Introduction: In the light of recent studies, the usefulness of the metabolic syndrome diagnosis in obese pediatric patients seems to be controversial. It leads to the pressing questions, if the metabolic syndrome diagnosis is reflecting risk of the cardiovascular complications in obese children. Aim of the study: To evaluate the incidence of metabolic syndrome in obese children, asses the role of insulin resistance in the metabolic complications and investigate if the diagnosis of MS has a clinical value in that group of patients. Material and methods: After the retrospective analysis of 588 records of obese children treated in metabolic outpatient clinic, 289 children (145 boys) in the mean age of 11 years, was qualified to the study. Diagnosis of metabolic syndrome was based on IDF 2009 criteria and HOMA-IR was used in the assessment of insulin resistance. Results: Metabolic syndrome was diagnosed in 69 children (24%) including 42 girls (61%, p < 0.05). Mean age was higher (12.4 vs. 10.9, p < 0.05) in patients with metabolic syndrome. Initial BMI Z-score was similar in the both groups (2.93 SD vs. 2.92 SD). However, further follow-up showed significantly (p < 0.001) less effective BMI z-score reduction in patients with metabolic syndrome. Insulin resistance was observed significantly more often in children with metabolic syndrome (77% vs. 35%, p < 0.0001). Moreover, aminotransferases were significantly higher in boys with metabolic syndrome (AST = 35 vs. 28 U/l, ALT = 38 vs. 23 U/l, p < 0.0001). Conclusions: The diagnosis of metabolic syndrome in obese children seems to have a predictive value for the clinical practice. Affected children are older and their criteria are present more often in girls. Insulin resistance seems to be an important factor associated with metabolic syndrome in obese children. The outcomes of behavioral therapy are less effective in children with metabolic syndrome. Affected boys are at higher risk of non-alcoholic fatty liver disease (NAFLD) in the future.
Objective: The aim of the study was to evaluate the effectiveness of behavioral therapy in childhood obesity in metabolic outpatient clinic. Material and methods: Records of the 587 (289 boys) obese children in the age of 10.73 ± 3.57 were retrospectively analyzed (2005-2016). The therapy included lifestyle modification (increased physical activity, and support from the dietician and psychologist). Anthropometrical assessment was based on BMI z-score index. Results: Initial BMI z-score was higher in boys (3.29 SD vs. 2.66 SD, p < 0.00001). At follow-up visit for an average of 3 months, with a 66.8% of the children reported, an improvement was observed in 70% of them, and greater weight loss was found in boys (∆BMI Z-score: 0.28 SD vs.-0.15 SD). Improvement of the nutritional status (∆BMI Z-score) correlated with the age of children and the initial weight (vs. age: r = 0.233, p < 0.01; vs. BMI Z-score: r =-0.610, p < 0.00001). Further follow-up showed a reduction in the number of children continuing the treatment (at the 3 rd visit: 28.3%; at the 4 th visit: 19.1%; at the 5 th visit or more: 12.7%). In children, who remained under control of the outpatient clinic, a reduction in BMI z-score (p < 0.00001) was observed from the 3 rd visit. Conclusions: Behavioral therapy on the outpatient clinic level is effective, but its effectiveness is pointedly reduced by the high number of children and their parents who avoid the treatment or refuse to continue this model of therapy. The essential challenge is to keep the motivation of both parents and children. Key words: childhood obesity, behavioral treatment, BMI, outpatient clinic. 3.7% girls and 3.6% boys [3,4], and this is the reason why we should pay special attention to these children in clinical practice. In consequence, they are likely to stay obese in future. The obesity epidemic is a serious and growing problem for public health systems worldwide [5-7], affecting all age groups including very young children [8]. The main and the most important problem of obesity are the short-and long-term consequences. Obesity can lead to numerous comorbidities such as diabetes mellitus type 2, hypertension, hyperlipidemia, or metabolic syndrome [8,9]. These progressive disorders lead to decline life expectancy. Regardless of multiple organic diseases, obesity often conduce to psychological distresses because is inevitably accompanied by discrimination and stigmatization
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