Pulmonary dysfunction in obese early adolescents

Abstract

AbstrakTujuan Prevalensi obesitas pada anak mengalami peningkatan yang berarti di seluruh dunia. Obesitas dapat menyebabkan berbagai komplikasi, termasuk gangguan fungsi paru. Penelitian uji fungsi paru pada anak obes masih terbatas dan menunjukkan hasil yang berbeda-beda. Penelitian ini bertujuan mengetahui proporsi gangguan fungsi paru pada remaja obes dini di Indonesia serta hubungan antara derajat obesitas dan derajat gangguan fungsi paru. Metode Uji potong lintang dilakukan di Departemen Ilmu Kesehatan Anak FKUI-RSCM pada bulan November 2007 sampai Desember 2008. Subjek adalah remaja berusia 10-12 tahun dengan obesitas. Pada subjek dilakukan uji fungsi paru untuk menilai FEV1/FVC, FEV1, FVC, V50, dan V25. Hasil Terdapat 110 subjek yang memenuhi kriteria penelitian. Jenis kelamin lelaki sebanyak 83 (75,5%) dan perempuan 27 (24,5%); median IMT 26,7 (22,6-54,7) kg/m2, 92 subjek (83,6%) superobes. Riwayat asma dan rinitis alergi terdapat pada 32 (29,1%) dan 46 (41,8%) subjek. Uji fungsi paru abnormal ditemukan pada 64 (58,2%) subjek, terdiri dari gangguan paru campuran 33 (30%), restriktif 28 (25,5%), dan obstruktif 3 (2,7%). Rerata nilai FEV1, FVC, V50, dan V25 mengalami penurunan, sedang rasio FEV1/FVC dalam batas normal. Tidak terdapat perbedaan bermakna rerata parameter uji fungsi paru pada kelompok superobes dan obes. Tidak ada korelasi antara IMT dengan parameter uji fungsi paru. Tidak terdapat hubungan antara derajat obesitas dengan derajat gangguan fungsi paru. Kesimpulan Gangguan fungsi paru pada remaja dini obes 58,2%. Kelainan tersering adalah tipe campuran (30%), restriktif (25,5%), dan obstruktif (2,7%). Tidak ada korelasi antara IMT dan parameter uji fungsi paru. (Med J Indones 2010; AbstractAim Obesity leads to various complications, including pulmonary dysfunction. Studies on pulmonary function of obese children are limited and the results are controversial. This study was aimed to determine proportion of pulmonary dysfunction on early adolescents with obesity and to evaluate correlation between obesity degree with pulmonary dysfunction degree.Methods A cross-sectional study was conducted at the Department of Child Health, Medical School, University of Indonesia, from November 2007 to December 2008. Subjects were 10 to 12 year-old adolescents with obesity. Subjects underwent pulmonary function test (PFT) to assess FEV1/FVC, FEV1, FVC, V50, and V25.Results 110 subjects fulfilled study criteria, 83 (75.5%) were male and 27 (24.5%) were female with median BMI 26.7 (22.6-54.7) kg/m2; 92 subjects (83.6%) were superobese. History of asthma and allergic rhinitis were found in 32 (29.1%) and 46 (41.8%) subjects, respectively. 64 (58.2%) subjects had abnormal PFT results consisting of restrictive type in 28 (25.5%) subjects, obstructive in 3 (2.7%), and combined type in 33 (30%). Mean FEV1, FVC, V50, and V25 values were below normal, while mean FEV1/FVC ratio was normal. There was no statistically significant correlation between BMI and PFT parameters. No significant correlation was found between degree o...

Lung function in obese children and adolescents without respiratory disease: a systematic review

“…Therefore, including children with previous respiratory diseases could evolve into sampling (selection of individuals), confounding (proven impact on outcomes) or information bias (previous knowledge of an existing problem). In this context, 66.7% (22/33) [ 12 – 15 , 17 – 21 , 25 , 26 , 29 , 32 – 37 , 39 – 42 ] of the studies excluded individuals with respiratory diseases, 27.3% (9/33) [ 16 , 22 – 24 , 27 , 28 , 30 , 31 , 38 ] did not mention respiratory diseases as a factor of exclusion or non-inclusion, and 6% (2/33) [ 11 , 43 ] excluded only individuals with a history of smoking. Among the studies that excluded previous respiratory diseases, several exclusion criteria could be observed: some authors excluded only individuals with exacerbation of asthma or cough; others excluded any respiratory conditions that might impair the evaluation; and others used standardized instruments such as the ISAAC questionnaire (The International Study of Asthma and Allergies in Childhood).…”

