The role of heredity and lifestyle in development of obesity and hypertension of children and adolescents

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THE ROLE OF HEREDITY AND LIFESTYLE IN DEVELOPMENT OF OBESITY AND HYPERTENSION OF CHILDREN AND ADOLESCENTS

MEDICAL DEPARTMENT, SAMARKAND STATE MEDICAL INSTITUTE.

Abstract

The article presents data from a survey of 55 obese children and adolescents. It was found that the main risk factors for the development of various types of obesity in children, including arterial hypertension, are hypercaloric nutrition, physical inactivity, heredity for obesity and hypertension of hypertension in both parents and maternal diabetes, and smoking in families. Great importance in progression of obesity and the manifestation of hypertension was the period of puberty. Identified risk factors should contribute to active educational and curative work among the children's population, to prevent the development of obesity (especially abdominal) and the formation of complications from this pathology.

Keywords: obesity, abdominal obesity, arterial hypertension, risk factors, children and adolescents.

The relevance of problem. Practically in all regions of the world, the number of obese children is growing steadily and doubles every three decades. Currently, in developed countries, up to 25% of adolescents are overweight, and 15% are obese. Thus, in Europe, 31.8% of schoolchildren suffer from obesity [ 2,4,6,7,8], Russia is among the 20 countries with a high frequency of childhood and adolescent obesity [ 7].

Along with obesity, there is a clear tendency toward a steady increase in the conditions associated with it, in particular, hypertension. The prevalence of hypertension among children and adolescents when applying various diagnostic criteria ranges from 0.4 to 8%. Some risk factors for obesity and hypertension may be present from an early period of life, therefore, children and adolescents represent the optimal contingent for studying the debut of the formation of diseases that are a complication of obesity and hypertension [1,3,5].

The risk of noninfectious diseases, including obesity and hypertension, is mainly determined by genetic risk factors and lifestyle [3].

Despite numerous studies, at the moment in our region there are no clear risk factors to predict the development and formation of arterial hypertension and obesity in children.

The goal of the work was to identify the main risk factors for the development of obesity and hypertension in children from the standpoint of heredity and lifestyle.

Materials and methods: 55 children with exogenously constitutional obesity and arterial hypertension were examined, which were revealed during dispensary examinations in family clinics in Samarkand, colleges in Samarkand and Samarkand region.

The criterion for the selection of patients was the determination of BMI and waist size in children and adolescents with identified overweight and / or obesity, which was above 97 percentile for a certain age and gender (WHO 2006). The study included 25 girls (45%) and 30 (55%) boys, whose average age was 14.35 ± 0.21 years (10 to 18 years).

Children with exogenously constitutional obesity were divided by the presence of abdominal (visceral) obesity and the presence of hypertension. In I group there were 17 people (16.83%) with a uniform type of obesity, with OT 80.11 ± 1.36, OT / OB 0.87 ± 0.01 cm. The II group included 38 children with AO, while OT was 99.82 ± 1.3 cm; OT / V 0.92 ± 0.009. 20 of them had normal blood pressure (group II A) and 18 children had a confirmed diagnosis of hypertension (group II B). Differences in the OT / OB ratio in groups I and II were significant (P <0.05). Moreover, the BMI value exceeded the 97 percentile and averaged 31.27 ± 0.51 kg / m ², with a range of indicators from 23.5 to 47.2 kg / m ². BMI in group I of patients reached 28.85 ± 0.52 kg / m ² ; in group II, it was significantly higher than 35.37 ± 0.63 kg / m ² (P <0.01).

The comparison group consisted of 20 children without obesity, aged 14.31 ± 0.63 years, with OT 64 ± 1.51 cm, OT / OB 0.81 ± 0.02 cm, with a difference in the OT / OB ratio was reliable with group I (P <0.01) and II (P <0.001). There were 9 girls and 11 boys. This contingent was selected in Samarkand city family polyclinics. All children were assigned to I health group. The average BMI in the comparison group was 19.44 ± 0.47 kg / m ², with a range of values from 18.2 to 20.4 kg / m ². The difference in BMI value with the observation group is significant (P <0.001).

