Prevalence of Metabolic Syndrome in Obese Prepubertal and Pubertal Children

Öz

Aim: Obesity associated with metabolic syndrome is characterized by glucose intolerance, insulin resistance, type 2 diabetes mellitus, dyslipidemia and other hormonal disorders in childhood. Unfortunately, if the preventive measures are not taken in time they become obese in the adult age. The prevalence of metabolic syndrome in the pediatric age group is still not well known in our country. The purpose of our study is to evaluate the prevalence of metabolic syndrome and other metabolic characteristics in the obese prepubertal and pubertal children.

Material and methods: We studied 70 obese children and adolescents. Each child was subjected to detailed examination including anthropometric measures, blood testing (biochemistry, blood fasting glucose, renal and hepatic function tests, lipids, electrolytes, hormonal testing including free T3, free T4, TSH, thyroid autoantibodies, fasting insulin levels and oral glucose tolerance test). The criteria of metabolic syndrome were defined according to modified WHO criteria. Homeostasis model assessment of insulin resistance (HOMA-IR) parameters were used as index of insulin resistance.

Results: Metabolic syndrome was found in 18.8% of cases. Metabolic syndrome was found in a significantly higher rate in the pubertal prepubertal group (P > 0.05). The data related with glucose homeostasis; fasting hyperinsulinemia, impaired glucose tolerance were 33.3% and 5.5% in the prepubertal group, where it was 64.7% and 23.5% in the pubertal group, respectively. Hypertension was observed in four pubertal cases (11.7%). Dyslipidemia were identified in 41.6% and 41.1% in prepubertal and pubertal groups, respectively, with no significant differences (P < 0.05).

Conclusion: Metabolic syndrome prevalence especially abnormal glucose homoeostasis among the obese pediatric age group was quite high. We suggested that, early diagnosis, regularly follow-up and if needed, treatment will prevent beta-cell destruction and development of type 2 diabetes mellitus in these cases.

Key words: Childhood obesity, obesity prevalence, metabolic syndrome, diabetes mellitus

Anahtar Kelimeler

• Childhood obesity, obesity prevalence, metabolic syndrome, diabetes mellitus

Obez Prepubertal ve Pubertal Çocuklarda Metabolik Sendrom Prevalansı

Öz

Amaç: Çocukluk çağında Metabolik Sendrom (MS), ilişkili obezite glukoz intoleransı, insülin direnci, tip 2 diabet, dislipidemi ve diğer hormonal bozukluklarla karakterizedir. Ne yazık ki Maalesef bu olgular koruyucu önlemler alınmadığı taktirde erişkin yaşamda obez hale gelecektirler. Pediatrik yaşta MS prevelansı ülkemizde halen iyi bilinmemektedir. Bu amaçla çalışmamızda prepubertal ve pubertal çocuklarda MS ve diğer metabolik özelliklere ait prevelansın değerlendirilmesi amaçlandı.

Gereç ve Yöntemler: 70 obez çocuk çalışmaya alındı. Antropometrik ölçümleri içeren detaylı muayenesi yapılan herbir çocuğa, kan biyokimyası; kan şekeri, renal ve hepatik fonksiyon testleri, lipidler, elektrolitler, hormonal değerlendirme için fT3, fT4, TSH tiroid otoantikorları, açlık insülin seviyeleri ve OGTT uygulandı. Metabolik sendrom kriterleri modifiye WHO kriterlerine göre tanımlandı. “Homeostasis model assessment of insulin resistance” (HOMA-IR) parametresi insülin rezistans indeksi olarak kullanıldı.

