ENDOKRYNOLOGIA PEDIATRYCZNA PDF

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Corresponding author: Agnieszka Zachurzok-Buczynska, Dept. Childhood obesity has reached epidemic proportions almost worldwide. Overweight children tend to become.

The increased incidence of childhood obesity. The gene pool promoting fat storing accompanied by a high caloric diet and sedentary. Childhood weight excess is associated with several adverse consequences. These co-morbidities, including type 2 diabetes mellitus,. Prevention and early recognition of obesity is crucial. Calculation and plotting body mass index to.

Paediatric obesity treatment should be individualized and focused not only on an obese subject but also on the. Interventions are based on lifestyle changes: diet modification — to reduce and stabilize caloric intake. Aggressive approaches, considered only in morbidly. Nadmierne nagromadzenie. BMJ, , Physical activity — key issues in treatment of childhood obesity.

Wieku Rozwoj. Overweight and obesity: AAP recommendations. In Caroli M. Chandra R. Childhood Obesity: from basic sciences to public health. Giuseppe de Nicola-Napoli. Child and Adolescent Obesity. Ed Cambridge University Press Child Educ. Pediatrics, , Child Psychol. Childhood obesity. Overweight children tend to become overweight adults who are at risk of increased morbidity and mortality. The increased incidence of childhood obesity seems to be multifactorial.

The gene pool promoting fat storing accompanied by a high caloric diet and sedentary lifestyle may lead to excessive adiposity. Childhood weight excess is associated with several adverse consequences which were believed to have been restricted to adult patients.

These co-morbidities, including type 2 diabetes mellitus, metabolic syndrome and obstructive sleep apnea, may contribute to cardiovascular diseases later in life. Moreover, children with excessive weight suffer from many psychological and orthopaedic diseases which can impair their development. Calculation and plotting body mass index to identify weight excess and, if present, monitoring obesity related co-morbidities should be done regularly in each child.

Paediatric obesity treatment should be individualized and focused not only on an obese subject but also on the whole family. Interventions are based on lifestyle changes: diet modification — to reduce and stabilize caloric intake and restructure eating habits, as well as increase physical activity.

Aggressive approaches, considered only in morbidly obese patients with severe co-morbidities, who failed lifestyle modification treatment, include restrictive hypocaloric diets, drug therapy and bariatric surgery.

Obesity — a pandemic of the 21 st century — is affecting more than a billion people worldwide. Two to three times more people are overweight. It is assessed that by the number of obese adults will have reached 1,12 billion individuals [1]. Unfortunately, this growing problem also concerns children of various ages.

Overweight children tend to become overweight adolescents and then overweight adults, whose obesity is associated with a number of serious medical complications and increased mortality. There has been a tenency towards its increasing prevalence in developing countries and in some parts of Africa the problem of childhood overweight has replaced malnutrition [3]. There are strong national differences in prevalence of childhood obesity.

In Europe a review of 21 surveys indicated generally lower levels of overweight among children from the countries of the central and eastern part of the continent compared to the countries surrounding the Mediterranean sea [4].

Risk factors This increased incidence of childhood obesity is multifactorial as it cannot be blamed on genetics or environment alone. Humankind evolved in environment in which the ability to store fat was a big advantage, and it is obviously not possible for the gene pool to change in one or two generations. However, genetic background is very important — genes may play a permissive role in fat storing paired with sedentary lifestyle and energy dense diet. Maternal and paternal obesity significantly increase the risk of overweight in their offspring, as well as the maintenance of increased body fat mass into adulthood [7].

Furthermore, parents commonly do not perceive their children as overweight or do not consider obesity as a risk factor of impaired physical health [9]. During the past two decades there has been a dramatic change in lifestyle that also affected the young generation.

Instead of playing outside, children spend an increasing amount of their spare time at home, watching television or playing computer games. Watching television is directly linked with childhood obesity not only due to the inactivity but also due to the energy dense food advertising [12]. In the past few decades, apart from lifestyle changes, eating habits of children have changed markedly.

The consumption of high-fat, high-salt fast food among U. High-carbohydrate soft drinks have replaced milk, the consequence of which is the decreased calcium intake. Children consume less vegetables and the most popular are potatoes [13]. The meal pattern has changed — breakfasts tend to be skipped and the main caloric load is consumed with a large dinner. Fast food restaurants offer larger portions at the same price and during the past 20 years the portion size in food outlets has increased more than twice [13].

