Endokrin Polikliniğimize Başvuran Obez Çocuklarda Metabolik Sendrom Sıklığı

Giriş ve Amaç: Polikliniğimize başvuran obez çocuk ve adölesanlarda metabolik sendrom (MS) sıklığının araştırılmasıdır.Gereç ve Yöntemler: Ekzojen obezite tanısı alan ve oral glukoz tolerans testi uygulanan 6-18 yaş arası 92 çocuk ve adölesan çalışmaya alındı. Hastaların dosyaları retrospektif olarak incelendi. NCEP/ATP III ve DSÖ tarafından erişkinler için tanımlanan MS kriterleri çocukluk çağı referans değerleri ile değiştirildi. Üç veya daha fazla kriter taşıyanlar MS olarak kabul edildi.Bulgular: 30 (%32) hastada MS tespit edildi. MS’i olanların 18’inde insülin rezistansı (IR), altısında bozulmuş açlık glukozu, dokuzunda bozulmuş glukoz intoleransı, ikisinde diyabet vardı. Dislipidemisi olan 27 MS’li hastanın 12’sinde hipertrigliseridemi, ikisinde HDL-C düşüklüğü, dokuzunda hipertrigliseridemi ve HDL-C düşüklüğü, üçünde hipertrigliseridemi ve LDL-C yüksekliği, birinde sadece LDL-C yüksekliği saptandı. 12 hastada sistolik, 10 hastada diyastolik hipertansiyon vardı. 21 MS’li hastanın 10’unda USG ile hepatosteatoz saptandı.Sonuç: Obez çocuk ve adölesanlarda MS sıklığı oldukça yüksektir. Bu hastalar ileride diyabet ve kardiyovasküler hastalık gelişimi açısından hipertansiyon, dislipidemi, IR ve/veya diyabet gibi birden fazla risk faktörü taşımaktadırlar.

Anahtar Kelimeler:

Dislipidemi, İnsülin rezistansı, Metabolik sendrom, Obezite

Prevalence of Metabolic Syndrome in Obese Children who Presented at Our Endocrinology Clinic

Objective: To investigate the prevalence of the metabolic syndrome in obese children and adolescents who presented at our endocrine clinic.Material and Methods: We included 92 children and adolescents between the ages of 6-18 who underwent a standard dose of oral glucose tolerance test with a diagnosis of exogenous obesity. Their medical records were analyzed retrospectively. We modified the criteria of metabolic syndrome (MS) for adults defined by the NCEP/ATP III and WHO with the pediatric age reference values. MS was diagnosed in those with three or more criteria.Results: 30 (32%) patients were diagnosed with MS. Among these patients with MS, we determined insulin resistance (IR) in 18, impaired fasting glucose in 6, impaired glucose tolerance in 9 and diabetes in 2 patients. Hypertriglyceridemia was found in 12 of 27 dyslipidemic MS patients, low HDL-C in two, hypertriglyceridemia and low HDL-C in nine, and hypertriglyceridemia and LDL-C elevation in three patients. LDL-C elevation was detected only in one patient. There was systolic hypertension in 12 patients. Ten patients had diastolic hypertension. Hepatosteatosis was determined by USG in 10 of 21 patients with MS.conclusion: Obese children have a high prevalence of MS. These patients possess multiple risk factors for the development of diabetes and cardiovascular disease in the future such as hypertension, dyslipidemia and insulin resistance

Keywords:

