Metabolic syndrome in children (literature review)

Abstract

Abstract. The review article presents the results of years of research of domestic and foreign scientists regarding the metabolic syndrome, which is one of the most important issues of modern medical science. This pathology combines such important components as abdominal obesity, reduced tolerance to carbohydrates, insulin resistance, dyslipidemia, hyperinsulinemia, chronic or acute arterial hypertension, hyperandrohenia in girls, reduced fibrinolytic activity, microalbuminuria, and hyperuricemia, which cause rapid development of complications leading to social exclusion, disability, and mortality. The main etiological factors of the metabolic syndrome are considered a genetic predisposition, poor diet, and lack of physical exercise. Hyperinsulinemia and insulin resistance, endocrine dysfunction of internal fat, excessive activity of sympathoadrenal and reninanhiotenzin-aldosterone systems, endothelial dysfunction, thus developing metabolic disorders, are important in the pathogenesis of the metabolic syndrome and its complications. The only criteria for the diagnosis of major components of the metabolic syndrome are obesity, hypertension, hyperglycemia, increased triglycerides, reduced levels of HDLP (high-density lipoprotein) in boys and girls. Anthropometric parameters in children and adolescents depend on age and gender, so for the diagnosis of overweight there are used protsentyl tables of BMI (body mass index) distribution in the population according to the age and gender. The evaluation of insulin resistance should consider not only the insulin level but also the level of glucose, which is important to identify the violations of glucose tolerance. Hyperinsulinemia against the backdrop of normoglycemia usually indicates the presence of insulin resistance. For the diagnosis of insulin resistance one can use the oral glucose ratio calculation of correlation between insulin and plasma glucose at the beginning and after two hours. In order to detect insulin resistance one can also use calculated indices of insulin sensitivity and insulin resistance. In children and adolescents, comprehensive treatment of the metabolic syndrome should include a complete change of lifestyle, concomitant treatment of obesity, abnormalities of carbohydrate metabolism, hypertension, and dyslipidemia. This change provides prompt normalization of regime and diet of the child, optimization of his/her physical exercise, comprehensive psychotherapy, problem-targeted training programs, and strict self-control. The main approach to the treatment of the metabolic syndrome in children is to optimize their lifestyle with increased physical activity and diet destination. The child should walk more, engage in various sports, and spend more time outdoors. At the same time, the child should be limited with a computer or TV. The diet should be highly calorific—with restriction of refined fats and «empty» carbohydrates (chocolate, sweet drinks, candy, and sugar). It is necessary to enrich the diet of the child with fruit and vegetables, as they are the main source of fiber. Meals should bring to 4-5 times a day, with breakfast must be complete. The metabolic syndrome in children and adults is easier to prevent than to cure, and to this should lead a healthy lifestyle; Резюме. В оглядовій статті наведені результати багаторічних досліджень вітчизняних та іноземних науковців стосовно метаболічного синдрому, який є одним із найважливіших питань сучасної медичної науки. Дана патологія поєднує такі важливі складові, як абдомінальне ожиріння, зниження толерантності до вуглеводів, інсулінорезистентність, дисліпідемію, гіперінсулінемію, хронічну або гостру артеріальну гіпертензію, гіперандрогенію у дівчат, знижену фібринолітичну активність, мікроальбумінурію, гіперурикемію, які спричиняють швидкий розвиток ускладнень, призводять до соціальної дезадаптації, інвалідності та смертності; Резюме. В обзорной статье представлены результаты многолетних исследований отечественных и иностранных ученых касательно метаболического синдрома, который является одним из самых важных вопросов современной медицинской науки. Данная патология объединяет такие важные составляющие, как абдоминальное ожирение, снижение толерантности к углеводам, инсулинорезистентность, дислипидемию, гиперинсулинемию, хроническую или острую артериальную гипертензию, гиперандрогению у дево- чек, сниженную фибринолитическую активность, микроальбуминурию, гиперурикемию, которые приводят к социальной дезадаптации, инвалидности и смертности.