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Kilolu Çocuklarda Metabolik Sendrom Sıklığı ve Özelliklerinin Araştırılması

Yıl 2022, Cilt: 44 Sayı: 4, 525 - 532, 19.07.2022
https://doi.org/10.20515/otd.1023692

Öz

Amaç: Fazla kilolu ve obez çocuklarda metabolik sendrom (MS) sıklığını ve özelliklerinin belirtilmesi
Yöntem: Çalışmaya İstanbul Okmeydanı Eğitim ve Araştırma Hastanesi Çocuk Sağlığı ve Hastalıkları polikliniğine başvuran sistemik, endokrin veya nörolojik hastalığı olmayan 102 fazla kilolu ve obez vaka alındı. Vakalar MS klinik bulguları, antropometrik ölçümler ve laboratuvar sonuçları (insülin direnci, kan şekeri, ‘high density lipoptorein’ (HDL) kolesterol (HDL-C), ‘low density lipoprotein’ (LDL) kolesterol (LDL-C), ‘very low density lipoprotein’ VLDL kolesterol (VLDL-C), trigliserit, C-reaktif protein (CRP), aspartat transaminaz (AST), alanin transaminaz (ALT), üre ve kreatinin düzeyleri) açısından araştırıldı, aile öyküleri sorgulandı. MS tanısını koymak için modifiye “National Cholesterol Education Program Adult Treatment Panel III” (NCEP/ATP III) kriterleri kullanıldı.
Bulgular: Vakaların ortalama yaşı 10.14±2.56 yıl (min:4 maks:15 yıl), %52.9’u (n=54) kız, %47.1’i (n=48) erkek idi. Çalışmaya alınan çocuk ve adolesanların %28.4’ü (n:29) fazla ağırlıklı ve %71.6’sı (n:73) obezdi. Obez ve fazla kilolu hastalarda hastalarda MS sıklığı sırasıyla %50,6 (n:37) ve %37,9 (n=11) idi. MS(+) olan grupta MS(-) olan gruba kıyasla aile öyküsünde MS olması (p=0,021), insülin direnci (p<0,001), açlık kan şekeri yüksekliği (p=0,008), akantozis nigrikans saptanması (p=0,021), hipertansiyon (p=0,001), bel çevresinde artış (p=0,014), CRP yüksekliği (p=0,048), trigliserit yüksekliği (p=0,008), VLDL-C yüksekliği (p=0,002) ve HDL-C düşüklüğü (p=0,047) istatistiksel olarak anlamlıydı.
Sonuç: Fazla ağırlıklı hastaların da obez vakalar gibi MS açısından tetkik ve takibi gereklidir. Ülkemizde MS sıklığının tespiti için çok merkezli prospektif çalışmalar gerekmektedir.

Destekleyen Kurum

Yoktur

Kaynakça

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Investigation of Metabolic Syndrome Frequency and Characteristics in Overweight Children

Yıl 2022, Cilt: 44 Sayı: 4, 525 - 532, 19.07.2022
https://doi.org/10.20515/otd.1023692

