Obezite tanısı almış çocuk ve adölesanlarda antropometrik ve laboratuvar parametrelerinin retrospektif değerlendirilmesi ve çocukluk yaş grubunda obezite ve metabolik sendrom (MS) risk faktörlerinin belirlenmesi. Metod: Çocuk endokrinoloji polikliniğimizde 2003 ile 2009 yılları arasında boya göre ağırlığı (BGA) %120.nin üstünde saptanarak obezite tanısı almış 4 ay-18 yaş arası (ort yaş: 10,4 ł3,3) 709 olgu çalışmaya alındı. Tüm olguların başlangıç ve kontrollerdeki anamnez kayıtları, fizik muayene bulguları, antropometrik ölçümleri, biyokimya ve hormonal parametreleri ile radyolojik tetkik sonuçları hasta kayıtlarından elde edildi. Metabolik sendrom (MS) Dünya Sağlık Örgütü kriterlerine göre konuldu. Tüm olguların vücut kitle indeksleri standart deviasyon skorları (VKİ SDS) hesaplandı. Sonuçlar: Toplam 709 olgunun 90.ı (%12,6) 0,3-6 yaş, 349.u (%49,2) 7-11 yaş, 270.i (%38,2) 12-18 yaş arasındaydı. 319 olgu (%44) puberteye girmişti. Olguların 348.inin (%49) erkek, 361.inin (%51) kız olduğu tespit edildi. Erkek olguların ortalama BGA ve VKİ SDS değerleri kız olgulardan anlamlı olarak yüksek bulundu (p<0,05). VKİ SDS 2,5 üstünde olan toplam 413 (%58) aşırı obez çocuğun 236.sı (%57) erkek ve 177.si (%43) kız olarak saptandı (p<0,05). Puberteye girmiş olguların ortalama VKİ SDS ve BGA.ları puberteye girmemiş gruba göre anlamlı olarak yüksek bulundu. (p<0,05) MS taraması yapılan 615 olgunun 240.ında (%39) MS tespit edildi. MS sıklığı 12-18 yaş arası olgularda 7-11 yaş olgulara göre anlamlı yüksek bulundu (p<0,05). Puberte saptanan olgularda MS sıklığı pubertesi olmayanlara gore anlamlı yüksek bulundu (p<0,05). Modifiye Cook kriterlerine göre ise MS sıklığı %34 olarak bulundu. Ailede risk faktörü bulunan (kalp hastalığı, şeker hastalığı, obezite, tansiyon yüksekliği) ve anne sütünü hiç almayan olgularda MS sıklığı anlamlı olarak yüksek saptandı (p<0,05). Sabah kortizol düzey yüksekliği veya diürinal ritm bozukluğu 222 (%31) olguda tespit edildi. Fakat hiçbir olguda Cushing sendromu tespit edilmedi. Sella spot grafisinde şüpheli patolojik görünüm 71 olguda (%10) rapor edildi. Kranial MR görüntülenmesinde bunlardan 10.unda (%13,8) hipofizer mikroadenoma sahip olduğu, kalan 2 olguda (%2,7) ise hipofiz hiperplazisi varlığı rapor edildi.
