Germany Journal

Document Type : Original Article

Author

Associate Professor of Pediatric Endocrinology & Metabolism, Tuberculosis and Lung Disease Research Center, Department of Otorhinolaryngology, Tabriz University Of medical Sciences, Tabriz, Iran

Abstract

This study was a prospective descriptive study that was conducted during 2019 with the participation of 500 children under 7 years old who referred to health centers in Tabriz. Blood pressure, height, weight and indicators of metabolic syndrome were measured for all children and the prevalence of this syndrome was measured based on body mass index. 50 (10%) of the study participants had metabolic syndrome; Participants in the study were divided into two groups based on whether or not they had metabolic syndrome and the relevant indicators were compared. Based on this classification, it was found that there are statistically significant differences between the waist ratio and metabolic syndrome as well as body mass index and metabolic syndrome between the two groups, Based on the results of the study, it was found that body mass index in people with metabolic syndrome was significantly higher than people without metabolic syndrome(P=0.005). This study showed that two important components of metabolic syndrome (abdominal obesity and obesity) are relatively common in Tabriz children under 7 years of age. Since changes in body mass index are affected by several factors, it seems necessary to consider the underlying role of these factors in the evaluation of obese children.

Keywords

Introduction

etabolic syndrome is a set of disorders that, when combined, increase the risk of heart disease, stroke and type 2 diabetes. These disorders include high blood pressure, high blood sugar, high waist fat and abnormal levels of cholesterol or triglycerides [1]. The presence of one of these disorders does not indicate the presence of metabolic syndrome, but indicates a higher risk of serious illness, and the more of these disorders a person has, the greater the risk of complications such as type 2 diabetes and heart disease [2,3].

Metabolic syndrome is highly associated with overweight or obesity and inactivity. It is also associated with a disorder called insulin resistance. The digestive system naturally breaks down the foods we eat into sugar [4]. Insulin is a hormone made by the pancreas to help sugar enter cells and be used as fuel for cells. In patients with insulin resistance, the cells do not respond naturally to insulin and glucose cannot enter the cells easily. As a result, even as the body makes more and more insulin and tries to lower blood sugar, blood sugar levels rise [5].

Most metabolic syndrome disorders do not have obvious signs or symptoms. One of the most visible signs is a large waist, and if your blood sugar is high, the signs and symptoms of diabetes such as binge drinking, fatigue and blurred vision may show up. Chest pain or shortness of breath can cause cardiovascular complications [6]. Acanthosis nigercans (dark spots on the skin, especially in wrinkled areas where sweating is high), excess hair growth, peripheral neuropathy (loss of sensation in the arms and legs), and retinopathy (retinal damage) in patients with insulin and high glucose resistance. Blood or type 2 diabetes is seen. Xanthoma or xanthelasma is seen in patients with severe fat disorders [7,8]. Recent studies indicate that the prevalence of this syndrome in children has reached ten percent, and the incidence of this syndrome in children can endanger the health status of children and communities. The first goal in the treatment of pediatric metabolic syndrome is to reduce the risk of cardiovascular disease and type 2 diabetes [9,10]. The first step in successful prevention management is to determine this syndrome and its various components in different population groups, especially children. Therefore, despite the two important components of metabolic syndrome and its high in adolescents, this study aims to determine the prevalence of some components. Metabolic syndrome (abdominal obesity and hypertension) in primary school children in Tabriz was designed to have an intervention program for both children and adolescents in this study and the first effective steps in the prevention and treatment of this Remove the components of the metabolic syndrome.

Materials and Methods

Study design: This study is a prospective descriptive study that was conducted during 2019 in health centers of Tabriz with the participation of 500 children under 7 years old. The sampling method was available and purposeful. Children were included in this study by observing the inclusion and exclusion criteria.

Inclusion and exclusion criteria: Inclusion criteria included age under 7 years and parents' consent to participate in the study. Exclusion criteria included children with mental disorders, children with thyroid disorders, and children with liver problems and diseases. Also, if we noticed any abnormalities in the children during the examinations (history of rickets, history of morbid overeating and history of overweight at birth), we excluded that child from the study process.

Methodology: An individual questionnaire (including surname, age, gender) was completed for each child. Children's blood pressure was measured from the right hand after ten minutes of rest using an alpk mercury sphygmomanometer (made in Japan). The tables presented in the fourth report of diagnosis, evaluation and treatment of pediatric hypertension were used to determine hypertension. These tables show systolic and diastolic pressures by age, sex, and percentile of height. In the present study, blood pressure  greater than or equal to 90 was defined as abnormal blood pressure and blood pressure less than 90 was defined as normal blood pressure. Then anthropometric indices including height, weight and waist circumference were measured. Weight measurement with Seca scales (made in Germany) with minimal clothing and without shoes with an accuracy of 100 grams. After contacting the gonia with the head, it was measured with an accuracy of half a centimeter. Waist circumference was measured while standing between the last tense and the iliac head during a normal exhalation. Then body mass index was measured using the existing formula.

