Springwald Anna, Różana-Kowalska Patrycja, Gibała Piotr, Zajdel-Cwynar Olimpia, Małecka-Tendera Ewa, Matusik Paweł
School of Medicine in Katowice, Department of Pediatrics and Pediatric Endocrinology, Medical University of Silesia, Katowice, Poland.
Scientific Society for Medical Students, Medical University of Silesia, Katowice, Poland.
Pediatr Endocrinol Diabetes Metab. 2019;25(1):17-22. doi: 10.5114/pedm.2019.84711.
In the light of recent studies, the usefulness of the metabolic syndrome diagnosis in obese pediatric patients seems to be controversial. It leads to the pressing questions, if the metabolic syndrome diagnosis is reflecting risk of the cardiovascular complications in obese chil-dren.
To evaluate the incidence of metabolic syndrome in obese children, asses the role of insulin resistance in the metabolic complications and investigate if the diagnosis of MS has a clinical value in that group of patients.
After the retrospective analysis of 588 records of obese children treated in metabolic outpatient clinic, 289 children (145 boys) in the mean age of 11 years, was qualified to the study. Diagnosis of metabolic syndrome was based on IDF 2009 criteria and HOMA-IR was used in the assessment of insulin resistance.
Metabolic syndrome was diagnosed in 69 children (24%) including 42 girls (61%, p < 0.05). Mean age was higher (12.4 vs. 10.9, p < 0.05) in patients with metabolic syndrome. Initial BMI Z-score was similar in the both groups (2.93 SD vs. 2.92 SD). However, further follow-up showed significantly (p < 0.001) less effective BMI z-score reduction in patients with metabolic syndrome. Insulin resistance was observed significantly more often in children with metabolic syndrome (77% vs. 35%, p < 0.0001). Moreover, ami-notransferases were significantly higher in boys with metabolic syndrome (AST = 35 vs. 28 U/l, ALT = 38 vs. 23 U/l, p < 0.0001).
The diagnosis of metabolic syndrome in obese children seems to have a predictive value for the clinical practice. Affected children are older and their criteria are present more often in girls. Insulin resistance seems to be an important factor associated with metabolic syn-drome in obese children. The outcomes of behavioral therapy are less effective in children with metabolic syndrome. Affected boys are at higher risk of non-alcoholic fatty liver disease (NAFLD) in the future.
根据最近的研究，代谢综合征诊断在肥胖儿科患者中的实用性似乎存在争议。这引发了紧迫的问题，即代谢综合征诊断是否反映了肥胖儿童心血管并发症的风险。
评估肥胖儿童中代谢综合征的发病率，评估胰岛素抵抗在代谢并发症中的作用，并调查代谢综合征诊断在该组患者中是否具有临床价值。
在对代谢门诊治疗的588例肥胖儿童记录进行回顾性分析后，选取了289名儿童（145名男孩），平均年龄为11岁，纳入研究。代谢综合征的诊断基于2009年国际糖尿病联盟（IDF）标准，采用稳态模型评估法胰岛素抵抗指数（HOMA-IR）评估胰岛素抵抗。
69名儿童（24%）被诊断为代谢综合征，其中包括42名女孩（61%，p<0.05）。代谢综合征患者的平均年龄较高（12.4岁对10.9岁，p<0.05）。两组的初始体重指数Z评分相似（2.93标准差对2.92标准差）。然而，进一步随访显示，代谢综合征患者的体重指数Z评分降低效果显著较差（p<0.001）。代谢综合征儿童中胰岛素抵抗的发生率明显更高（77%对35%，p<0.0001）。此外，代谢综合征男孩的转氨酶明显更高（谷草转氨酶[AST]=35对28 U/L，谷丙转氨酶[ALT]=38对23 U/L，p<0.0001）。
肥胖儿童代谢综合征的诊断似乎对临床实践具有预测价值。受影响的儿童年龄较大，且该标准在女孩中更常见。胰岛素抵抗似乎是肥胖儿童代谢综合征的一个重要相关因素。行为疗法在代谢综合征儿童中的效果较差。受影响的男孩未来患非酒精性脂肪性肝病（NAFLD）的风险更高。
