Epidemiološke i kliničke karakteristike gojazne dece sa metaboličkim komplikacijama gojaznosti i bez njih

Abstract

REZIME: Pandemija gojaznosti u populaciji dece i adolescenata predstavlja značajan javno zdravstveni problem na šta ukazuje trostruki porast prevalencije gojaznih među mladima u Srbiji tokom poslednjih 13 godina. Uporedo sa porastom učestalosti gojaznosti kod mladih uočava se porast prevalencije i ranija pojava komplikacija gojaznosti kao što su tip 2 dijabetesa melitusa i drugih poremećaja koji se opisuju u sklopu metaboličkog sindroma. Cilj ove teze bio je da se odredi učestalost metaboličkih komplikacija kod gojazne dece i adolescenata, kao i da se analiziraju epidemiološke i kliničke karakteristike gojazne dece i adolescenata sa i bez metaboličkih komplikacija gojaznosti. U okviru ove retrospektivne kohortne studije bilo je uključeno 411 gojazne dece i adolescenata, uzrasta 5-19 godina. Podaci o ispitanicima prikupljeni su iz medicinske dokumentacije Službe za endokrinologiju Instituta za zdravstvenu zaštitu majke i deteta Srbije „Dr Vukan Čupić“ u Beogradu. Od poznatih metaboličkih komplikacija gojaznosti kod 0,7% dece i adolescenata otkriven je tip 2 dijabetesa melitusa, 58,1% je imalo niske vrednosti HDL holesterola, 21,3% hipertrigliceridemiju, 16,0% povećanu koncentraciju ukupnog holesterola, 20,2% povećanu koncentraciju LDL holesterola, 46,5% arterijsku hipertenziju, 44,5% hiperinsulinemiju, 67,9% rezistenciju na insulin, 16,5% povišen nivo aminotransferaza, a 45,2% hiperuricemiju. Ispitivana deca i adolescenti bez metaboličkih komplikacija gojaznosti u odnosu na ispitanike sa metaboličkim komplikacijama bili su u proseku mlađi i u ranijim stadijumima pubertetskog razvoja, imali su manju prevalenciju ekstremne i abdominalne gojaznosti, akantoze nigrikans, hiperinsulinemije, rezistencije na insulin, hiperholesterolemije, povišenih koncentracija LDL holesterola, aminotransferaza i mokraćne kiseline. Rezultati istraživanja ukazuju na visoku prevalenciju metaboličkih komplikacija kod gojazne dece i adolescenata što hitno zahteva niz javno zdravstvenih mera u cilju zaustavljanja epidemije gojaznosti među mladima u našoj zemlji.

ABSTRACT: Pandemic of childhood obesity represents one of the most important global public health issues, also supported by the fact that during the last 13 years prevalence of childhood obesity has tripled in Serbia. With the rise in the prevalence of obesity in youth, increasing prevalence and earlier occurrence of obesity-related comorbidities such as type 2 diabetes has been observed in the pediatric population. The aim of the present study was to assess the prevalence of metabolic complications of obesity in obese children and adolescents, as well as to analyze epidemiological and clinical characteristics of the obese youth with and without metabolic complications of obesity. Total of 411 obese children and adolescents, aged 5-19 years were included in this retrospective cohort study. Data were acquired by analyzing medical records of the Department of Endocrinology in the Institute of Mother and Child Healthcare of Serbia “Dr Vukan Čupić” in Belgrade. Among investigated metabolic complications of obesity, type 2 diabetes was discovered in 0.7%, low HDL cholesterol in 58.1%, high triglycerides in 21.3%, high total cholesterol in 16%, high LDL cholesterol in 20.2%, hypertension in 46.5%, hyperinsulinaemia in 44.5%, insulin resistance in 67.9%, high transaminases 16,5%, and hyperuricemia in 45,2% of the subjects. When compared to subjects with metabolic complications of obesity, subjects without metabolic complications were younger and in the earlier stages of pubertal development, with lower degree of obesity and abdominal obesity. Obese children and adolescents without metabolic complications of obesity also had lower prevalence of acanthosis nigricans, hyperinsulinaemia, insulin resistance, hypercholesterolemia, high LDL cholesterol, high transaminases and hyperuricemia. Results of the present study show high prevalence of metabolic disturbances in obese children and adolescents, which emphasizes the urgent need for advanced preventive strategies in order to oppose the epidemic of childhood obesity in Serbia.