ABSTRACT
BACKGROUND: The frequency of arterial hypertension (AHT) in children is around 3.2-4.5% nowadays, however 3-4 decades ago it was below 1.5%. In obese children AHT is 3-5 times more frequent than in lean children. AIM: Retrospective evaluation of frequency of AHT and metabolic complications in obese children and adolescents. MATERIAL AND METHODS: One hundred seventy children and adolescents (100 girls) at the mean age of 14.6 years (range: 10-18 years) diagnosed with simple obesity admitted to The Department of Pediatric and Adolescent Endocrinology in Krakow, Poland were assessed in the study. Patients were divided into three groups: 1- obese normotensive (n=43), 2- obese prehypertensive (n=31), 3- obese hypertensive (n=96). Blood pressure (BP) was assessed by Korotkow method. The result was expressed as a mean of 3 independent BP measurements. Biochemical analysis included oral glucose tolerance test with assessments of glucose, insulin and HOMA-IR (the homeostatic index for insulin resistance) as well as lipid profile and uric acid measurements. RESULTS: AHT was found in 96 patients (55.8%), in 53 girls (52%) and 43 boys (61.4%). Prehypertensive values of BP were found in 31 patients (18 girls). Systolic AHT was found in 90 patients (52.9%), diastolic AHT in 56 patients (32.9%), and both systolic and diastolic AHT in 50 patients (29.4%). In group 3. BMI was higher than in group 1. BMI correlated significantly with systolic and diastolic BP. Uric acid levels were higher in group 3. than in group 1., and higher in patients with diastolic AHT. Basal insulin levels were higher in diastolic AHT patients and poststimulatory insulin was higher in systolic AHT patients. HOMA-IR was higher in patients with diastolic AHT than in patients with normal diastolic BP. Lipid profile did not differ between the groups, however the highest percentage of patients with abnormal lipid profile was found in group 2. CONCLUSION: An early endocrine referral in pediatric obese patients is advisable to monitor complications of obesity.
Subject(s)
Hypertension/epidemiology , Obesity/epidemiology , Adolescent , Body Mass Index , Child , Comorbidity , Diastole , Female , Humans , Incidence , Insulin Resistance , Male , Retrospective Studies , SystoleABSTRACT
BACKGROUND: Obesity affects approximately 45 millions of children worldwide. Some of them present with secondary dyslipidemia that leads to premature atherosclerosis. AIM OF THE STUDY: 1) Assessment of the frequency and type of dyslipidemia in obese adolescents. 2) An attempt at defining risk factors of atherogenic lipid profile in obese adolescents. MATERIAL AND METHODS: In 146 (84 girls/62 boys) obese (mean BMI SDS 4.95, 95% CI 4.62-5.29) adolescents (age 10-18, mean 14.7 years), the levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc) and triglicerydes (TG) were measured. Atherogenic dyslipidemia was defined as a high TG level with a concomitant low HDLc level. Standard oral glucose tolerance test was performed with the assessment of fasting and after 120' post-load of 75 g of glucose and insulin levels; the insulin resistance index HOMA-IR was calculated. RESULTS: The mean values of the lipid fractions were in normal ranges: TC 4.64 mmol/L (95% CI 4.48-4.8), LDLc 2.86 mmol/L (95% CI 2.73-2.99), TG 1.4 mmol/L (95% CI 1.3-1.5), and HDLc 1.16 (95% CI 1.1-1.2). However, in 50.69% of the patients (45.24% girls and 58.06% boys), elevated levels of TC, LDLc, and TG were observed respectively in 23.29%, 17.81% and 37.67%, and low HDLc in 15.07% of patients. A total of 10.96% of the patients presented with coexistence of a low HDLc and a high TG. In 26.7%, dyslipidemia was followed by arterial hypertension. There was a reverse correlation between a low HDLc value and BMI SDS [R (-) 0.22, p < 0.05] and not with TC, LDLc, and TG. The relative risk of abnormal lipid profile occurrence was higher in obese patients with insulin resistance (OR 1.72; 95% CI 0.8-3.4; p = 0.12), being significant only for boys (OR 3.67; 95% CI 1.1-12.1; p = 0.03). There was a reverse correlation between fasting insulin level, HOMA-IR and HDLc [R (-) 0.2; p < 0.05; R (-) 0.2; p < 0.05) respectively], as well as TG (R 0.26 ; p < 0.05; R 0.26; p < 0.05, respectively), and between post-load insulin level and TG (R 0.24; p < 0.05). CONCLUSIONS: 1) Lipid disorders occur in about one-half of obese adolescents, of which 10% presents with atherogenic lipid profile. 2) One of the most important risk factors of atherogenic lipid profile occurrence is insulin resistance, especially in boys. The severity of the obesity (BMI-SDS) is of lesser importance.
