Çocuklarda Metabolik Sendromun Tedavisinde Beslenme Yönetimi

Yıl 2012, , 92 - 97, 01.12.2012

Nalan Hakime Noğay , Gülden Köksal

https://doi.org/10.4274/Jcp.10.04

Öz

Metabolik sendrom, merkezi yada abdominal obezite, hipertrigliseridemi,hipertansiyon, düşük HDL kolesterol ve yüksek açlık glukoz düzeylerinden en az üçünesahip olunması olarak tanımlanmaktadır. Metabolik sendrom daha çok erişkinlerinsorunu olarak bilinirken, son yıllarda çocuklarda da önemli bir sorun olarak karşımızaçıkmaktadır. Çocuklarda metabolik sendromun tanımlanmasında değişik araştırmagrupları tarafından önerilen farklı tanımlamalar vardır. Bu tanımların hepsi deobezitenin bir parçası olan BKI Beden Kitle İndeksi ve bel çevresini, dislipidemininbir parçası olan yükselmiş trigliserit ve düşük HDL kolesterol, yükselmiş kan basıncı veglukoz metabolizmasının bir göstergesi olan bozulmuş açlık glukoz toleransı ya dabozulmuş açlık insülin düzeyleri gibi özellikleri içermektedir. IDF Uluslar arası DiyabetFederasyonu çocuklarda yaş ile ilgili farklılıklardan dolayı, tanımlamaların yaşgruplarına göre yapılmasını önermiştir. Çocuklarda obezite sıklığının artması,metabolik sendrom sıklığını arttıran en önemli neden olarak kabul edilmektedir.Metabolik sendromun bileşenleri kilo kontrolü, diyet ve fiziksel aktivite gibi farklıyaşam tarzı ile kontrol edilebilmektedir. Bu nedenle metabolik sendromun tedavisindeöncelikle beslenme alışkanlıkları ve fiziksel aktivite gibi etmenlere yönelik müdahaleyapılmalıdır. Bu derleme yazıda çocuklarda metabolik sendromun beslenme tedavisi tartışılacaktır

Anahtar Kelimeler

Metabolik sendrom, beslenme, çocuklar

Nutritional Management of Metabolic Syndrome in Children

Öz

The metabolic syndrome is defined as the presence of at least three of the followingcriteria: central or abdominal obesity, hypertrglyceridemia, hypertension, low HDLcholesterol and high fasting glucose levels in an individual. Although metabolicsyndrome is known as a problem of adults, in recent years it appears to be a majorproblem in children also. Identification of the metabolic syndrome in children is basedon different definitions proposed by different research groups. All of the definitionsshare common features: First, all definitions include an obesity element waistcircumference or BMI , two “dyslipidemia” elements elevated triglycerides and lowHDL cholesterol , elevated blood pressure, and a component representing glucosemetabolism impaired fasting glucose or impaired glucose tolerance . Because of theage-related differences in children and adolescents, the IDF suggests definingmetabolic syndrome according to age groups. The increase in the prevalence ofobesity in children, increase in the frequency of metabolic syndrome leading to thecause. Components of metabolic syndrome can be controlled separately by lifestyleinterventions such as weight control, diet, and physical activity. Therefore, the primarytreatment of metabolic syndrome should focus on factors such as dietary habits andphysical activity. In this article, we discuss nutritional therapy of the metabolicsyndrome in children

