Weight loss as the cornerstone in the therapyof metabolic syndrome in adolescents
Background. In the last decade, the relationship between metabolic syndrome (MS) and obesity is being actively discussed. An early detection of fat metabolism violations and treatment of healthy adolescents is an important component of primary prevention of metabolic syndrome. The aim of the study was to examine the clinical and epidemiological characteristics of obesity in adolescents and to estimate the effectiveness of primary prevention of metabolic syndrome. Materials and methods. The medical forms 026/o Medical record of a child (for pre-school and general educational institutions) of 656 adolescents aged 16-18 years, who study at HSEI of Ukraine Bukovinian State Medical University colleges within 2014-2016 years were analyzed. According to the result of the analysis, a study group was formed of 50 teenagers with overweight and obesity. The violation of fat metabolism was verified using percentile tables: BMI within 85-95 percentile was estimated as overweight, above 95 percentile - as obesity. In addition, there were analyzed of 67 medical records of inpatients adolescents who were treated for obesity in the Department of Endocrinology of the Chernivtsi Regional Children’s Hospital in the period from 2006 to 2016. There analyze such laboratory parameters as the levels of cholesterol, thyroid hormones, blood glucose fasting test and glucose tolerance test, levels of elastase-1 in feces, and the results of additional research tool. There was formed a clinical group of 20 adolescent parents who underwent a range of measures, including a complete exclusion of easily digestible refined carbohydrates from daily meals, a certain amount of physical activity, correction of day regimen. Results. The analysis of medical records of 656 teenagers data showed a violation of physical development in 50 (7.6 %) patients, including excess body weight in 28 (56 %), obesity in 22 (44 %) persons. Half of examined patients with overweight and obesity had clinical symptoms of hormonal imbalance (striae, hyperhidrosis, black acanthosis, hyperkeratosis, acne, hirsutism, gynecomastia, oily seborrhea). The increased blood pressure was observed in 72.6 % of adolescents. Different versions of carbohydrate metabolism impairment found in 42.7 % of cases. Nearly half of teens had changes in lipid profile, each seventh had deviations in hemocoagulation system, 17.1 % of adolescents had decreased pancreatic functional activity that manifested as a decrease of elastase-1 in feces. The vast majority of teens had a hereditary burden of obesity, diabetes type 2 and hypertension. 92.5 % of adolescents with obesity had some components of MS. The combination of obesity with one of the metabolic syndrome components was registered in 56.4 % cases, with two components in 32.2 %, with three components in 11.2 % of cases. Among 20 patients in the program in 12 (60 %) cases body weight became normal, in 8 (40 %) persons obesity remained. The effectiveness of the program was confirmed by a decrease in the prevalence of modified risk factors: poor nutrition by 13 %, smoking by 6.9 %, violation of physical activity by 25.2 %, increase of awareness by 54 %, decrease of metabolic syndrome components (body weight by 30 %, hypertension by 33.7 %, carbohydrate metabolism by 20 %, dyslipoproteinemia by 3.3 %). Conclusions. Violation of fat metabolism among adolescents occurred in 7.6 % cases, in particular excess body weight in 56 %, and obesity in 44 % persons. 92.5 % of obese adolescents had the components of metabolic syndrome. The combination of abdominal obesity with one of the components of metabolic syndrome is 56.4 %, with two components - 32.2 %, with three components - 11.2 %. The effectiveness of suggested program to reduce body weight is 60 % and it is confirmed by the decrease of the prevalence of modified risk factors for metabolic syndrome.