Öz

To investigate the frequency and characteristics of metabolic syndrome (MS) in overweight and obese children. We included 102 overweight and obese cases without systemic, endocrine, or neurological diseases who applied to Istanbul Okmeydanı Training and Research Hospital Pediatrics Outpatient Clinic in the study. We investigated the patients in terms of MS clinical findings, anthropometric measurements, laboratory results (insulin resistance, blood glucose, 'high-density lipoprotein (HDL) cholesterol (HDL-C), 'low-density lipoprotein' (LDL) cholesterol (LDL-C), 'very low' Density lipoprotein (CLDL) cholesterol (VLDL-C), triglyceride, C-reactive protein (CRP), aspartate transaminase (AST), alanine transaminase (ALT), urea and creatinine levels), and family histories. Modified "National Cholesterol Education Program Adult Treatment Panel III" (NCEP ATP III) criteria were used to diagnose MS. The mean age of the cases was 10.14±2.56 years (min:4 max:15 years), 52.9% (n=54) were female, 47.1% (n=48) were male. Of the children and adolescents included in the study, 28.4% (n: 29) were overweight and 71.6% (n: 73) were obese. The prevalence of MS in obese and overweight patients was 50.6% (n:37) and 37.9% (n=11), respectively. In the MS(+) group compared to the MS(-) group, having MS in the family history (p=0.021), insulin resistance (p<0.001), high fasting blood glucose (p=0.008), acanthosis nigricans (p=0.021), hypertension (p=0.001), increase in waist circumference (p=0.014), high CRP (p=0.048), high triglyceride (p=0.008), high VLDL-C (p=0.002) and low HDL-C (p=0.047) ) was statistically significant. Examination and follow-up of overweight patients in terms of Metabolic syndrome is required, just like obese patients. Multicenter prospective studies are needed to determine the frequency of MS in our country.