Bulgular: Tüm olgularda MS prevalansı %18,8 olarak saptandı. MS prepubertal gruba göre pubertal grupta anlamlı derecede yüksekti (P > 0,05). Glukoz homeostazına ilişkin bulgular, prepubertal grupta açlık hiperinsülinemisi, bozulmuş glukoz toleransı olup sırasıyla %33,3 ve %5,5 idi. Aynı bulgular pubertal grupta sırasıyla %64,7 ve %23,5 idi. Hipertansiyon 4 (%11,7) pubertal vakada gözlendi. Prepubertal ve pubertal grupta dislipidemi sırasıyla %41,6 ve %41,1 olarak saptandı. Bu yönü ile anlamlı farklılık yoktu (P < 0,05).

Sonuçlar: Obez pediatrik yaş grubunda özellikle anormal glukoz homeostazını içeren MS prevelansı belirgin yüksek saptandı. Sonuç olarak bu olgularda erken tanı, düzenli izlem ve gerekirse tedaviyle, beta hücre yıkımının ve tip 2 diabet gelişiminin önlenebileceği düşünülebilir.

Anahtar kelimeler: Çocukluk çağı obezitesi,obezite prevelansı, metabolik sendrom, diabetes mellitus.

Anahtar Kelimeler

• Çocukluk çağı obezitesi,obezite prevelansı, metabolik sendrom, diabetes mellitus

Kaynakça

1. Knerr I. Obesity and metabolic syndrome in children and adolescents. MMW Fortschr Med 2004; 146: 41-3.
2. Atabek EA, Pirgon O, Kurtoğlu S. Prevalence of metabolic syndrome in obese Turkish children and adolescents. Diab Res Clin Pract 2006; 72: 315-21.
3. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diab Med 1998; 15: 539-53.
4. Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child 1969; 44: 291-303.
5. ISPAD Clinical practice consensus guidelines 2014 Compendium. Definition, epidemiology and classification of diabetes in children and adolescents. In: Craig ME, Jefferies C, Dabelea D et al. Pediatric Diabetes 2014: 15 (Suppl.20) 4-17.
6. Conwell LS, Trost SG, Brown WJ, Batch JA. Indexes of insulin resistance and secretion in obese children and adolescents. Diab Care 27: 2004; 314-9.
7. Barkai L, Paragh G. Metabolic syndrome in childhood and adolescence. Orv Hetil 2006; 147: 243-50.
8. Valerio G, Licenziati MR, Iannuzi A et al. Insulin resistance and impaired glucose tolerance in obese children and adolescents from Southern Italy. Nutr Metab Cardiovasc Disease 2006; 16: 279-84.

9. Wiegand S, Maikowski U, Blankenstein O et al. Type 2 diabetes and impaired glucose tolerance in European children and adolescents with obesity - a problem that is no longer restricted to minority groups. Eur J Endocrinol 2004; 151: 191-206.
10. Chen W, Bao W, Begum S, Elkasabany A, Srinivasan SR, Berenson GS. Age-related patterns of the clustering of cardiovascular risk variables of syndrome X from childhood to young adulthood in a population made up of black and white subjects: the Bogalusa Heart Study. Diabetes 2000; 49: 1042-48.
11. Raitakari OT, Porkka KV, Ronnemaa T, et al. The role of insulin in clustering of serum lipids and blood pressure in children and adolescents. The cardiovascular risk in young Finns study. Diabetologia 1995; 38: 1042-50.
12. 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; 157: 821-7.
13. Cruz ML, Weigensberg MJ, Huang TT, Ball G, Shaibi GQ, Goran MI. The metabolic syndrome in overweight Hispanic youth and the role of insulin sensitivity. J Clin Endocrinol Metab 2004; 89: 108-13.
14. Babaoğlu K, Hatun S, Arslanoğlu I, et al. Evaluation of glucose intolerance in adolescents relative to adults with type 2 diabetes mellitus. J Pediatr Endocrinol Metab 2006; 19: 1319-26.
15. Boney CM, Verma A, Tucker R, Vohr B. Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics 2005; 115: 290-6.
16. Dabelea D, Hanson R, Lindsay R, et al. Intrauterine exposure to diabetes conveys risk for type 2 diabetes and obesity: a study of discordant sibships. Diabetes 2000; 49: 2208-11.