The boys are three times more often obese than girls and 1.4 times more often overweight. The blood pressure is directly correlated with increased BMI, waist and hip circumference in the examined children. The abdominal obesity is a predictor of hypertension in adolescents. The result of the present study has demonstrated the real epidemiology of obesity and systemic hypertension in children and adolescents, and should motivate family doctors and paediatricians to prevent this pathology in Ukraine.
Diabetes mellitus is a chronic metabolic disease with the manifestation possible in any period of life. The incidence of diabetes is rising around the world, and studies show that children are at an increasing risk of developing the disease. Type 1 diabetes accounts for over 90% of childhood and adolescent diabetes, although less than 10% of children suffer from type 2 diabetes. Over the last few decades, inherited monogenic forms of DM were discovered and studied. An extremely rare form of diabetes (less than 1-2% of all diabetes in young people), with neonatal diabetes as a subset, and is usually suspected if a child is diagnosed with diabetes at less than 6 months of age. We present the first case reported in Ukraine of a child diagnosed with permanent neonatal diabetes resulting from a EIF2AK3 gene missense mutation of exon 15 (WolcottRallison Syndrome). Despite low incidence of the permanent neonatal diabetes, this diagnosis should be considered in infants with persistent hyperglycaemia requiring insulin therapy.
IntroductionThe prevalence of obesity constantly increases worldwide and definitely increases the risk of premature death in early adulthood. While there is no treatment yet with proven efficacy for the metabolic clamp such as arterial hypertension, dyslipidemia, insulin resistance, diabetes type 2, and fatty liver disease, it is imperative to find a way to decrease cardiometabolic complications. Early prevention strategies beginning in childhood are the most logical step to reduce future cardiovascular morbidity and mortality. Therefore, the aim of the current study is to determine the most sensitive and specific predictive markers of the metabolically unhealthy phenotype with high cardiometabolic risk in overweight/obese adolescent boys.MethodsThis study was carried out at the Ternopil Regional Children's hospital (Western Ukraine) and involved 254 randomly chosen adolescent overweight or obese boys [median age was 16.0 (15.0,16.1) years]. A control group of 30 healthy children with proportional body weight comparable in gender and age to the main group was presented. A list of anthropometrical markers with biochemical values of carbohydrate and lipid metabolism with hepatic enzymes was determined. All overweight/obese boys were divided into three groups: 51.2% of the boys with metabolic syndrome (MetS) based on the IDF criteria; 19.7% of the boys were metabolically healthy obese (MHO) without hypertension, dyslipidemia, and hyperglycemia; and the rest of the boys (29.1%) were classified as metabolically unhealthy obese (MUO) with only one criterion (hypertension, dyslipidemia, or hyperglycemia).ResultsBased on multiple logistic regression analysis that included all anthropometric and biochemical values and calculated indexes in boys from the MHO group and MetS, it was revealed that the maximum likelihood in the prediction of MetS makes the combination of triglyceride glucose index, pediatric nonalcoholic fatty liver disease fibrosis index (PNFI), and triglyceride-to-high-density lipoprotein cholesterol ratio (R2 =0.713, p<0.000). By tracing the receiver operating characteristic curve, the model is confirmed as a good predictor of MetS (AUC=0.898, odds ratio=27.111 percentage correct=86.03%) in overweight and obese boys.ConclusionTriglyceride glucose index, pediatric NAFLD fibrosis index, and triglyceride-to-high-density lipoprotein cholesterol ratio are a valuable combination of predictive markers of the metabolically unhealthy phenotype in Ukrainian overweight/obese boys.
Introduction: Arterial hypertension (HTN) among children is progressively increasing. These concerns have led to an update of the guidelines about childhood hypertension by the European Society of Hypertension (ESH) in 2016 and the American Academy of Pediatrics (AAP) in 2017, and their thresholds for HTN differ. The current research aims to compare the prevalence of hypertension in Ukrainian teenagers using 2 different guidelines and to check the impact of gender, age, and excess weight on hypertension. Material and methods:The sample includes 540 Ukrainian students of 2 secondary urban schools, aged 10-17 years. Blood pressure and anthropometrical measurements were taken and compared with percentile tables. Results: The prevalence of abnormal BP (11.3% and 15.2%) and HTN (1.9% and 4.1%) was determined with ESH and AAP guidelines, respectively, and they strongly depended on which definitions and criteria were used. Boys were much more predisposed to abnormal BP. Comparing both guidelines, there was no significant difference in HTN prevalence in children aged 10-12 years; nevertheless, AAP recognized HTN almost twice as often in teenagers aged ≥ 13 years. Excess body weight was identified in 17.2% of the school-age children, twice as frequently as in males. Conclusions:The results have shown a higher prevalence of HTN in teenagers and children with excessive weight more significant in boys and between children with positive markers of abdominal obesity due to both guidelines, without a significant difference in prevalence after re-classification; however, AAP recommendations might be preferable.
Introduction. Childhood obesity and associated metabolic comorbidities is a major global health concern. Metabolic syndrome (MS) is a cluster of metabolic abnormalities that confers a substantial increase in cardiovascular disease risk. In the context of the childhood obesity pandemic, a distinct subgroup of youth with obesity less prone to the development of metabolic disturbances, called “metabolically healthy obese” (MHO), recently has come into focus. However, the diagnostic criteria of both conditions are still controversial in children. Therefore, the purpose of our research is to estimate the prevalence of metabolic syndrome and metabolically healthy obesity in school-age boys using international reference standards and to recognize the most sensitive metabolic markers. Materials and methods. This study was carried out at the Ternopil regional hospital (Western Ukraine) and involved randomly chosen 112 boys from rural and urban population; aged 10–17 years (mean ± SD, 14.6 ± 0.25). Height, weight and waist and hip circumferences were measured by standard methods in each patient. Body mass index (BMI, kg/m2), waist-to-height ratio (WtHR), waist-to-hip ratio (WHR) were calculated by common formulas. Obesity was defined as a BMI ≥ 2SD for age and gender. Blood pressure was measured and estimated according to European Society of Hypertension guidelines (2016). Biomarkers of carbohydrate and lipid metabolism were tested. Discussion. The study identified prominent physical and metabolic differences in groups of patients with MHO and manifested MS, as well as in the high-risk group for the realization of MS. As a result of this project, MHO and MS were confirmed in 49.11 % and 9.82 % surveyed boys, respectively. The rest of teenagers (32.14 %) based on metabolic disturbances, formed a cluster of the high-risk realization of MS. Moreover, fasting hyperglycemia and glucose intolerance were identified only in patients with manifested MS in 10.91 % and 5.45 % cases, respectively. It was found that the waist-to-height ratio > 0.5 is an informative test of obesity in general, and the waist-to-hip ratio > 0.9 is a sensitive screening tool for abdominal obesity in boys in our population. Based on the results, the triglyceride index is the most sensitive biomarker of insulin resistance compared to triglyceride-to-high density lipids cholesterol ratio and atherogenic coefficient in school-age boys. The results can be applied in pediatric practice for early identification of patients with metabolically unhealthy obesity with WHR and the triglyceride index at the early preclinical stage of MS manifestation. Keywords children, metabolically healthy obesity, metabolic syndrome, triglyceride index.
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