Kaynakça

  • NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet. 2017 Dec 16;390(10113):2627-2642. doi: 10.1016/S0140-6736(17)32129-3. Epub 2017 Oct 10. PMID: 29029897; PMCID: PMC5735219.
  • Berenson GS, Srinivasan SR, Bao W, Newman WP 3rd, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med. 1998 Jun 4;338(23):1650-6. doi: 10.1056/NEJM199806043382302. PMID: 9614255.
  • Reaven G. The metabolic syndrome or the insulin resistance syndrome? Different names, different concepts, and different goals. Endocrinol Metab Clin North Am. 2004 Jun;33(2):283-303. doi: 10.1016/j.ecl.2004.03.002. PMID: 15158520.
  • Reaven GM. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes. 1988 Dec;37(12):1595-607. doi: 10.2337/diab.37.12.1595. PMID: 3056758.
  • Shulman GI. Ectopic fat in insulin resistance, dyslipidemia, and cardiometabolic disease. N Engl J Med. 2014 Sep 18;371(12):1131-41. doi: 10.1056/NEJMra1011035. Erratum in: N Engl J Med. 2014 Dec 4;371(23):2241. PMID: 25229917.
  • Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC Jr, Spertus JA, Costa F; American Heart Association; National Heart, Lung, and Blood Institute. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005 Oct 25;112(17):2735-52.
  • Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, Yeckel CW, Allen K, Lopes M, Savoye M, Morrison J, Sherwin RS, Caprio S. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med. 2004 Jun 3;350(23):2362-74. doi: 10.1056/NEJMoa031049. PMID: 15175438.
  • Günöz, H., Öcal, G., Yordam, N., & Kurtoğlu, S. (2003). Pediatrik Endokrinoloji. 1. basım. Pediatric Endokrinoloji ve Oksoloji Derneği Yayınları, Kalkan matbaacılık, Ankara, 768-769.
  • Neyzi O, Ertuğrul T, (2002). Pediatri 1. 3. baskı. Nobel Tip Kitabevleri, Ankara, 91-96.
  • Arslan, M., Atmaca, A., Ayvaz, G., Başkal, N., Beyhan, Z., Bolu, E., ... & Yılmaz, M. (2009). Metabolik sendrom klavuzu. Türkiye Endokrinoloji ve Metabolizma Derneği.
  • Smetanina N, Valickas R, Vitkauskiene A, Albertsson-Wikland K, Verkauskienė R. Prevalence of Metabolic Syndrome and Impaired Glucose Metabolism among 10- to 17-Year-Old Overweight and Obese Lithuanian Children and Adolescents. Obes Facts. 2021;14(3):271-282. doi: 10.1159/000514720. Epub 2021 May 5. PMID: 33951670; PMCID: PMC8255643.
  • Gauthier BM, Hickner JM, Noel MM. High prevalence of overweight children in Michigan primary care practices. An UPRNet study. Upper Peninsula Research Network. J Fam Pract. 2000 Jan;49(1):73-6. PMID: 10678343.
  • Pucci G, Alcidi R, Tap L, Battista F, Mattace-Raso F, Schillaci G. Sex- and gender-related prevalence, cardiovascular risk and therapeutic approach in metabolic syndrome: A review of the literature. Pharmacol Res. 2017 Jun;120:34-42. doi: 10.1016/j.phrs.2017.03.008. Epub 2017 Mar 12. PMID: 28300617.
  • Cook S, Weitzman M, Auinger P, Nguyen M, Dietz WH. Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination Survey, 1988-1994. Arch Pediatr Adolesc Med. 2003 Aug;157(8):821-7. doi: 10.1001/archpedi.157.8.821. PMID: 12912790.
  • Friend A, Craig L, Turner S. The prevalence of metabolic syndrome in children: a systematic review of the literature. Metab Syndr Relat Disord. 2013 Apr;11(2):71-80. doi: 10.1089/met.2012.0122. Epub 2012 Dec 18. PMID: 23249214.
  • Davidsson L, Alkhabbaz E, Vijayan V, Alhubail A, Shaltout A, Alkandari H. Intermediate hyperglycaemia, insulin resistance and metabolic syndrome among obese Arab children (12-17 years old) in Kuwait. Prim Care Diabetes. 2021 Feb;15(1):191-193. doi: 10.1016/j.pcd.2020.02.001. Epub 2020 Feb 19. PMID: 32085984.
  • Retnakaran R, Zinman B, Connelly PW, Harris SB, Hanley AJ. Nontraditional cardiovascular risk factors in pediatric metabolic syndrome. J Pediatr. 2006 Feb;148(2):176-82. doi: 10.1016/j.jpeds.2005.08.025. PMID: 16492425.