“…The articles included were produced in 18 countries, with a predominance of European (8) [ 21 – 23 , 31 , 34 , 35 , 40 ], South American (8) [ 17 , 18 , 26 , 32 , 33 , 37 , 39 , 41 ] and Asian (7) [ 11 , 13 , 15 , 27 , 30 , 31 , 42 ] countries. Also, 4 studies from North America were included [ 19 , 24 , 38 , 43 ], as well as one from Central America [ 29 ], one from Oceania [ 20 ] and four from intercontinental countries ( three Euroasians [ 14 , 25 , 36 ] and one from Asia and Oceania [ 12 ]).…”

“…There was no uniform definition of obesity among studies: 27.3% (9/33) [ 11 , 14 , 15 , 20 , 35 – 37 , 40 , 42 ] used references by Cole et al [ 45 – 47 ]; 21.2% (7/33) [ 12 , 17 , 19 , 26 , 29 , 38 , 43 ] used the criteria established by the Center for Disease Control and Prevention (CDC); 15.1% (5/33) [ 13 , 18 , 33 , 39 , 41 ] used the definition of the World Health Organization (WHO); 12.1% (4/33) [ 16 , 24 , 32 , 34 ] did not mention any references for the definition of obesity; and 27.3% (9/33) [ 14 , 21 – 23 , 25 , 27 , 28 , 31 , 36 ] used references according to their countries of origin. Two [ 14 , 36 ] of the studies mentioned above, used references by Cole et al [ 45 – 47 ] in addition to references according to their countries of origin.…”

“…Among the spirometry variables, forced expiratory volume in the first second (FEV 1 ) of the forced vital capacity (FVC) was the most prevalent marker in the studies, included in 90.9% (30/33) [ 11 , 12 , 14 – 24 , 26 , 27 , 29 – 43 ] of the analyses, followed by FVC and the FEV 1 /FVC ratio, used in 87.9% (29/33) [ 11 – 24 , 26 , 27 , 29 – 39 , 42 , 43 ] and 72.7% (24/33) [ 11 , 12 , 14 – 18 , 21 – 24 , 26 , 27 , 31 – 39 , 42 , 43 ] of the studies, respectively. Forced expiratory flow between 25 and 75% of FVC (FEF 25–75% ) was also a widely assessed marker, being analyzed in 57.6% (19/33) [ 11 , 14 , 15 , 17 – 21 , 29 – 36 , 39 , 42 , 43 ] of the studies.…”

“…Thus, weight index is a potential marker to predict some diseases, reinforcing the importance of maintaining weight in the prevention of diseases in schoolchildren. However, the causal relationship and physiological mechanisms to explain the changes need to be further studied LoMauro et al [ 12 ] (2016) - Italy To verify whether the thoracoabdominal volume of male adolescents with obesity during exercise has specific characteristics to deal with the increasing ventilatory demand and to investigate whether a short period of multidisciplinary program for weight loss, including respiratory muscle resistance training, can modify the geometry and volume of the rib cage Not mentioned Prospective and intervention 11 male adolescents (Tanner 3 to 5), with standard deviation of BMI > 2, in relation to the Italian standards Spirometry (MedGraphics CPX/D, Medical Graphics Corp., Saint Paul, Minn., USA) and OEP (Smart System BTS, Milan, Italy) Spirometry: ERS – standing OEP: Standardized instrument and position not mentioned FVC, FEV 1 , FEV 1 /FVC, PEF, total and compartmental volume in FRC and TLC, TV, RR, MV FEV 1 /FVC was greater than 80% predicted in the individuals, indicating the absence of OVD, but with a possible indication of a restrictive pattern. After the intervention, there was an improvement in the absolute and predicted values of FVC, and a reduction in IC of the lung and abdominal rib cage was observed Hyperinsulflation of the abdominal rib cage occurs during incremental exercise from moderate intensity to peak intensity in order to recruit lung volume, being an adaptation of the ventilatory dynamics to deal with the overload of the chest wall due to obesity, optimizing the synergism between the diaphragm and the abdominal musculature.…”