial hypertension, early myocardial infarctions and strokes, thrombotic diseases), as well as disorders of carbohydrate (impaired glucose tolerance, type 2 diabetes mellitus), lipid (hyperlipidemia of atherogenic orientation), purine metabolism (hyperuricemia, gout). Particular attention to these diseases is dictated by their proven hereditary nature and making a significant contribution to the development of metabolic syndrome both among parents and 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 children - an obligate risk factor of the metabolic syndrome. When evaluating an anamnesis, one should also consider the provoking influence of environmental factors, or behavioral factors such as lack of exercise, bad habits, a high calorie diet with the use of more easily digestible carbohydrates and fats than physiological needs (which is often of a general family nature), stress effects, and the process Urbanization, contributing to the consolidation of this lifestyle.

Particular attention when the child is included in the risk group requires an evaluation of his genotype. At the present time, a large number of variants of polymorphism of genes responsible for the formation and severity of the signs that make up the metabolic syndrome are known. These signs are insulin resistance / hyperinsulinemia, obesity, including its abdominal form, variants of dyslipidemia, arterial hypertension, hyperuricemia, thrombophilia. Possessing information on the variant of genetic polymorphism of a specific patient, it is possible to assume with a certain degree of probability the possibility of developing components of the metabolic syndrome in him, especially in combination with the favorable conditions of the external environment.

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

Given this point, more attention is paid to the study of prenatal and postnatal factors, creating the prerequisite for the development of disorders leading to the formation of components of the metabolic syndrome. These factors include the pathological course of pregnancy, including the reduction of gestation, the development of gestational diabetes in the mother (which is accompanied by fetal hyperinsulinemia and entails macrosomia), periods of intrauterine fasting. No less important in assessing the predisposition to the metabolic syndrome have weight parameters of the newborn. Thus, according to the conducted studies, low or high birth weight (the phenomenon of intrauterine growth retardation and macrosomia with a mass of <2800 g and> 4000 g respectively, acting as prenatal markers and reflecting the processes of insulin resistance and hyperinsulinemia) is considered a predictor of development and persistence of obesity, hypertension , dyslipidemia, impaired glucose tolerance / type 2 diabetes mellitus and hypercoagulability already at school age. The specific features of the course of the first year of the child's life also have a certain significance. These include the lack or short duration of breastfeeding, the presence of periods of fasting, accelerated growth and weight gain, as well as adverse effects at this age.

Criteria for inclusion in the risk group should 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 percentiles by age, sex and height), which threatens the development of obesity (BMI> 95th percentile or body weight exceeding 90th percentile by 10% or more), persisting and in the adult state. The danger is not only the tendency to abdominal obesity (OT> 90th percentile by age and sex) having a pronounced correlation with insulin resistance and hyperinsulinemia and acting as an independent risk factor for early development of cardiovascular diseases, dyslipidemias, type 2 diabetes mellitus and metabolic syndrome not only in adults, but also such early clinical manifestations of the metabolic syndrome as dyslipidemia (increased total cholesterol, triglycerides and LDL cholesterol, decreased cholesterol on HDL), hyperuricemia and increased blood pressure to the borders with high (average arterial blood pressure level between the 90th and 95th percentiles by age, sex and height), propensity to hypercoagulable and initial manifestations of violations of carbohydrate metabolism in the form of impaired fasting blood glucose or impaired glucose tolerance.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11]

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.

[12], [13], [14], [15], [16], [17]