Aim: To evaluate anthropometric and laboratory parameters in children and adolescents diagnosed with obesity retrospectively and to determine the risk factors for obesity and metabolic syndrome in pediatric age group. Method: Seven hundred and nine patients aged between 4 months and 18 years (mean age: 10.4ł3.3) who had weight for height (W/H) over %120 and diagnosed as obesity between 2003 and 2009 years in our department of pediatric endocrinology were included in the study. All data of the patients including the history records, physical examination findings, anthropometric measurements, biochemical and hormonal parameters, radiological examinations at the diagnosis and controls have been obtained from patient records. The diagnosis of metabolic syndrome (MS) has been done based on modified WHO criteria. Body mass index standard deviation scores (BMI SDS) of the patients were also calculated. Results: Of the 709 patients, 90 (12.6%) were between 0.3-6 years old, 349 patients (49.2%) were between 7-11 years old and 270 patients (38.2%) were between 11-18 years old. Three hundred and nineteen cases (%44) were in puberty. It has been determined that 348 (49%) cases were male and 361 (51%) were female. The mean W/H and BMI SDS values of the male cases were found significantly higher than that of female cases (p<0.05). Of 413 children with severe obesity who had BMI SDS over 2.5 SDS, 236 (57%) were males and 177 (43%) were females (p<0.05). The mean BMI SDS and W/H values of patients in puberty were significantly higher than patients who were not in puberty. Six hundred and fifteen cases scanned for MS and determined in 240 cases (39%). The frequency of MS in cases aged between 12-18 years old was higher than cases aged between 7- 11 years old (p<0.05). Patients with puberty had significantly higher frequency of MS compared with patients who had no puberty (p<0.05). The frequency of MS was found to be 34% when the patients evaluated according to modified Cook criteria. MS frequency was found significantly higher in cases who had risk factors in the family (cardiovasculer disease, diabetes, obesity, hypertension) and had no feeding with breast milk (p<0.05). High basal cortisol levels and/or cortisol diurnal rhythm disorders have been detected in 222 cases (%31). However, none of these cases were diagnosed with Cushing syndrome. Suspicious pathological views in sella spot radiographies have been reported in 71 (10%). Cranial MR revealed that 10 cases of them (13.8%) had pituitary microadenom and pituitary hyperplasia were present in the remaining 2 (2.7%). Discussion: In this study, while obesity frequency was found similar in both sexes, it has been determined that boys had more severe obesity than girls. Presence of obesity in the family seems to be the most important risk factor for developing of obesity in childhood. The frequency of MS in children was found high concordance with the previous studies. Age, presence of the risk factor in the family, pubertal status, feeding without breast milk was found to be the most important factors increasing the MS risk. While scaning for Cushing syndrome seems appropriate to look in selected children with obesity, further studies are needed for sella spot radiographs.
Keywords: Children, adolescent, obesity, metabolic sydrom, risk factors.
Tez (Tıpta Uzmanlık) - Süleyman Demirel Üniversitesi, Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, 2010.
Kaynakça var.
Obezite tanısı almış çocuk ve adölesanlarda antropometrik ve laboratuvar parametrelerinin retrospektif değerlendirilmesi ve çocukluk yaş grubunda obezite ve metabolik sendrom (MS) risk faktörlerinin belirlenmesi. Metod: Çocuk endokrinoloji polikliniğimizde 2003 ile 2009 yılları arasında boya göre ağırlığı (BGA) %120.nin üstünde saptanarak obezite tanısı almış 4 ay-18 yaş arası (ort yaş: 10,4 ł3,3) 709 olgu çalışmaya alındı. Tüm olguların başlangıç ve kontrollerdeki anamnez kayıtları, fizik muayene bulguları, antropometrik ölçümleri, biyokimya ve hormonal parametreleri ile radyolojik tetkik sonuçları hasta kayıtlarından elde edildi. Metabolik sendrom (MS) Dünya Sağlık Örgütü kriterlerine göre konuldu. Tüm olguların vücut kitle indeksleri standart deviasyon skorları (VKİ SDS) hesaplandı. Sonuçlar: Toplam 709 olgunun 90.ı (%12,6) 0,3-6 yaş, 349.u (%49,2) 7-11 yaş, 270.i (%38,2) 12-18 yaş arasındaydı. 319 olgu (%44) puberteye girmişti. Olguların 348.inin (%49) erkek, 361.inin (%51) kız olduğu tespit edildi. Erkek olguların ortalama BGA ve VKİ SDS değerleri kız olgulardan anlamlı olarak yüksek bulundu (p<0,05). VKİ SDS 2,5 üstünde olan toplam 413 (%58) aşırı obez çocuğun 236.sı (%57) erkek ve 177.si (%43) kız olarak saptandı (p<0,05). Puberteye girmiş olguların ortalama VKİ SDS ve BGA.ları puberteye girmemiş gruba göre anlamlı olarak yüksek bulundu. (p<0,05) MS taraması yapılan 615 olgunun 240.ında (%39) MS tespit edildi. MS sıklığı 12-18 yaş arası olgularda 7-11 yaş olgulara göre anlamlı yüksek bulundu (p<0,05). Puberte saptanan olgularda MS sıklığı pubertesi olmayanlara gore anlamlı yüksek bulundu (p<0,05). Modifiye Cook kriterlerine göre ise MS sıklığı %34 olarak bulundu. Ailede risk faktörü bulunan (kalp hastalığı, şeker hastalığı, obezite, tansiyon yüksekliği) ve anne sütünü hiç almayan olgularda MS sıklığı anlamlı olarak yüksek saptandı (p<0,05). Sabah kortizol düzey yüksekliği veya diürinal ritm bozukluğu 222 (%31) olguda tespit edildi. Fakat hiçbir olguda Cushing sendromu tespit edilmedi. Sella spot grafisinde şüpheli patolojik görünüm 71 olguda (%10) rapor edildi. Kranial MR görüntülenmesinde bunlardan 10.unda (%13,8) hipofizer mikroadenoma sahip olduğu, kalan 2 olguda (%2,7) ise hipofiz hiperplazisi varlığı rapor edildi.