Dyslipidemia, Insulin resistance, Metabolic syndrome, Obesity,

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De Ferranti SD, Osganian SK. Epidemiology of pediatric metabolic syndrome and type 2 diabetes mellitus. Diab Vasc Dis Res 2007;4:285-96.
Hatun Ş. Metabolic syndrome in childhood: Defining the problem. J Clin Res Ped Endo 2009;65-71.
Hatun Ş. Çocukluk çağında metabolik sendrom: Güncel durum. Türk Ped Arş 2011;46:1-5.
Grundy SM, Brewer HB Jr, Cleeman JI, Smith SC, Lenfant C. Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institude/American Heart Association conference on scientific issues related to definition. Arterioscler Thromb Vasc Biol 2004;4:e13-8.
Metabolik Sendrom Çalışma Grubu. Metabolik Sendrom Kılavuzu. Türkiye Endokrinoloji ve Metabolizma Derneği 2009.
Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. I: Diagnosis and Classification of Diabetes Mellitus Provisional Report of a WHO Consultation. Diabet Med 1998; 15:539-53.
Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486-97.
Zimmet P, Alberti KG, Kaufman F, Tajima N, Silink M, Arslanian S, et al. The metabolic syndrome in children and adolescents - an IDF consensus report. Pediatr Diabetes 2007;8:299-306.
Şıklar Z. Çocuk ve Adölesanlarda obezite komplikasyonları ve metabolik sendrom. Türkiye Çocuk Hast Derg Obezite Özel Sayısı 2012;1:48-58.
Alvarez MM, Vieira AC, Sichieri R, da Veiga GV. Prevalence of metabolic syndrome and of its specific components among adolescents from Niterói City, Rio de Janeiro State, Brazil. Arq Bras Endocrinol Metabol 2011;55:164-70.
Bitsori M, Kafatos A. Dysmetabolic syndrome in childhood and adolescence. Acta Paediatr 2005; 94:995-1005.
Cruz ML, Goran MI. The metabolic syndrome in children and adolescents. Curr Diab Rep 2004;4:53-62.
Sen Y, Kandemir N, Alikasifoglu A, Gonc N, Ozon A. Prevalence and risk factors of metabolic syndrome in obese children and adolescents: The role of the severity of obesity. Eur J Pediatr 2008;167:1183-9.
Kozan O, Oğuz A, Abaci A, Erol C, Ongen Z, Temizhan A, et al. Prevelance of the metabolic syndrome among Turkish adults. Eur J Clin Nutr 2007;61:548-53.
Bundak R, Furman A, Gunoz H, Darendeliler F, Bas F, Neyzi O. Body mass index references for Turkish children. Acta Paediatr 2006;95:194-8.
Individual Calculator for British 1990 Growth Reference Data by Mark Delderfield. 2005.
Tümer N, Yalçınkaya F, Ince E, Ekim M, Köse K, Cakar N, et al. Blood pressure normograms for children and adolescents in Turkey. Pediatr Nephrology 1999;13:438-43.
WHO consultation: definition, diagnosis and classification of diabetes mellitus and its complications. Report of a WHO consultation. Part 1: Diagnosis and Classification of Diabetes Mellitus. Geneva, WHO/NCD/NCS/99.2, World Health Org,1999.
Molleston JP, White F, Teckman J, Fitzgerald JF. Obese children with steatohepatitis can develop cirrosis in childhood. Am J Gastroenterol 2002;97:2460-2.
Loria P, Lonardo A, Bellentani S, Day CP, Marchesini G, Carulli N. Non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease: An open question. Nutr Metab Cardiovascular Dis 2007;17:684-98.
Manco M, Bottazzo G, De Vito R, Marcellini M, Mingrone G, Nobili V. Nonalcoholic fatty liver disease in children. J Am Coll Nutr 2008;27:667-76.
Petta S, Muratore C, Craxi A. Non-alcoholic fatty liver disease pathogenesis: The present and the future. Dig Liver Dis 2009;41:615-25.
Tilg H, Moschen AR. Insülin resistance, inflammation, and non-alcoholic fatty liver disease. Trends Endocrinol Metabol 2008;19:371-9.
D’Adamo E, Marcovecchio ML, Giannini C, Capanna R, Impicciatore M, Chiarelli F, et al. The possible role of liver steatosis in defining metabolic syndrome in prepubertal children. Metabolism 2010;59:671-6.