Metabolic syndrome causes a violation of all types of metabolism. This failure (MS) - includes 3 mandatory components: increased insulin in the blood and resistance of cellular receptors to it, abdominal obesity and hypertension (arterial hypertension).
The essence of pathology
Hyperinsulinemia and obesity in the metabolic syndrome are mandatory criteria. This concept of MS is unified and introduced in 2005 by the International Diabetes Federation (IDF).
These disorders mean the involvement of hormones, metabolism and psychosomatics. But the basis of all remains visceral (central) obesity. The insidiousness of MS lies in the fact that the risk of heart disease, diabetes, strokes, etc., is significantly increased.
It is impossible to completely cure MS, but with the help of a proper diet and proper treatment, many disorders can be leveled.
The metabolic syndrome according to ICD 10 (international classifier of diseases) is not considered a separate diagnosis, has the code E66.0-9 and is called "Morbid obesity." MS, or Syndrome X, only accompanies pathologies such as arterial hypertension, obesity, type 2 diabetes, ischemia. These pathologies are potentially fatal, so doctors called them the "lethal quartet." This list of pathologies leads to the most serious consequences: stroke, cerebrosthenic syndrome, polycystic ovary, impotence, heart attack, and finally, MS simply shortens life.
Violations of the lipid profile, hyperandrogenism in girls are considered mandatory, homeostasis is impaired with increased blood coagulation, microalbuminuria, hyperuricemia.
The prevalence of the syndrome is quite high - 30% of the adult population, and after 45 years - already 40%. But MS is constantly getting younger, and the metabolic syndrome in children and adolescents today reaches 17%. Contributes to this and the fact that MS is often hereditary. Disorders of the gene on the 19th chromosome are noted.
In children, the metabolic syndrome causes: diabetes, heart disease, liver and stomach diseases, endocrinopathy, hypertension.
By the way! According to scientists, up to 6 years of age, there is no metabolic syndrome in children.
Visceral or abdominal obesity is the most dangerous. It is combined with a mandatory violation of lipid and carbohydrate metabolism. The synthesis of fats is increased, glucose is not absorbed, and insulin grows. Cells become immune to it.
Causes of MS
If a pregnant woman has been diagnosed with diabetes (gestational), this often affects the health of the newborn. The earliest manifestations of MS with its innate nature are dyslipidemia and hypertension. And its further manifestations depend already on a lifestyle, eating behavior, family traditions, etc.
Influencing the appearance of the syndrome can be:
- lack of nutrition of the fetus;
- birth weight disorders;
- feeding features (often MS is characteristic for artificers);
- heredity;
- low social level with eating disorders (predominance of fats and carbohydrates);
- Unhealthy Lifestyle;
- urbanization and physical inactivity;
- childhood infections.
A child with MS will also transfer the problem to puberty.
Pathogenesis of MS in children and adolescents
The kidneys and central nervous system are always sensitive to insulin. With its increase, electrolytes accumulate in the blood, fluid is retained in the tissues. Plaques begin to be deposited on the walls of blood vessels. Endothelial function is impaired.
Glucose is elevated in the blood, muscles and liver cannot be completely utilized. Heart function is impaired, renal blood flow decreases, the RAAS system (renin-angiotensin-aldosterone system) is activated - it is a hormonal structure responsible for regulating the pressure and volume of circulating blood. It exacerbates the situation, creating a vicious circle. The synthesis of fats increases, and they are deposited in adipocytes (fat cells), the amount of which increases (obesity, as a result). Pressure surges during the day do not affect heart function in the best way.
Symptoms of MS in children
Symptoms in children are less pronounced. Therefore, it is necessary to be attentive even to insignificant at first glance manifestations.
The main signs: insulin resistance, hyperglycemia and glucosuria. Side, but also important symptoms: pressure fluctuations throughout the day with a tendency to increase, hypercholesterolemia and increased LDL. What does it mean?
We are talking about low density lipoproteins, known as the harmful type of cholesterol. It contributes to the appearance of plaques on the endothelium, the lumen of the vessels as a result decreases, atherosclerosis develops early.
The most reliable indicator for the diagnosis of microalbuminuria and hyperuricemia becomes. Also the presence of abdominal obesity with a high body mass index; respiratory disturbances during sleep are often noted.