Data analysis: Data were entered into SPSS software (version 21) and the prevalence of obesity, central obesity and hypertension (systolic and diastolic) by percentage and qualitative variables using non-parametric test (chi-square) and for Quantitative variables t-test was used.

Ethical considerations: For this study, the code of ethics (IR.TBZMED.REC.1399.1037) was obtained from Tabriz University of Medical Sciences; Conscious consent was obtained from the parents of all participants after explaining the objectives of the research and ensuring that sampling and participation in the research were free. Coordination with the Vice Chancellor for Health of Tabriz University of Medical Sciences for sampling in health centers in Tabriz was also done.

Results

Mean (standard deviation) age of patients in non-metabolic syndrome group 6.2 (1.2) years and mean (standard deviation) age group of metabolic syndrome group 6.3(1.02) (P Value= 0.145) and mean (standard deviation) Body mass index of patients in non-metabolic syndrome group was 32.8 (8.67) and the mean (standard deviation) of patients in metabolic syndrome group was 24.2 (7.06). (P Value=0.036). 50 (10%) of the study participants had metabolic syndrome; Participants in the study were divided into two groups based on whether or not they had metabolic syndrome and the relevant indicators were compared. Based on this classification, it was found that there are statistically significant differences between the waist ratio and metabolic syndrome as well as body mass index and metabolic syndrome between the two groups (Table 1).

 

Table 1: Comparison of general condition of study participants

Variable

Metabolic Syndrome (N=50)

Non metabolic syndrome(N=450)

P Value

Age

6.3 ±1.02

6.2 ±1.2

0.145

Sex

Girl

20(40%)

225 (50%)

0.895

Boy

30(30%)

225 (50%)

Body Mass Index

Mean

24.2 ±7.06

32.8±8.67

0.036

Normal

5(10%)

259(57.55%)

0.005

Overweight

4(8%)

163(36.22%)

Fat

11(22%)

20(4.44%)

Obesity type I

17(34%)

8(1.77%)

Obesity type II

8(16%)

0(0%)

Obesity type III

5(10%)

0(0%)

WSI

very low

8(16%)

80(17.77%)

0.347

Low

7(14%)

63(14%)

Normal

10(20%)

88(19.55%)

high

13(26%)

109(24.22%)

Very high

12(24%)

110(24.44%)

 

Based on the results of the study, it was found that body mass index in people with metabolic syndrome was significantly higher than people without metabolic syndrome(P=0.005).

Discussion

Experts are still unsure about the cause of metabolic syndrome. People should consider having metabolic syndrome as an alarm and prevent this serious disease in the future by making simple changes in eating and behavioral habits. A number of risk factors are involved in the development of this disease, some of which include the following [11,12]. Insulin resistance: Insulin is a hormone that helps the body use glucose and convert it into energy. In insulin resistant people, this hormone does not work properly; [13]. Therefore, the body produces more insulin to fight the rise in glucose levels, which can lead to diabetes; Insulin resistance is closely related to abdominal weight gain [14]. Obesity: According to obesity experts, especially abdominal obesity, increases the risk of metabolic syndrome. Having belly fat, along with fat in other parts of the body, seems to play an important role in increasing the risk of developing this syndrome. Unhealthy lifestyle: A diet high in processed foods and lack of adequate physical activity can contribute to the disease [15,16]. Hormonal imbalance: Hormones may play a role in the development of this syndrome; For example, polycystic ovary syndrome (PCOS), which affects fertility, causes hormonal imbalance and metabolic syndrome [17,18]. The prevalence of this syndrome has increased in recent years. It is estimated that about 20 to 25 percent of adults are affected [19]. This syndrome is associated with central obesity and insulin resistance. Obesity is involved in high blood pressure, high blood LDL cholesterol (bad cholesterol), low HDL cholesterol (good cholesterol) and hyperglycemia (high blood sugar). Abdominal obesity is particularly associated with metabolic risk factors. Metabolic syndrome is a set of metabolic complications of obesity. In insulin resistance disease, the body cannot use insulin well [20]. The body needs insulin in daily life to convert sugar and starch into energy. If the body is unable to do this, diabetes or diabetes will occur. In some people, insulin resistance is inherited. In these people, acquired factors (such as increased body fat and lack of physical activity) can cause insulin resistance and metabolic syndrome. Most people with insulin resistance also have central (abdominal) obesity [21].

Limitation

Lack of knowledge about birth weight, lack of information about the nutritional status of children, lack of information about the weight of parents and also lack of knowledge about the activity of children were some of the limitations of this study that are recommended to be addressed in future studies. Due to the high prevalence of metabolic syndrome in children under 7 years of age, it is recommended to take preventive measures for these children.

Conclusion

This study showed that two important components of metabolic syndrome (abdominal obesity and obesity) are relatively common in Tabriz children under 7 years of age. Since changes in body mass index are affected by several factors, it seems necessary to consider the underlying role of these factors in the evaluation of obese children.

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