Doro Altan Anna Maria, Manca Bitti Maria Luisa, Buonomo Ersilia, Scarcella Paolo, Mancinelli Sandro, Arcano Susanna, Palombi Leonardo
Dipartimento di Sanità Pubblica - Università di Roma Tor Vergata.
Ig Sanita Pubbl. 2008 May-Jun;64(3):345-60.
Prevention of childhood obesity and of its complications is an increasingly important public health priority. During 2002-2003 a network of family paediatricians working in the territory of a local health organisation in Rome (Italy) was created, in order to evaluate the health status of obese children. A preferential diagnostic and therapeutic management workup procedure was then developed for these patients at the Paediatrics department of the "Policlinico Tor Vergata" (PTV) university teaching hospital in Rome (Italy).
Family paediatricians invited children aged 6-14 years with a body mass index (BMI) above the 95th percentile, to a clinical consultation at PTV where each child then underwent a clinical evaluation (including blood pressure measurement and evaluation of family history of cardiovascular disease and type 2 diabetes mellitus) and laboratory testing (including oral glucose tolerance testing-OGTT, measurement of cholesterol and trygliceride levels). The BMI z score and insulin resistance index (HOMA-IR) were also calculated and pubertal stage was assessed.
Overall, 168 children, with a mean age of 11 years, were evaluated; 53% were males. The mean BMI z score was 2.43+/-0.45. Forty-four percent of children were found to be hypertensive and 28.3% had a positive family history for type 2 diabetes mellitus. Fifteen children (9%) were found to have Impaired Glucose Tolerance (IGT) while one child was frankly diabetic. Thirty-six children (23.4%) were diagnosed with a metabolic syndrome (MS). Systolic blood pressure was significantly correlated with BMI z score and with 2 hour glucose levels. Obese children with either hypertension or a family history of diabetes were significantly more likely to have glucose intolerance or metabolic syndrome (GI, OR= 4.7 ; MS, OR= 6.8)
A high percentage of obese children and adolescents develop metabolic complications. The percentage of children with such complications is greater when other risk factors such as hypertension and family history of type 2 diabetes are present. Family paediatricians play a fundamental role in the prevention, evaluation and treatment of child obesity. This study underscores the importance of performing routine evaluations of BMI and blood pressure in children aged 6-14 years, eventually by extending well-child visits to this age group.
预防儿童肥胖及其并发症是日益重要的公共卫生优先事项。2002年至2003年期间，在意大利罗马一个地方卫生组织辖区内建立了一个家庭儿科医生网络，以评估肥胖儿童的健康状况。随后，在意大利罗马“托尔韦尔加塔综合医院”（PTV）大学教学医院的儿科为这些患者制定了优先诊断和治疗管理检查程序。
家庭儿科医生邀请体重指数（BMI）高于第95百分位数的6至14岁儿童到PTV进行临床会诊，每个儿童随后接受临床评估（包括血压测量以及心血管疾病和2型糖尿病家族史评估）和实验室检查（包括口服葡萄糖耐量试验-OGTT、胆固醇和甘油三酯水平测量）。还计算了BMI z评分和胰岛素抵抗指数（HOMA-IR）并评估了青春期阶段。
总体而言，共评估了168名儿童，平均年龄为11岁；53%为男性。平均BMI z评分为2.43±0.45。44%的儿童被发现患有高血压，28.3%有2型糖尿病家族史阳性。15名儿童（9%）被发现有糖耐量受损（IGT），1名儿童为明显糖尿病患者。36名儿童（23.4%）被诊断患有代谢综合征（MS）。收缩压与BMI z评分和2小时血糖水平显著相关。患有高血压或糖尿病家族史的肥胖儿童更有可能出现糖耐量异常或代谢综合征（糖耐量异常，OR = 4.7；代谢综合征，OR = 6.8）
很大比例的肥胖儿童和青少年会出现代谢并发症。当存在高血压和2型糖尿病家族史等其他危险因素时，患有此类并发症的儿童比例更高。家庭儿科医生在儿童肥胖的预防、评估和治疗中发挥着重要作用。本研究强调了对6至14岁儿童进行BMI和血压常规评估的重要性，最终可通过将儿童健康检查扩展至该年龄组来实现。
