Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Obes Rev. 2022 Dec;23(12):e13513. doi: 10.1111/obr.13513. Epub 2022 Oct 26.
The rise in prevalence of childhood obesity is paralleled by an increase in obesity-related metabolic complications, which add significantly to the population burden of cardiovascular morbidity in the long term. Early detection of obesity-related metabolic complications through appropriate screening strategies forms a crucial aspect of obesity management. We performed a scoping review of international and national guidelines on the management of pediatric obesity to evaluate the recommendations on screening for metabolic complications, namely, hypertension, diabetes, dyslipidemia, and non-alcoholic fatty liver disease. Thirty guidelines were included, 23 (76.7%) of which had some guidance on screening for metabolic complications. However, there were significant variations in the extent and details of recommendations for screening for these metabolic complications. There has been no consensus on the body mass index (BMI) thresholds, age of onset, frequency, and screening tests recommended for detecting hypertension, diabetes, dyslipidemia, and non-alcoholic fatty liver disease between guidelines. These variations did not appear to be polarized based on geographical location or population ethnicity. We provide our recommendations on metabolic screening based on the strength of evidence in the guidelines, also incorporating recommendations from key childhood hypertension, diabetes, and lipid guidelines. Appropriate implementation of screening strategies is crucial to improve detection of metabolic complications, to allow for earlier or more intensified interventions for affected children with obesity.
儿童肥胖症的患病率不断上升，与之相伴的是肥胖相关代谢并发症的增加，这将大大增加心血管疾病发病率在长期对人群造成的负担。通过适当的筛查策略早期发现肥胖相关代谢并发症是肥胖管理的重要方面。我们对国际和国家儿童肥胖管理指南进行了范围综述，以评估针对代谢并发症（即高血压、糖尿病、血脂异常和非酒精性脂肪肝）的筛查建议。共纳入 30 项指南，其中 23 项（76.7%）对代谢并发症的筛查有一定的指导。然而，对于这些代谢并发症筛查的建议在范围和详细程度上存在显著差异。指南之间对于检测高血压、糖尿病、血脂异常和非酒精性脂肪肝的建议，包括 BMI 阈值、发病年龄、频率和筛查试验，尚未达成共识。这些差异似乎不是基于地理位置或人群种族而极化的。我们根据指南中的证据强度提供了代谢筛查建议，同时还纳入了儿童高血压、糖尿病和血脂指南中的建议。适当实施筛查策略对于提高代谢并发症的检出率至关重要，从而可以更早或更强化地干预肥胖儿童的相关疾病。
