RISK FACTORS FOR METABOLIC SYNDROME IN OBESE CHILDREN

Obesity and closely associated metabolic syndrome develop under the influence of a combination of genetic and environmental factors  and are a challenging problem in the present-day pediatrics.

Objective of the study: determination of the significant risk factors causing the formation of metabolic syndrome in childhood   and their ranking according to the degree of etiological conditionality and manageability. 483 children aged 5–16 years were examined: 237 children who had metabolic syndrome, 246 children who did not. The complex study included a number of clinical laboratory and instrumental methods of study performed using the conventional methods. Methods of epidemiological statistics were used   to calculate the relative (RR) and attributive (AR) risks, as well as the etiological fraction of relative risk (EF).

Results. It has been established that risk factors for the development of metabolic syndrome with a very high and high degree of etiological conditionality which are difficult to control include abdominal (visceral) type of obesity, hyperglycemia, hypertriglyceridemia,  those which are averagely difficult to control – lowering of high density lipoprotein cholesterol, hyperuricemia, and the controlled  (conditionally controlled) factors include the body mass index more than 30 kg/m², the duration of obesity of 5 and more years,   the birth weight less than 2500 g, hepatobiliary disorders (non-alcoholic liver disease, biliary sludge, gallbladder cholesterosis),  eating disorders in the form of a “night eating syndrome”, obesity either in the mother or both parents, mother’s or maternal grandmother’s type 2 diabetes. It has been proven that the timely initiation of therapy and prophylactic measures at the early stages of the  disease, contributing to a reduction of the obesity degree and duration of the disease, allows to reduce the risk of forming metabolic  syndrome in a child by 23%, improving maternal health and normalizing the body weight during the planning of pregnancy – by 22%.

Conclusions. The analysis of genetic, physiological and social and economic factors enables assessing their contribution to the  formation of metabolic syndrome and to classify the risk groups for its development. After classification of risk factors according   to the degree of control the researchers can focus on a group of controlled factors and choose the most effective algorithms of therapeutic and preventive measures.

1. Lazebnik L.B., Zvenigorodskaya L.A. Metabolic syndrome and digestive organs. Moscow: Anaharsis 2009; 184. (in Russ)

2. Metabolic syndrome. G.E. Rotberg (ed.). Moscow: Medpress-inform 2007; 223. (in Russ)

3. Leontieva I.V. Metabolic syndrome in children and adolescents: controversial issues. Pediatriya im. Speranskogo 2010; 89 (2): 146–150. (in Russ)

4. Bokova T.A. Metabolic syndrome in children. Textbook. Moscow: Forte print 2013; 36. (in Russ)

5. Sherbakova M.Yu., Lebedkova S.E., Turkina T.I., Sinitsyn P.A, Roshupkin A.N. Metabolic syndrome in children and adolescents. Orenburg 2011; 162. (in Russ)

6. Netrebenko O.K. Infant origins of obesity. Lechenie I profilaktika 2011; 1: 42–49. (in Russ)

7. Minyailova N.N., Sundukova E.L., Rovda Yu.I. The relationship of low birth weight with markers of metabolic syndrome in adolescents with obesity. Pediatriya im. Speranskogo 2010; 89 (5): 24–32. (in Russ)

8. Gluckman P.D, Hanson M.A, Low F.M. The role of developmental plasticity and epigenetics in human health. Birth Defects Res C Embryo Today 2011; 93 (1): 12–18. DOI: 10.1002/bdrc.20198.

9. Волгина С.Я., Валиуллина М.Х. Факторы риска развития ожирения у девушек-подростков. Рос педиатр журнал 2005; 4: 60–63. [Volgina S.Ya., Valiulina M.H. Risk factors for obesity in adolescent girls. Ros pediatr zhurnal 2005; 4: 60–63. (in Russ)]

10. Thjodleifsson B., Olafsson I., Gislason D. Gislason Th., Jögi R., Janson C. et al. Infections and obesity: A multinational epidemiological study. Scand J Infect 2008; 40: 381–386. DOI:10.1080/00365540701708293

11. Weiss R., Dufour S., Taksali S.E., Tamborlane W.V. Peter- sen K.F., Bonadonna R.C. et al. Prediabetes in obese youth: a syndrome of impaired glucose tolerance, severe insulin resistance, and altered myocellular and abdominal fat partitioning. Lancet 2003; 362: 951–957.

12. Calabro P., Yeh E.T. Obesity, inflammation, and vascular disease: the role of the adipose tissue as an endocrine organ. Subcell Biochem 2007; 42: 63–91. DOI: 10.1093/ajcn/83.2.461S

13. Desruisseaux M.S., Nagajyothi О.А., Trujillo M.E. Adipocyte, adipose tissue, and infectious disease. Infection and Immunity 2007; 75 (3): 1066–1078. DOI: 10.1128/IAI.01455-06

14. Calcaterra V., Amici M.D., Klersy C., Torre C., Brizzi V., Scaglia F. et al. Adiponectin, IL-10 and metabolic syndrome in obese children and adolescents. Acta Biomed 2009; 80: 117–123. DOI: 10.1111/j.1365-2265.2007.03115.x

15. Macé K., Steenhout P., Klassen P., Donnet A. Protein quality and quantity in cow’s milk-based formula for healthy term infants: past, present and future. Nestle Nutr Workshop Ser Pediatr Program 2006; 58: 189–205. DOI: 10.1159/000095063

16. Roland-Cachera M.F., Deheeger M., Akrout M. Influence of adiposity development: follow-up study of nutrition and grow from 10 months to 8 years of age. Int J Obes Relat Metab Disord 1995; 19: 573–578.

17. Guerre-Mille M., Rouault C., Poulain P., André J., Poitout V., Peters J.M. et al. PPAR-γ -null mice are protected from high-fat diet-induced insulin resistance. Diabetes 2001; 50: 2809–2814.

18. Molnar D., Porszasz J. The effect of fasting hyperinsulinaemia on physical fitness in obese children. Eur J Pediatr 1990; 149 (8): 570–573.

19. Teitelbaum J.E., Sinha P., Micale M., Yeung S., Jaeger J. Obesity is related to multiple functional abdominal diseases. J Pediatr 2009; 154 (3): 444–446. DOI: 10.1016/j.jpeds.2008.09.053

20. Bokova T.A., Ursova N.I., Lukina E.V., Koshurnikova A.S. The state of the digestive system in children with metabolic syndrome – topical issues of diagnosis and treatment. Textbook. Moscow: MONIKI 2015; 27. (in Russ)

21. Zimmet P., Alberti K.G., Kaufman F., Tajima N., Silink M., Arslanian S., Wong G., Bennett P., Shaw J., Caprio S., IDF Consensus Group. The metabolic syndrome in children and adolescents – an IDF consensus report. Pediatr Diabetes 2007; 8 (5): 299–306. DOI: 10.1111/j.1399-5448.2007.00271.x

22. Plavinski S.L. Biostatistika. Planning, processing and presentation of the results of biomedical research using the SAS system. SPb 2005; 153. (in Russ)

23. Fletcher R., Fletcher S., Vagner E. Clinical epidemiology. Fundamentals of evidence-based medicine. Moscow: Media Sfera 1998; 345. (in Russ)

24. Babanov S.A., Vorobiova E.V., Gailis P.V. Epidemiology of non-communicable diseases: challenges at the modern stage. Profilakticheskaya meditsina 2011; 3: 11–14. (in Russ)