When examining children, a special questionnaire was used to determine the anamnesis, genealogical history and lifestyle of children with exogenously constitutional obesity, as well as determining the quality of life of children, psychological and social adaptation.

Results and discussion: Heredity is one of the main non-modifiable risk factors for obesity and cardiovascular disease. Carrying out a comparative analysis with the control group without obesity and other chronic diseases, it was found that the frequency of obesity and overweight in relatives of I degree of kinship of patients of the main group was 54.5%. More than half of close relatives (parents, siblings) were obese or overweight, while close relatives of the control group experienced obesity and overweight in only 20% of cases, i.e. every fifth close relative suffered from this pathology.

When evaluating index of body weight of parents of children surveyed found that in families of children with a uniform type of obesity have fathers in 29.4 % there is an excess of body weight and 17.6% - obesity, while the mothers of excess body weight observed in 2 9.4 % and obesity in 17.6%. In 17.6% of families of children with a uniform type of obesity, both parents had excess body weight or obesity.

A similar picture was observed in families of children with abdominal obesity: in this case, a predominance of obesity was observed in mothers in the group of children with obesity and hypertension (38.8%), and overweight in both parents (22.2%).

The risk of developing cardiovascular pathology was also high in patients with obesity; this was associated with a high incidence of diseases of the cardiovascular tract. Essential arterial hypertension was ubiquitous and amounted to 50% and 55.5% in relatives of the 1st degree of relationship 2a and 2b group, as well as 75% and 77.7% of relatives of the 2nd degree of kinship (in group 2a and 2b, respectively), and cases of coronary heart disease and atherosclerosis were also found with high frequency. Almost every fourth close relative of a patient with AO suffered from this pathology (25% and 22.2%, respectively). When analyzing the heredity for the incidence of coronary heart disease and atherosclerosis in patients with a uniform type of obesity, it was found that these indicators had a minimum frequency (5.8%) in patients of the first degree of kinship. Also, the frequency of hypertension in relatives of the 1st and 2nd degrees of kinship was observed in 23.5% and 29.4%, respectively.

The identification of cases of diabetes in families of individuals with hypertension was an important hereditary factor, so the cases of type II diabetes in relatives of the 1st degree of kinship were 10% and 11.1% in group 2A and 2B, respectively. Relatives of the 2nd degree of kinship showed a high frequency of this condition, 35% and 44.4%. At the same time, maternal diabetes was predominant, especially in children with obesity and hypertension. This factor suggests that a violation of carbohydrate metabolism is often associated or caused by obesity, in particular abdominal nature.

Unambiguously abdominal obesity is one of the main risk factors for the development of cardiovascular pathology, and arterial hypertension in combination with abdominal obesity is the main component of the metabolic syndrome.

In the analysis of non-modifiable risk factors, inactivity and malnutrition are of greatest importance.

A feature of our national cuisine is the abundance of carbohydrates and refractory fats. In this regard, in most patients, there was a violation in the diet of food expressed in unilateral carbohydrate nutrition or the presence of cases of systematic overeating, eating fast food.

Thus, when analyzing the children's nutrition according to questionnaires, it was found that the nutrition of all children was irrational, hypercaloric, unbalanced by nutrients both in patients with a uniform type of obesity and in patients with hypertension. In obese children, there was an excess of hard fats, easily digestible carbohydrates, often children liked to eat fried potatoes, pasta, flour products, nipples, sausages, chocolate bars, carbonated drinks. In 35.2%, 35% and 33.3% of children, respectively, in groups 1, 2a and 2b, excess calories were due to easily digestible carbohydrates in drinks, i.e. these children consumed daily juices and / or sodas up to 1-2 liters. In 41.1%, 35% and 44.4% of children, respectively, in groups 1, 2a and 2b, the hyper caloric diet was also due to frequent visits to fast food restaurants, the use of a large amount of fried potatoes (more than 3 times a week) with consumption food in them, up to 50-75% of daily calories. At the same time, 58.8%, 65% and 72.2% of children lacked unsaturated fatty acids (i.e. fish dishes and vegetable oils) in their diets, while 35.2% of 25% and 27.7% of children lacked dietary fiber (eating fresh vegetables, fruits).