Anahtar Kelimeler

Metabolic syndrome, nutrition, children

Kaynakça

• 1. Mallare JT, Karabell AH, Velasques-Mieyer P, Stender SRS, Christensen ML. Current and future treatment of metabolic syndrome and type 2 diabetes in children and adolescents. Diabetes Spectrum 2005;18:220-8.
• 2. Halpern A, Mancini MC, Magalhães ME, Fisberg M, Radominski R, Bertolami MC , et al. Metabolic syndrome, dyslipidemia, hypertension and type 2 diabetes in youth: from diagnosis to treatment. Diabetol Metab Syndr 2010;2:55.
• 3. McAuley K, Mann J. Thematic review series: patient-oriented research. Nutritional determinants of insulin resistance. J Lipid Res 2006;47: 1668-76.
• 4. Breslow JL. N-3 fatty acids and cardiovascular disease. Am J Clin Nutr 2006;83:1477-82.
• 5. Canete R, Gil-Campos M, Aguilera CM, Gil A. Development of insulin resistance and its relation to diet in the obese child. Eur J Clin Nutr 2007;46:181-7.
• 6. Casazza K, Dulin-Keita A, Gower BA, Fernandez JR. Differential influence of diet and physical activity on components of metabolic syndrome in a multiethnic sample of children. J Am Diet Assoc 2009;109:236-44.
• 7. Aeberli I. Nutritional risk factors for the metabolic syndrome in overweight children. Degree of Doctor of Sciences. Zurich ZH, Switzerland, 2008.
• 8. Mrdjenovic G, Levitsky DA. Nutritional and energetic consequences of sweetened drink consumption in 6-to-13 year old children. J Pediatr 2003;142:604-10.
• 9. Nguyen S, Choi HK, Lusting RH, Hsu CY. Sugar-sweetened beverages, serum uric acid, and blood pressure in adolescents. J Pediatr 2009;154:807-13.
• 10. Anderson JW, Baird P, Davis RH Jr, Ferreri S, Knudtson M, Koraym A, et al. Health benefits of dietary fiber. Nutrition Rev 2009;67:188-205.
• 11. Ventura EE, Davis JN, Alexander KE, Shaibi GQ, Lee W, ByrdWilliams CE, et al. Dietary intake and the metabolic syndrome in overweight Latino children. J Am Diet Assoc 2008;108:1355-9.
• 12. Davis JN, Alexander KE, Ventura EE, Toledo-Corral CM, Goran MI. Inverse relation between dietary fiber intake and visceral adiposity in overweight Latino youth. Am J Clin Nutr 2009;90:1160-6.
• 13. Vrolix R, van Meijl LE, Mensink RP. The metabolic syndrome in relation with the glycemic index and the glycemic load. Physiol Behav 2008;94:293-9.
• 14. Kelly A, Brooks LJ, Dougherty S, Carlow DC, Zemel BS. A cross-sectional study of vitamin D and insulin resistance in children. Arch Dis Child 2011;96:447-52.
• 15. Delvin EE, Lambert M, Levy E, O'Loughlin J, Mark S, GrayDonald K, et al. Vitamin D status is modestly associated with glycemia and indicators of lipid metabolism in FrenchCanadian children and adolescents. J Nutr 2010;140:987-91.
• 16. Huerta MG, Roemmich JN, Kington ML, Bovbjerg VE, Weltman AL, Holmes VF , et al. Magnesium deficiency is associated with insulin resistance in obese children. Diabetes Care 2005;28:1175-81.
• 17. Kelishadi R, Gouya MM, Adeli K, Ardalan G, Gheiratmand R, Majdzadeh R, et al. Factors associated with the metabolic syndrome in a national sample of youths: CASPIAN study. Nutr Metab and Cardiovasc Dis 2008;18:461-70.
• 18. Ma B, Lawson AB, Liese AD, Bell RA, Mayer-Davis EJ. Dairy, magnesium and calcium intake in relation to insulin sensitivity: approaches to modeling a dose-dependent association. Am J of Epidemiol 2006;164:449-58.
• 19. Cruz ML, Goran MI. The metabolic syndrome in children and adolescents. Curr Diab Rep 2004;4:53-62.
• 20. Barlow SE, Expert Committee. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 2007;120(Suppl 4):164-92.
• 21. August GP, Caprio S, Fennoy I, Freemark M, Kaufman FR, Lustig RH, et al. Prevention and treatment of pediatric obesity: an endocrine society clinical practice guideline based on expert opinion. J Clin Endocrinol Metab 2008;93:4576-99.
• 22. Krebs NF, Himes JH, Jacobson D, Nicklas TA, Guilday P, Styne D. Assesment of child and adolescent overweight and obesity. Pediatrics 2007;120(Suppl 4):193-228.
• 23. Division of Nutrition and Physical activity: Research to practice series no.4. Does breastfeeding reduce the risk of pediatric overweight? Atlanta: Centers for Disease Control and Prevention 2007.
• 24. Krebs NF, Gao D, Gralla J, Collins JS, Johnson SL. Efficacy and safety of a high protein, low carbohydrate diet for weight loss in severely obese adolescents. J Pediatr 2010;157:252-8.
• 25. Bennett B, Sothern MS. Diet, exercise, behavior: the promise and limits of lifestyle change. Semin Pediatr Surg 2009;18:152-8.
• 26. Daniels SR, Greer FR; Committee on Nutrition. Lipid screening and cardiovascular health in childhood. Pediatrics 2008;122:198-208.
• 27. Narchi H. Assessment and management of hypertension in children and adolescents: part b-investigations and management. Journal of Medical Sciences 2011;4:14-24.
• 28. Alton I. Hypertension. Guidelines for Adolescent Nutrition Services 2005; Chapter 11:125-35.
• 29. Lurbe E, Cifkova R, Cruickshank JK, Dillon MJ, Ferreira I, Invitti C, et al. Management of high blood pressure in children and adolescents: recommendations of the European Society of Hypertension. J Hypertens 2009;27:1719-42.
• 30. Smart C, Aslander-van Vliet E, Waldron S. Nutritional management in children and adolescents with diabetes. Pediatric Diabetes 2009;10:100-17.
• 31. The TODAY Study Group. Design of a family-based lifestyle intervention for youth with type 2 diabetes: the TODAY study. Int J Obes (Lond) 2010;34:217-26.