Журнал «Здоровье ребенка» (62) 2015. Тематический выпуск "Детская гастроэнтерология"
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Gastrointestinal pathology in children with obesity
Авторы: Sorokman T.V., Sokolnyk S.V., Shlyk O.G. — Bukovinian State Medical University, Chernivtsi, Ukraine
Рубрики: Педиатрия/Неонатология
Разделы: Клинические исследования
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Overweight and obesity are observed in 24% of children and adolescents, and is considered to be one of the global problems. That is why the WHO Regional European Office on surveillance for obesity in children (COSI - Childhood Obesity Surveillance Initiative) has begun to collect data about children’s obesity.
The significance of the problems of excess body weight is determined by the threat of disability of younger patients and reduction of overall life expectancy in connection with the development of comorbidities. In particular, the pathology of digestive system is fairly common.
Objective: to investigate the frequency and structure of the digestive system pathology in children with overweight and obesity.
Material and research methods. The study involved 120 children with overweight and obesity. Children were aged 10-17 years old. The study included a complete clinical examination of children, laboratory and instrumental methods. All children underwent measurements of height, body weight and waist and thighs circumference according the standard method. The diagnosis of excessive body weight was established according the body mass index (BMI), which was higher than the 85 percentile, but less than 95 percentile according to age and gender nomograms, obesity - BMI within values equal to or higher than 95 percentile data. Normal body weight was diagnosed within BMI values ranging from 5 to 85 percentile. The recommendations of IDF Consensus, 2007, according to which the abdominal obesity is diagnosed in children aged 10-16 years old with a waist circumference (WC) equal to or greater than 90 percentile according to age and gender, in children over 16 years old - with WC equal to or more than 94 cm in boys, and girls with WC equal to or more than 80 cm. Statistical analysis of the results was performed using the software with the methods of variation statistics.
Results of research and their discussion. An overweight was diagnosed in 20 individuals (18.1%), obesity - in 100 individuals (83.83%). The abdominal obesity type was diagnosed in 48 children (40.0%).
Boys dominated among the surveyed group of children with overweight - 70 persons (58.3%), while girls appeared to be 50 (41.7%) (p <0.001). Among obese children the number of boys was more significant - 67 (67.0%) versus 33 girls. Among all girls the abdominal obesity was diagnosed in 9 cases (32.1%) among boys - 51.6% (29 persons). Gender analysis of anthropometric indices showed significantly higher values of growth, body weight, waist and thigh circumferences, as well as their ratio among boys (p <0.05). Overweight and obesity were registered more often among boys older than 16 years (60.0%) and girls 12-16 years (20%).
The pathology of the digestive system was observed in 79 (65.8%) children with excess body weight and obesity. In the structure of gastrointestinal diseases chronic gastroduodenitis prevailed - 35 cases (35.0%), 2 (2.0%) among which were overweighed and 33 (33.0%) - patients with obesity. The ulcer-destructive lesions of the mucous membrane of the gastrointestinal tract, bile-stone disease and chronic bowel disease recorded virtually among children with overweight. Functional diseases of the digestive system predominated in this group of patients (55.0%). A different pattern was observed in children with obesity. In 54% of children with obesity various chronic diseases of the digestive pathology of gastroduodenal area was observed, and 46% of children had functional diseases of the digestive system with a predominance of lesions of the biliary system (20%) above functional disorders of the gastrointestinal tract (13%).
The analysis of the main complaints of children enrolled in the hospital was conducted. It should be noted that in 26 overweight or obese children (21.6%) the complaints during hospitalization were absent. In most cases children complained of abdominal pain (62 cases, 51.6%). The most common localization of pain was epigastric region (37.5%), right hypochondriac region (23.3%) and umbilical area (12.0%), the majority of children indicated the periodicity of pain manifestation, sporadic (58 cases, 93 5%) and only 4 (6.5%) indicated the frequent pain. Dyspeptic complaints were recorded in half of the children (50.6%) with overweight and obesity, combined with concomitant diseases of the digestive system (nausea in 100% of patients, 27.5% of heartburn, belching air in 25%, acid regurgitation in 22 5%, metallic taste in 17.5%, 17.5% diarrhea and constipation in 12.5%).
Despite the fact that the survey group included only children who are overweight and obese, only 49 of them (40.8%) complained of excess body weight in their age. The fact that the complaints expressed overweight 56% of surveyed girls and 41.1% of boys is of peculiar attention. 22 patients (18.3%) complained of increased appetite, especially in the evening time. The emerging of quick fatigue was mentioned by 17 children (14.1%). 6 patients (5.0%) complained of periodical heart ache, associated with physical and emotional stress in most cases. Emotional lability was observed in 13 cases, all girls.
Thus, the analysis of complaints in children with overweight and obesity showed their variety, but pain, dyspeptic signs and symptoms of autonomic dysfunction were more frequently registered. The high prevalence of concomitant dysfunction of the digestive system can be explained by the similarity of the etiological factors that determine the occurrence of obesity and diseases of the gastrointestinal tract. An important role is played by the actual alimentary factor - violations of the food taking and its nutritional and energy imbalance.
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