Gajewska Joanna, Klemarczyk Witold, Ambroszkiewicz Jadwiga, Chełchowska Magdalena, Riahi Agnieszka, Zielińska Anna, Ołtarzewski Mariusz, Laskowska-Klita Teresa
Zakład Badań Przesiewowych, Instytut Matki i Dziecka w Warszawie.
Med Wieku Rozwoj. 2010 Oct-Dec;14(4):357-64.
Early childhood obesity may play an important role in development of the metabolic syndrome characterized by abnormalities in several major cardiovascular risk factors. Only a few studies demonstrate that weight reduction leads to an improvement of the atherogenic risk-factor profile in prepubertal children.
The aim of this study was to assess the concentration of C-peptide and selected parameters of lipid profile in prepubertal obese children before and after weight reduction therapy.
Changes in nutrition, anthropometric and biochemical parameters including C-peptide concentration and lipid profile were determined in 52 obese children (z-score BMI > or =2SD) aged 4-10 years, before and after a 3-months lifestyle intervention programme. This programme consisted of dietary (1200-1400 kcal/day) and physical activity modifications and behaviour therapy, including individual psychological care of the child and its family. The reference group consisted of 30 healthy normal-weight children. Total cholesterol, LDL and HDL-cholesterol and triglicerydes levels were measured by routine enzymatic methods. Concentration of C-peptide was determined using the immunoenzymatic kit.
All obese children were divided into two groups: A and B. In group A with decreased BMI by 10% (25.4 +/- 3.1 vs. 22.8 +/- 2.9 kg/mi; p < 0.01) after the 3-months therapy we found also decreased concentrations of triglicerydes and C-peptide by about 20% (77.9 +/- 28.5 vs. 60.7 +/- 17.5 mg/dl; p < 0.02) and 35% (2.96 +/- 1.52 vs. 1.94 +/- 1.40 ng/ml; p < 0.05) respectively. In group B, without changes in the BMI during therapy, no significant differences in these biochemical parameters were observed. Moreover, higher level of total cholesterol and LDL-cholesterol by 10% (p < 0.05) observed in this group may be related to dietary cholesterol, which was similar both at baseline and 3 months later.
We suggest that weight-reduction programme is necessary in prepubertal obese children with abnormal lipid profile as a prevention of metabolic syndrome in later life. Our findings support the beneficial effects of weight reduction programme if it is accepted by obese children and their parents. Additionally, we suggest, that C-peptide may be useful in monitoring of this therapy. Further studies with longer term intervention are needed to confirm the value of this biochemical marker in the management of prepubertal obese children.
儿童期肥胖可能在以几种主要心血管危险因素异常为特征的代谢综合征的发展中起重要作用。仅有少数研究表明体重减轻可改善青春期前儿童的动脉粥样硬化危险因素状况。
本研究的目的是评估青春期前肥胖儿童在减肥治疗前后C肽浓度和血脂谱的选定参数。
在52名4至10岁的肥胖儿童（z评分BMI≥2SD）中，测定了为期3个月的生活方式干预计划前后营养、人体测量和生化参数的变化，包括C肽浓度和血脂谱。该计划包括饮食（1200 - 1400千卡/天）、体育活动调整和行为疗法，包括对儿童及其家庭的个体心理护理。对照组由30名健康的正常体重儿童组成。总胆固醇、低密度脂蛋白和高密度脂蛋白胆固醇以及甘油三酯水平采用常规酶法测定。C肽浓度使用免疫酶试剂盒测定。
所有肥胖儿童分为A、B两组。在3个月治疗后BMI下降10%（25.4±3.1 vs. 22.8±2.9 kg/m²；p < 0.01）的A组中，我们还发现甘油三酯和C肽浓度分别下降了约20%（77.9±28.5 vs. 60.7±17.5 mg/dl；p < 0.02）和35%（2.96±1.52 vs. 1.94±1.40 ng/ml；p < 0.05）。在治疗期间BMI无变化的B组中，这些生化参数未观察到显著差异。此外，该组中观察到的总胆固醇和低密度脂蛋白胆固醇水平升高10%（p < 0.05）可能与饮食胆固醇有关，在基线和3个月后饮食胆固醇相似。
我们建议，对于血脂谱异常的青春期前肥胖儿童，减肥计划对于预防日后生活中的代谢综合征是必要的。我们的研究结果支持减肥计划的有益效果，前提是肥胖儿童及其父母接受该计划。此外，我们建议C肽可能有助于监测这种治疗。需要进行更长期干预的进一步研究，以证实这种生化标志物在青春期前肥胖儿童管理中的价值。
