Журнал «Здоровье ребенка» 6 (49) 2013

Introduction. One of the most important problems of modern medicine is the metabolic syndrome (MS),syndrome of insulin resistance, which combine  such important factors as abdominal obesity, reduced tolerance to  carbohydrates and type II diabetes mellitus, dyslipidemia, arterial hypertension and other factors according to WHO. Nowadays, metabolic disorders occur in childhood and their risk factors are needed to investigate. From childhood it’s also needed to carry out and to choose methods of treatment and prophylaxis of  MS. MS spread in childhood is 4-30% of cases among population, especially in  obese children and adolescents. Thus, in Pediatrics metabolic syndrome has no scientific background , only few studies exist dealing with this problem.

Materials and methods. 225 children  aged 14-18 years (135 boys – 60,0% and 90 girls – 40,0% ) with different signs of MS were examined. All of them  live in different iodine rich regions: 65 – in premountain regions and 75 – in Precarpathian regions, 85 of them – in mountain regions. The control group is 30 healthy children aged 14-18 years. Methods of examination include family history, antropometry (body height, weight, index of body weight IBW, hip size, waist size and their correlation), laboratory examination and instrumentation. Physical development  of children was defined according to centile tables. The biochemical findings included general cholesterol (GC), lipoprotein cholesterol of high density (LCHD), lipoprotein cholesterol of low density (LCLD), triglyceride (TG) and glucose findings. The content of GC , TG and LCHSD were defined by enzymic colorimetric method (reagent of production of High Technology Inc.USA, with BioChemSA apparatus.) LCLD were calculated according to formula: LCLD (mmol/l)= general LC – LCHD- TG 2,2. Index of atherogenesis (IA): IA= /GC LCHD/LCLD ).To diagnose MS the International Diabetes Federation criteria for children were used. The insulin secretion was examined by  the standardized oral glucose tolerance testing (OGTT).To diagnose insulin resistance HOMA index was used. Homeostasis model assessment – insulin after fasting (mcu/ml) X glucose after fasting (mmol/l ): 22,5, and  Caro Index were used for correlation of glucose and insulin. The processing of the obtained results were performed with the use of medical statistics and application package of Statistica 7,0 “MS Exel”. The correlation between these phenomena were evaluated according to correlation coefficiency with the following assessment of reliability  coefficient.

Results of investigation.  Waist size  and hip size in the investigated groups are higher both in boys and in girls. The study of lipid metabolism in adolescents with MS living in Precarpathia with different iodine supply is important criteria  in complications, such as atherosclerosis, ischemic heart attack and other cardio-vascular complications. In adolescent girls IBW in obesity increases in premountain regions to 33,73±0,80 comparatively with plains ( 32,62±0,64,p < 0,05 ) and 36,19±0,77 ( p<0,05 – 0,01 ) – in a mountain region. Similarly, IBW  increase occurs in excessive body weight  in those children who live in plains from 27,06±0,26 to 26,86±0,28 ( p<0,05) – in premountain regions and to 28,41±0,44 ( p< 0,05 ) – in mountain regions. Waist size of  girls is the same  from  80,40±0,48 – in plain regions 84,7±0,59 (p<0,05 ) – in mountain regions. The noticeable change is observed in girls living in premountain and  mountain regions : 80,75 ±0,92 and 84,70±0,59 ( p< 0,01).The rest indexes of physical development ( hip and waist size, their correlation ) both in obesity and excessive body weight in girls regardless of their living are not significantly varied. The pathologic heart rhythm was diagnosed in 20,0%, conductivity – in 34,6% ( without persistent arterial extra systole ),signs of early ventricular repolarization in 10,0% of cases). Hypertrophy of myocardium of the left ventricle was diagnosed in 13,1% of cases in children with hypertension. In 36,9% of cases of children the arterial blood pressure was high. In most children (63,1%) blood pressure was higher than 95 and hypertension was diagnosed.

The biochemical findings established that despite of living regions in girls with obesity and excessive body weight all investigated indexes were high : GC (p<0,01 – 0,001 ), TG (p<0,001 ), cholesterol of LCLD (p<0,001), index of atherogenesis (p<0,01- 0,001 ) and decrease of cholesterol level of LCHD ( p< 0,001). The high content of LCLD in the blood serum  is one of the criteria among factors of atherosclerosis, thus LCLD transport cholesterol to tissues, i.e. penetrate into the walls of vessels. The significant difference  in indexes of obese girls in the premountain  and  mountain regions was not revealed. In  girls living in mountain and plain regions the difference of triglyceride (1,75±0,03 and 1,55±0,06 mmol/l, p < 0,001 ) and cholesterol of LCHD ( 0,91±0,06 )  and (2,43± 0,2) mmol/l, (p<0,05) was revealed. In girls with excessive body weight  the difference in certain indexes of lipid metabolism shows significantly high level of cholesterol of LCHD (1,35±0,07) mmol/l and index of atherogenesis 1,70±0,22 against 1,57± 0,05, p<0,05 and 1,14±0,13 ,p<0,05 correspondingly. It indicates the decrease of cholesterol transporting from tissues to the liver with its following transformation and removal from the organism.

The regularity of carbohydrate metabolism disorders was revealed. There was higher glucose level in the blood in adolescent girls with obesity (4,52±0,16 mmol/l ) than in with excessive body weight (4,03±0,13) mmol/l ,(p<0,05). The rise of glucose level was observed only in children of premountain regions.

Regardless of the region of living in obesity and in excessive body weight (p,0,05-0,001) IPI (p<0,001) increased, HOMA index (p<0,01-0,001) and the level of Caro  (p<0,05-0,01) without differences  between them in girls of both groups decreased.

The analysis of physical development and carbohydrate and lipid metabolism in boys and in girls shows the pathological changes from normal sizes.

In all children, despite of the place of living, the increase of physical development  indexes (p<0,001) and carbohydrate metabolism (p<0,01-0,001), lipids (p<0,05-0,001) in obesity was revealed. In obesity in all regions of Precarpathia the investigated parameters have more pathologic changes than in excessive body weight(p<0,05-0,001).It is important to admit that the most definite changes of lipid metabolism in  boys with obesity were observed in the mountain region: GC level was increased (5,21±0,17)mmol/l, TG to(1,89±0,04)mmol/l and atherogenesis index 5,44±0,34 comparatively 4,60±0,21 (p<0,01) and 4,25±0,60(p<0,05) in children of plain regions .The differences in indexes of all regions were not revealed. In boys of with excessive body weight living of Precarpathia lipid metabolism pathology was not revealed. In boys with MS both lipid and carbohydrate metabolism was observed: high glucose level(p<0,05-0,001), IPI (p<0,001),HOMA index (P<0,01) and low Caro level (p<0,01-0,001) in all regions of living, thus without changes between the latter. The  regularity of disorders of lipid and carbohydrate metabolism in MS of children are proved and established by correlation analysis of their sizes. Obesity in childhood and in adolescence progresses and leads to the complications in an adulthood.

Conclusions. In the Precarpathian regions  with  iodine deficiency in a soil and in a drinking water obesity is more observed among elderly pupils.

With IMT increase lipid and carbohydrate metabolism disorders occur with the signs of MS.The llatter are important predictors for early complications of MS : atherosclerosis development and type II diabetes. Taking into consideration that Precarpathia is  the endemic area of iodine deficiency, the prophylaxis is  necessary. It must include the use of iodine preparation  Iodinomarine and also well-balanced diet rich in this important element.