  • Al-Hamad D, Raman V. Metabolic syndrome in children and adolescents. Transl Pediatr. 2017 Oct;6(4):397-407. doi: 10.21037/tp.2017.10.02. PMID: 29184820; PMCID: PMC5682379.
  • van Vliet-Ostaptchouk, J. V., Nuotio, M. L., Slagter, S. N., Doiron, D., Fischer, K., Foco, L., ... & Wolffenbuttel, B. H. (2014). The prevalence of metabolic syndrome and metabolically healthy obesity in Europe: a collaborative analysis of ten large cohort studies. BMC endocrine disorders, 14(1), 1-13.
  • Barstad LH, Júlíusson PB, Johnson LK, Hertel JK, Lekhal S, Hjelmesæth J. Gender-related differences in cardiometabolic risk factors and lifestyle behaviors in treatment-seeking adolescents with severe obesity. BMC Pediatr. 2018 Feb 14;18(1):61. doi: 10.1186/s12887-018-1057-3. PMID: 29444663; PMCID: PMC5813385.
  • Calcaterra V, Larizza D, De Silvestri A, Albertini R, Vinci F, Regalbuto C, Dobbiani G, Montalbano C, Pelizzo G, Cena H. Gender-based differences in the clustering of metabolic syndrome factors in children and adolescents. J Pediatr Endocrinol Metab. 2020 Feb 25;33(2):279-288. doi: 10.1515/jpem-2019-0134. PMID: 31927520.
  • Boney CM, Verma A, Tucker R, Vohr BR. Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics. 2005 Mar;115(3):e290-6. doi: 10.1542/peds.2004-1808. PMID: 15741354.
  • Pathirana MM, Lassi ZS, Ali A, Arstall MA, Roberts CT, Andraweera PH. Association between metabolic syndrome and gestational diabetes mellitus in women and their children: a systematic review and meta-analysis. Endocrine. 2021 Feb;71(2):310-320. doi: 10.1007/s12020-020-02492-1. Epub 2020 Sep 15. PMID: 32930949.
  • Paek KW, Chun KH, Lee KW. Relationship between metabolic syndrome and familial history of hypertension/stroke, diabetes, and cardiovascular disease. J Korean Med Sci. 2006 Aug;21(4):701-8. doi: 10.3346/jkms.2006.21.4.701. PMID: 16891816; PMCID: PMC2729894.
  • Liese AD, Mayer-Davis EJ, Tyroler HA, Davis CE, Keil U, Schmidt MI, Brancati FL, Heiss G. Familial components of the multiple metabolic syndrome: the ARIC study. Diabetologia. 1997 Aug;40(8):963-70. doi: 10.1007/s001250050775. Erratum in: Diabetologia 1998 May;41(5):608. PMID: 9267993.
  • Williams JE, Paton CC, Siegler IC, Eigenbrodt ML, Nieto FJ, Tyroler HA. Anger proneness predicts coronary heart disease risk: prospective analysis from the atherosclerosis risk in communities (ARIC) study. Circulation. 2000 May 2;101(17):2034-9. doi: 10.1161/01.cir.101.17.2034. PMID: 10790343.
  • Park HS, Park JY, Cho SI. Familial aggregation of the metabolic syndrome in Korean families with adolescents. Atherosclerosis. 2006 May;186(1):215-21. doi: 10.1016/j.atherosclerosis.2005.07.019. Epub 2005 Aug 26. PMID: 16126214.
  • Magge SN, Goodman E, Armstrong SC; COMMITTEE ON NUTRITION; SECTION ON ENDOCRINOLOGY; SECTION ON OBESITY. The Metabolic Syndrome in Children and Adolescents: Shifting the Focus to Cardiometabolic Risk Factor Clustering. Pediatrics. 2017 Aug;140(2):e20171603. doi: 10.1542/peds.2017-1603. PMID: 28739653.
  • Adıyaman, P., Ocal, G., Berberoğlu, M., Aycan, Z., Evliyaoğlu, O., & Çetinkaya, E. (2002, September). Hyperinsulinism and dyslipidemia in glucose tolerant and intolerant obese children. In 41 st Annual Meeting of the European Society for Pediatric Endocrinology (pp. 25-28).
  • Sentalin PBR, Pinheiro AO, Oliveira RR, Zângaro RA, Campos LA, Baltatu OC. Obesity and metabolic syndrome in children in Brazil: The challenge of lifestyle change. Medicine (Baltimore). 2019 May;98(19):e15666. doi: 10.1097/MD.0000000000015666. PMID: 31083270; PMCID: PMC6531096.
  • Tresaco B, Bueno G, Moreno LA, Garagorri JM, Bueno M. Insulin resistance and impaired glucose tolerance in obese children and adolescents. J Physiol Biochem. 2003 Sep;59(3):217-23. doi: 10.1007/BF03179918. PMID: 15000453.