These factors were exacerbated by a sedentary lifestyle of children. The lifestyle of obese children was characterized by increased school workload and reduced motor activity. Thus, 47% of children with a uniform type of obesity had complicated training with attending two or more circles, and half of the children (50%) in each of the groups with abdominal obesity had it.

Reduced activity was observed in 58.8% of children with uniform obesity and in 60% and 72.2% of children with obesity and children with obesity and hypertensions, respectively. Children of the 1st group spent 3.9 ± 1.4 hours per day in front of the TV and / or computer, and children with obesity and obesity and hypertension 4.5 ± 1.1 and 4.3 ± 1.2 hours, respectively, which exacerbated physical inactivity and caused psycho-emotional overstrain. Often children did not attend physical education classes at school.

Only about one fourth of the children in the group with a uniform type of obesity (23.5%), and one fifth of the children with obesity and obesity and hypertension (20% and 16.6% each) periodically did physical exercises. The most frequently mentioned are running, morning exercises, a gym, soccer, volleyball, swimming. Children in rural areas also had a restriction in physical activity, most often parents of children complained about the child's refusal to do housework or housework.

An analysis of similar factors in the control group revealed that they often led the right way of life, and there were no cases of systematic overeating here, only 10% of cases revealed cases of unilateral carbohydrate nutrition. In addition, cases of physical inactivity were found in a much lower percentage ratio, which amounted to 15%.

Smoking is the most manageable risk factor in the development of hypertension. Our study showed that in the examined group of children and adolescents with various types of obesity, 3 (12%) girls out of 25 and 10 (33.3%) boys out of 30 smoke, including nasvai. Moreover, it was revealed that this contingent of children began to smoke at the age of 1012 years. The survey revealed that in the families of girls, both parents smoke more often - 16% than in the families of boys -- 13.3%. In almost half of the surveyed families, fathers smoke: 32% in girls 'families and 50% in boys' families. In about one in six and seven families, mothers smoke: 16% in girls 'families and 13.3% in boys' families.

Social factors make a big contribution to unmodified risk factors, since the majority of people in the control group with no chronic diseases were 75% of socially prosperous families (15) with a high level of parental education, so 50% had higher education in this sample (10 ) parents. Despite the relatively high standard of living in 33 (60%) patients with obesity, the number of parents with higher education was only 18 (32.7%) of parents. When grouping, it was found that there were no special differences in the educational level of parents (29.4%; 35%; 33.3%, respectively, in groups 1, 2a, and 2b).

These factors once again confirm the special role of social factors, in particular the presence of education in the formation of a healthy lifestyle.

When determining the reliability of risk factors ( RR - relative risk), it was found that heredity in obesity, especially on the maternal side (p <0.05), is the most important in the development of obesity, and for children with hypertension the burden of hypertension in both parents and sugar maternal diabetes (p <0.05; p <0.05) (table 1).

Table 1. Risk indicators (RR) in sick children of the compared groups

Note: * p <0.05 with respect to control.

For all compared groups, a reliable risk factor was excess calorie nutrition, lack of exercise (p <0.05; p <0.05). In the development of hypertension, the body mass index and waist volume were important, as well as smoking in the families of the parents. For the development of obesity and hypertension with obesity, the period of puberty had importance (p <0.05; p <0.05; p <0.05).

Conclusions: The main risk factors for the development of various types of obesity in children, including hypertension, are hypercaloric nutrition, physical inactivity, heredity in obesity, especially in the maternal line, and for children with hypertension, the burden of hypertension in both parents and maternal diabetes. In the development of hypertension, the body mass index and waist volume, as well as smoking in the families of the parents, were of great importance. For the development of obesity and hypertension with obesity, the period of puberty had importance. All of the above risk factors require active educational and therapeutic work among children with these risk factors to prevent the development of obesity (especially abdominal) and the formation of complications from this pathology.

curative obesity metabolic children