Obesity in children
Obesity of 1 degree in children is an excess of weight by 15-28%. This is the easiest. At the same time, the children look simply full. Parents do not force such children to play sports, do not limit their choice of food. Meanwhile, obesity of 1 degree in children requires a full treatment.
2 degree of obesity - excess of weight reaches already 30-49%, 3rd - 50 - 99%, 4th degree - 100%.
A fat child in a year and up to 3 years - should not cause concern among parents. Brown fat prevails at this age, which has a high metabolic rate. It leads only to growth and rapid development. As a rule, by 3 years the weight is normal. But when one of the parents is obese, it is possible for a child in 30% of cases, and if both parents - then in 60%.
At first glance, MS does not seem particularly dangerous, especially since it lasts for a very long time almost asymptomatically. But he slowly kills the body. All its violations grow like a snowball.
Metabolic syndrome in children follows a development pattern:
- lack of exercise and hypokinesia in a child;
- addiction to sweets;
- fast foods
- overeating - all this leads to a loss of sensitivity of cells to insulin.
The pancreas works in the avral system, constantly increasing insulin production and depleting, hyperinsulinemia appears, which leads to dyslipidemia, vascular function is complicated, hyperglycemia is constantly in the blood. The beginning of MS goes unnoticed.
Key symptoms of MS:
- first, in a hungry state, anger, increased irritability, unstable mood;
- aggression is possible (the brain lacks glucose);
- because of the latter, a constant craving for sweets;
- loss of strength due to lack of energy from glucose;
- daytime drowsiness, apathy, lethargy;
- night snoring and respiratory arrest in a dream, as a result of which rest becomes inferior.
Also at night, pressure often increases. Visceral fat disrupts the functioning of internal organs, compressing them; disorders of purines - uric acid is deposited in the joints, and gout occurs.
Due to vasospasm and hypertension, increased insulin in the blood , red spots appear on the neck and chest, and increased pressure in the child causes cephalgia and cardialgia. The pulse and heartbeat are quickened, there is a lack of coordination of movements, thirst, dry mouth, diuresis and other symptoms of diabetes mellitus.
There is a tendency to constipation, night sweats.
Diagnostic measures
Clinical recommendations for metabolic syndrome indicate that the diagnosis is made after receiving lipid profile data, blood sugar and considering the degree of obesity. Of particular importance is gender, age.
Metabolic syndrome criteria (markers) for diagnosis:
- Large or required: abdominal fat, disorders with insulin, disorders with glucose (increased fasting glucose, impaired glucose tolerance, type 2 diabetes).
- Small or additional markers - dyslipidemia (increase in triglyceride concentration, decrease in lipoproteins).
LDL is elevated - what does it mean?
This means an increase in the level of bad or bad cholesterol, which will not fail to be deposited on the vascular endothelium, clogging them and reducing their elasticity. They become brittle and brittle, taper. Hypertension becomes permanent, heart function is disturbed.
The waist volume for diagnosis has recently been measured by percentiles.
A percentile is a hundredth of the volume of a measured population, expressed as a percentage. Children with over 90 percentiles are more likely to be at all risk factors. In favor of MS, it will be said that the level of triglycerides is 1.7 mmol / L, HDL <1.03 mmol / L, blood pressure is higher than 130/85 mm Hg. Art., an increase in fasting venous blood glucose level of 5.6 mmol / L. It is also important for diagnosis to determine the hormonal background and conduct an ultrasound of the thyroid gland.
Treatment principles
According to the clinical recommendations of the metabolic syndrome, the main tasks of treatment are normalization of weight and restoration of sensitivity of cellular receptors to insulin.
For this, diet and physical education are used. The treatment of the metabolic syndrome is therefore divided into traditional (drug) and alternative, it is always complex.
The second is more important. It includes:
- A diet with a minimum of fats (fried, fast foods, simple sugars from the diet to remove).
- Eating foods with a low glycemic index - cereals and vegetables.
- Regular exercise. And not only limited to walking, but also give cardio and power loads on the body.
Often children for the most part have difficulty understanding the importance of diet and exercise. Therefore, here to increase their motivation you need your own example. The most correct weight loss is 1 kg per week.