  • Saltiel AR, Kahn CR. Insulin signalling and the regulation of glucose and lipid metabolism. Nature. 2001 Dec 13;414(6865):799-806. doi: 10.1038/414799a. PMID: 11742412.
  • Das RR, Mangaraj M, Panigrahi SK, Satapathy AK, Mahapatro S, Ray PS. Metabolic Syndrome and Insulin Resistance in Schoolchildren From a Developing Country. Front Nutr. 2020 Mar 31;7:31. doi: 10.3389/fnut.2020.00031. PMID: 32296710; PMCID: PMC7141174.
  • Ten S, Maclaren N. Insulin resistance syndrome in children. J Clin Endocrinol Metab. 2004 Jun;89(6):2526-39. doi: 10.1210/jc.2004-0276. PMID: 15181020.
  • Fu JF, Liang L, Dong GP, Jiang YJ, Zou CC. [Obese children with benign acanthosis nigricans and insulin resistance: analysis of 19 cases]. Zhonghua Er Ke Za Zhi. 2004 Dec;42(12):917-9. Chinese. PMID: 15733362.
  • Bray GA. Complications of obesity. Ann Intern Med. 1985 Dec;103(6 ( Pt 2)):1052-62. doi: 10.7326/0003-4819-103-6-1052. PMID: 4062125.
  • Jmal L, Jmal A, Abdennebi M, Feki M, Boukthir S. Prevalence of metabolic syndrome in Tunisian overweight and obese children. Tunis Med. 2019 Jan;97(1):133-139. PMID: 31535705.
  • Cruz ML, Goran MI. The metabolic syndrome in children and adolescents. Curr Diab Rep. 2004 Feb;4(1):53-62. doi: 10.1007/s11892-004-0012-x. PMID: 14764281.
  • DeBoer MD. Assessing and Managing the Metabolic Syndrome in Children and Adolescents. Nutrients. 2019 Aug 2;11(8):1788. doi: 10.3390/nu11081788. PMID: 31382417; PMCID: PMC6723651.
  • Hansen BC. The metabolic syndrome X. Ann N Y Acad Sci. 1999 Nov 18;892:1-24. doi: 10.1111/j.1749-6632.1999.tb07782.x. PMID: 10842649.
  • Genoni G, Menegon V, Secco GG, Sonzini M, Martelli M, Castagno M, Ricotti R, Monzani A, Aronici M, Grossini E, Di Mario C, Bona G, Bellone S, Prodam F. Insulin resistance, serum uric acid and metabolic syndrome are linked to cardiovascular dysfunction in pediatric obesity. Int J Cardiol. 2017 Dec 15;249:366-371. doi: 10.1016/j.ijcard.2017.09.031. Epub 2017 Sep 14. PMID: 28935462.
  • Fröhlich M, Imhof A, Berg G, Hutchinson WL, Pepys MB, Boeing H, Muche R, Brenner H, Koenig W. Association between C-reactive protein and features of the metabolic syndrome: a population-based study. Diabetes Care. 2000 Dec;23(12):1835-9. doi: 10.2337/diacare.23.12.1835. PMID: 11128362.
  • Festa A, D'Agostino R Jr, Howard G, Mykkänen L, Tracy RP, Haffner SM. Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS). Circulation. 2000 Jul 4;102(1):42-7. doi: 10.1161/01.cir.102.1.42. PMID: 10880413.
  • Lambert M, Delvin EE, Paradis G, O'Loughlin J, Hanley JA, Levy E. C-reactive protein and features of the metabolic syndrome in a population-based sample of children and adolescents. Clin Chem. 2004 Oct;50(10):1762-8. doi: 10.1373/clinchem.2004.036418. Epub 2004 Aug 12. PMID: 15308596.
  • Gutin B, Owens S, Treiber F, Islam S, Karp W, Slavens G. Weight-independent cardiovascular fitness and coronary risk factors. Arch Pediatr Adolesc Med. 1997 May;151(5):462-5. doi: 10.1001/archpedi.1997.02170420032005. PMID: 9158437.
  • Wattigney WA, Harsha DW, Srinivasan SR, Webber LS, Berenson GS. Increasing impact of obesity on serum lipids and lipoproteins in young adults. The Bogalusa Heart Study. Arch Intern Med. 1991 Oct;151(10):2017-22. PMID: 1929690.
Toplam 46 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm ORİJİNAL MAKALELER / ORIGINAL ARTICLES
Yazarlar

Akan Yaman 0000-0002-7550-6765

İbrahim Kandemir 0000-0002-1720-9711

Fügen Pekün 0000-0003-1337-9657

Yayımlanma Tarihi 19 Temmuz 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 44 Sayı: 4

Kaynak Göster

Vancouver Yaman A, Kandemir İ, Pekün F. Kilolu Çocuklarda Metabolik Sendrom Sıklığı ve Özelliklerinin Araştırılması. Osmangazi Tıp Dergisi. 2022;44(4):525-32.


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