The article presents a literature review which devotes to one of the major issues of healthcare today obesity in children and adolescents. The consequences of childhood obesity, methods of determination and pathophysiology of obesity are described in detail. It was considered the influence of genetic factors in the formation of obesity, the effect of intestinal microbiota in the pathogenesis of obesity. The literature search was carried out in the databases of NCBI, PubMed, PubMed Central, eLIBRARY.ru, etc. Obesity in children and adolescents is one of the most important issues for people from most countries in today's world. Worldwide, the prevalence of this pathology has increased over the past three decades. Obesity in children and adolescents is a complex, multifactorial disease in which genetic and non-genetic factors can be identified. Although the vast majority of childhood obesity incidents are exogenous, a small proportion may have endogenous causes. Currently, particular importance is attached to the study of hereditary predictors of obesity and its main complications. Being a complex and inherited trait (disease), obesity is a consequence of the interaction of genetic predisposition, epigenetics, metagenomics, and the environment. Also, recent experimental and clinical data show the importance of intestinal microbiota, which can cause overweight and obesity in some patients. Molecular genetic studies have confirmed changes in intestinal biocenosis with developing obesity in children and adolescents. Obesity, which began in childhood, causes short-term and long-term adverse effects on physical and psychosocial health and largely becomes a risk factor for the development of various metabolic disorders and cardiovascular pathology. Understanding the multifactorial mechanisms involved in the formation of obesity in children and adolescents provides opportunities for the early prevention of obesity and its complications.

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Aim. To determine the frequency and nature of myocardial damage in children on the background of long-term remission of acute lymphoblastic leukemia, to assess the significance of the concentration of the N-terminal precursor of the brain natriuretic peptide and of the protein that binds fatty acids in blood serum. Methods. The observation group included 22 children aged 7 to 17 years, who are in long-term remission of acute lymphoblastic leukemia. The average duration of the remission was 6.1±1.0 years. All children were treated according to the standard and intermediate risk group protocol ALL-MB-2002. The control group included 65 children. A clinical and instrumental examination, including 12-lead electrocardiography, as well as complex transthoracic Doppler echocardiography was conducted. Analysis of the diastolic function of the myocardium was performed during assessment of the ratio of peak transmitral flow velocities (E/A), of the index of myocardial stiffness and of the time indicator B(E-Ea). The content of the N-terminal precursor of the brain natriuretic peptide and of the protein that binds fatty acids in blood serum was determined by enzyme immunoassay. Results. In 70% of the children with acute lymphoblastic leukemia who are in the remission stage for over 5 years, noted was the development of early signs of diastolic myocardial dysfunction, in 50% of the patients of this group reported was a significant increase in the concentration of the marker of heart failure - brain natriuretic peptide. At the same time, in a third of the examined individuals an increase in concentration of the protein that binds fatty acids was revealed, which may be indicative of myocardial damage at the cellular level. Positive correlation links between the indicators of initial manifestations of the evolving left ventricular diastolic dysfunction in children, who are in long-term remission of acute lymphoblastic leukemia, and the content of the N-terminal precursor of the brain natriuretic peptide have been revealed. Conclusion. The increase in the levels of the mentioned indicators makes it possible to identify high-risk groups for cardiovascular disease development among the cohort of children who are in long-term remission of acute lymphoblastic leukemia in order to develop preventive and rehabilitative programs.

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