No records are needed here. Medications become an adjunct in treatment for MS. Pills will not change a bad lifestyle and will not remove bad habits.
From drugs, doctors prescribe those that reduce appetite and can reduce the intake of fats in the body. The endocrinologist must take into account that the child's body perceives all drugs negatively. Therefore, their purpose should be minimal and reasonable. For example, Orlistat reduces lipase activity.
With high blood pressure, a teenager in school should be exempted from translation exams and even graduation.
This may be decided upon a statement from the parents of a special commission.
With III-IV degrees of obesity, stable hypertension, type 2 diabetes, young men are not drafted into the army. The examination is carried out by a cardiologist, neurologist and ophthalmologist. With a lesser degree of obesity, the question of conscription is decided individually, taking into account hemodynamics, glucose tolerance.
Special diet
It is advisable to replace animal fat with vegetable oils. Margarine, fried, smoked are excluded.
It is better to eat seafood, nuts. The meat is not red, preferably chicken or fish.
Dairy products are nonfat. Exclude fast carbohydrates - chocolate, sweets, ice cream, chewing gum, soda.
A piece of bitter chocolate is allowed once a day. You can use sweeteners - add to dishes or tea.
Flour products, dried fruits and sweet fruits are also at a minimum. They need to be replaced with legumes, vegetables, nuts. In general, sweet fruits and other permitted "goodies" are allowed only in the morning.
You can eat bran bread, cereal and wholemeal.
Key general recommendations:
- reduce salt to 2 g per day;
- fractional and frequent meals - in small portions, with a multiplicity of 5-6 times a day, at one time;
- the most high-calorie should be breakfast and lunch.
Snacks are allowed:
- nuts, cottage cheese, fruits;
- do not eat carbohydrates for dinner;
- maximum sugar per day - 20 g;
- better vegetable salads or fish;
- chew food thoroughly;
- drink after eating only after 30 minutes. Steam or bake.
Fasting for weight loss is prohibited. Fasting days once a week are not forbidden. Diet for metabolic syndrome is lifelong. The best menu for teens can be considered Mediterranean dishes.
Physical exercise
If parents can not conduct physical exercises with the child constantly, then it is better to write their offspring in the section. Independent hobbies include swimming, cycling, running, wrestling.
At first, the load should not exceed 15 minutes, because MS increases the load on the joints and muscles. Therefore, the mode is only sparing. After training, eating is allowed only after half an hour.
Drug therapy
Treatment of the metabolic syndrome with medications can be prescribed when diet and exercise do not help.
Indications for prescribing drugs:
- BMI ≥ 27 kg / m 2 , but there is poor heredity, a round stomach, the presence of risk factors for heart disease.
- BMI ≥ 30 kg / m 2 .
To correct violations of carbohydrate metabolism, PSSP is used - sugar-lowering tablets.
Among them:
- Sulfonylureas, biguanides, clayides, insulin potentiators (sensitizers),
- Alpha glucosidase inhibitors (reduce the absorption of carbohydrates from the intestine).
The doctor selects and prescribes them, not the parents.
"Metformin-biguanide" increases insulin sensitivity and reduces intestinal glucose absorption; dosage is individual.
"Orlistat" or "Xenical" do not allow intestinal fats to be absorbed; calorie decreases. If carbohydrates prevail in the diet, this remedy does not work.
Sibutramine (Meridia or Reduxin) reduces appetite and increases energy expenditure by the body.
Treatment of MS without losing weight does not make sense. Even removing 10 kg of weight reduces the risk of mortality by 20%. In addition, pressure, hyperglycemia and cholesterol are normalized.
Weight loss is achieved by the use of herbs, caffeine tablets to increase energy consumption of the body, drugs to reduce appetite (Phentermine, Mazindol). By the way, anorectics in children are not used due to side effects. They can only be assigned to adolescents. For the prevention of MS, medications are not prescribed. Other drugs are symptomatic.
Prevention of MS in children and adolescents
The child needs to be motivated by his example. When assigning a diet to a child, all family members will have to follow it. Regular medical examinations are mandatory.
Metabolic syndrome is a very dangerous phenomenon that entails many problems. A child with such a pathology should be constantly monitored by a doctor and all symptoms should be stopped in a timely manner.