Low birth weight as well high birth weight and maternal gestational diabetes mellitus also relate to later obesity. A U-shaped relationship between birth weight and obesity in young adult life was found [14].

It is suggested that intrauterine factors, such as suboptimal nutrition or hyperglycemia, may program later body composition — decreased lean mass and increased fat mass, independent of maternal and genetic influences [16].

Co-morbidities Childhood overweight is associated with several adverse consequences. Obese children are at high risk for adult obesity and obesity in adults leads to increased morbidity. However, as the incidence of childhood obesity has increased, paediatricians face health problems that were formerly restricted to adult patients.

In Europe, although less common, it is present in ethnic minorities. It is also reported in obese Caucasian adolescents, mostly girls with positive family history for T2DM [18].

In overweight children with signs associated with insulin resistance hypertension, dyslipidaemia, acanthosis nigricans, polycystic ovarian syndrome , T2DM could also be possible. It is worth mentioning that in patients with early-onset T2DM the incidence of nephropathy is higher than in those with type 1 diabetes [19].

Males of Spanish origin are at the highest risk of MS, however abdominal obesity increases the risk of MS in all overweight adolescents. Children who have components of MS tend to dislpay them in adulthood. There are no definite criteria of the MS for paediatric age group, and very limited paediatric reference values for waist circumference in Caucasian children are present [21].

It could be associated with androgen overproduction by sex hormone-producing enzymes of adipose tissue and by adrenals and ovaries due to hyperinsulinaemia. Moreover, sex hormone binding globulin SHBG production in the liver is reduced in obesity, which causes an increased level of free sex hormone fraction. This abnormal profile of sex hormones causes that overweight adolescents girls are at risk of menstrual disorders, hirsutism and polycystic ovarian syndrome [22].

It is a clinical-pathological condition in which liver biopsy shows the signs of steatosis, inflammation and hepatocyte destruction. Its natural history may have a benign course without severe liver function impairment or in rare cases — progression to cirrhosis. Most children are asymptomatic and a clinical challenge is to identify those at risk for progression to cirrhosis as the candidates for potential therapy. Obstructive sleep apnoea syndrome OSA is strongly associated with obesity.

In patients with OSA sleep architecture is disrupted with several obstructive episodes and arousal every night [24]. Even in obese children subclinical, functional and structural changes in the heart and vessels can be found. Other co-morbidities are also associated with excessive body weight.

Psychological problems associated with childhood obesity include poor self image, social isolation, aggression, depression, suicide, promiscuity, drug and alcohol addiction, bulimia, and binge eating.

Prevention In the American Academy of Paediatrics issued a policy statement on prevention of paediatric obesity and overweight [26]. Other strategies should be breastfeeding encouragement, healthy eating habits and physical activity promotion as well as limitation of TV viewing. Prevention of obesity in children should be the first line of treatment and it should be introduced at the population level, targeting communities such as school as well as individuals.

However, it is doubtful whether obesity is preventable using currently available intervention strategies. Data from randomized trials to support any particular strategy to prevent the development of overweight in children are lacking. BMI is the most practical measure and a calculated value should be plotted on charts with age and sex reference values and followed up at each visit.

Country-specific BMI charts and cut-off points for definition of overweight and obesity should be used. Additionally, in clinical evaluation of an obese child we propose waist circumference measurement, as a very useful and cheap method of visceral fat content estimation.

Clinical examination should be focused on ruling out rare, secondary reasons for obesity, such as: 1. The assessment of an obese child should include a detailed medical history with drawing special attention to: 1.

Linear growth, weight gain and the age of onset of obesity. Limitations and complications due to obesity e. Family history obesity and obesity related co-morbidities: diabetes, hypertension, early heart disease, etc. Co-morbidities such as hypertension, severe dyslipidaemia, T2DM should be managed when identified, without waiting until the weight loss is achieved.

Treatment Not just children or adolescents but the entire family and all caregivers should be involved in the treatment program to promote the environmental changes essential for a long term success [27—29]. Many studies have shown that family-based weight-loss programs are much more successful in promoting lifestyle changes for children than individual counselling [30, 31].

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