Aim: To evaluate anthropometric and laboratory parameters in children and adolescents diagnosed with obesity retrospectively and to determine the risk factors for obesity and metabolic syndrome in pediatric age group. Method: Seven hundred and nine patients aged between 4 months and 18 years (mean age: 10.4ł3.3) who had weight for height (W/H) over %120 and diagnosed as obesity between 2003 and 2009 years in our department of pediatric endocrinology were included in the study. All data of the patients including the history records, physical examination findings, anthropometric measurements, biochemical and hormonal parameters, radiological examinations at the diagnosis and controls have been obtained from patient records. The diagnosis of metabolic syndrome (MS) has been done based on modified WHO criteria. Body mass index standard deviation scores (BMI SDS) of the patients were also calculated. Results: Of the 709 patients, 90 (12.6%) were between 0.3-6 years old, 349 patients (49.2%) were between 7-11 years old and 270 patients (38.2%) were between 11-18 years old. Three hundred and nineteen cases (%44) were in puberty. It has been determined that 348 (49%) cases were male and 361 (51%) were female. The mean W/H and BMI SDS values of the male cases were found significantly higher than that of female cases (p<0.05). Of 413 children with severe obesity who had BMI SDS over 2.5 SDS, 236 (57%) were males and 177 (43%) were females (p<0.05). The mean BMI SDS and W/H values of patients in puberty were significantly higher than patients who were not in puberty. Six hundred and fifteen cases scanned for MS and determined in 240 cases (39%). The frequency of MS in cases aged between 12-18 years old was higher than cases aged between 7- 11 years old (p<0.05). Patients with puberty had significantly higher frequency of MS compared with patients who had no puberty (p<0.05). The frequency of MS was found to be 34% when the patients evaluated according to modified Cook criteria. MS frequency was found significantly higher in cases who had risk factors in the family (cardiovasculer disease, diabetes, obesity, hypertension) and had no feeding with breast milk (p<0.05). High basal cortisol levels and/or cortisol diurnal rhythm disorders have been detected in 222 cases (%31). However, none of these cases were diagnosed with Cushing syndrome. Suspicious pathological views in sella spot radiographies have been reported in 71 (10%). Cranial MR revealed that 10 cases of them (13.8%) had pituitary microadenom and pituitary hyperplasia were present in the remaining 2 (2.7%). Discussion: In this study, while obesity frequency was found similar in both sexes, it has been determined that boys had more severe obesity than girls. Presence of obesity in the family seems to be the most important risk factor for developing of obesity in childhood. The frequency of MS in children was found high concordance with the previous studies. Age, presence of the risk factor in the family, pubertal status, feeding without breast milk was found to be the most important factors increasing the MS risk. While scaning for Cushing syndrome seems appropriate to look in selected children with obesity, further studies are needed for sella spot radiographs.
Keywords: Children, adolescent, obesity, metabolic sydrom, risk factors.