RU2528644C1 - Method of obesity typing by waist measurement at bend of elbow in children suffering obesity - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves measuring a waist at the level of a navel (WN) and at the level of a bend of elbow (WBE). A gynoid type of obesity is stated, if the WN and WBE testify to different types of obesity. An abdominal obesity is stated, if the WN and WBE testify to an abdominal type of obesity.

EFFECT: method enables providing typing of obesity more accurately and conducting the differentiation therapy.

2 ex, 1 tbl

Description

The invention relates to medicine, namely to pediatrics, endocrinology.

According to the literature, we have not found a specific way to measure the waist. Traditionally, the waist (OT) is measured at the navel (A.V. Mazurin, I.M. Vorontsov. Propaedeutics of childhood diseases. - SPb .: Foliant Publishing House LLC, 2001. - 111 pp.). There is a method of determining OT, for example, in sewing production, at the level of the elbow bend (Trukhanova A.T. Basics of sewing production: Sample textbook for students in grades 8–9 of high school. - M .: Education, 1989. - 160 p.) . But in medical practice, we have not encountered such a method of measuring RT. The value of OT measures the nature of obesity (Oganov R.G., Mamedov M.N. National Clinical Recommendations of the All-Russian Scientific Society of Cardiology. - M .: MediEXPO, 2009. - 388 pp.). Gynoid and abdominal types of obesity are distinguished. Particular attention is paid to the study of the abdominal type of distribution of the subcutaneous fat layer, which is diagnosed in children: up to 16 years, if the waist exceeds the value characteristic of the 90th percentile for the corresponding gender and age; in patients over 16 years old - with a waist size of 94 cm or more in males, 80 cm or more in females (Srinivasan S, Meyers L., Berenson G. Predictability of childhood adiposity and insulin for developing insulin resistance syndrome (syndrome X) in young adulthood: the Bogalusa Heart Study // Diabetes. - 2002. - Vol. 51. - P.204-209). This type of obesity is the main criterion for the metabolic syndrome associated with a high risk of mortality, cardiovascular complications (coronary heart disease, atherosclerosis) and type 2 diabetes mellitus (Chazova I.E., Mychka VB. Prevention, diagnosis and treatment of metabolic syndrome . - M., 2005 .-- 48 p.). Metabolic syndrome was diagnosed in accordance with the recommendations of the All-Russian Scientific Society of Cardiology in 2009 for the diagnosis and treatment of metabolic syndrome. It is believed that its presence is judged by the combination of abdominal obesity with two signs: the presence of arterial hypertension, a decrease in high-density lipoproteins, an increase in triglycerides and an increase in fasting blood sugar. According to various authors, in the structure of the metabolic syndrome in children, abdominal obesity arterial hypertension and hypertriglyceridemia are most often detected. The absence of arterial hypertension does not exclude the presence of a metabolic syndrome in this case and is consistent with the position of the All-Russian Scientific Society of Cardiology that arterial hypertension may not be detected in the early stages of its development. Given that abdominal obesity is the main criterion for this syndrome, it is necessary to most accurately determine the value of the waist volume in order to prevent premature diagnosis of the abdominal distribution of the subcutaneous fat layer, which is a risk of developing the metabolic syndrome. When measured in different ways, the results vary significantly, and in one patient, both the gynoid type of obesity, not associated with a high risk of cardiovascular disease, and the android (abdominal) can be diagnosed.

The technical result of our proposed method is that there are two groups that have different types of obesity according to the results of measuring the waist at the level of the elbow and the navel, and not having any, regardless of the method of measuring the volume of the waist, establish the gynoid type of obesity in the first group and abdominal in the second, associated with a significant increase in the level of triglycerides in the blood serum, which indicates a more accurate determination of the type of obesity by the volume of the waist at the level of the elbow.

A total of 33 obese teenagers aged 14 to 16 years were examined. All patients were determined by the waist in two ways: the first - at the level of the elbow, the second - at the navel. According to the measurement results, two groups were distinguished: the first consisted of patients who were diagnosed with gynoid obesity in the first method, abdominal obesity was diagnosed in the second, and the second group were children in whom both methods recorded abdominal obesity. All patients were calculated body mass index. The study of lipid metabolism was carried out by recording the level of triglycerides in blood serum. The groups did not significantly differ in age and gender. Also, given the effect of the degree of obesity on triglycerides, the average body mass index in both groups did not significantly differ. During the examination, the first group consisted of 15 children (of which 8 were boys and 7 girls), with an average age of 15.14 ± 0.29 years (table). The body mass index was 30.03 ± 0.55 kg / m ² . The percentage of excess body mass averaged 36.3 ± 2.66%. The level of triglycerides in blood serum is 0.93 ± 0.06 mmol / L. The second group included 18 children (of which 10 boys and 8 girls), whose average age did not differ from the patients of the first group (15.78 ± 0.29 years). The value of the body mass index and the degree of obesity also did not differ from those in the first group (31.46 ± 0.55 kg / m ² and 39.79 ± 2.4%, respectively), which made it possible to exclude the influence of these parameters on the level of triglycerides, which were significantly higher than that of representatives of the first group (1.3 ± 0.11, p <0.005).

Thus, in the examined children of the first group, in which, depending on the method of measuring RT, various types of subcutaneous fat distribution were recorded, the TG values were significantly lower than in patients of the second group, who, regardless of the method of measuring RT, were diagnosed with abdominal obesity, which allows us to conclude that the examined children of the first group have gynoid obesity (measured at the level of the elbow), and not abdominal (measured at the level of the navel), which proves the goal conformity of measurement of RT at the level of the elbow bend in order to exclude premature diagnosis of abdominal obesity.

The effect of the proposed method for measuring RT at the level of the elbow bend is that the method improves the accuracy of determining the type of obesity and conduct differential therapy.

Clinical examples:

1. Patient B., 16 years old, was hospitalized with a diagnosis of hypothalamic syndrome of puberty, obesity of the second degree. Complained of overweight, periodic headaches. A pathological increase in body weight was noted from the age of 8, weather increases of 10 kg / year, in recent years, body weight has stabilized. The premorbid background and family history are not burdened. Anthropometric indicators: weight - 93.8 kg, height - 181 cm, BMI - 28.4 kg / m ² , excess body weight - 31% (2 degree of obesity), OT at the level of the elbow bend was 90 cm, which is below 90 percentile the distribution of RT depending on gender and age (appendix) and less than 94 cm, the criteria adopted by men (table), which indicates gynoid obesity. OT at the navel level is 102 cm, which exceeds both the 90 percentile and the accepted standard for men (abdominal obesity). Physical examination revealed an excessive distribution of the subcutaneous fat layer and skin-trophic syndrome (the presence of follicular keratosis in the arms and striae on the stomach and back). During daily monitoring of blood pressure, an increase in the average systolic blood pressure at night was recorded (variability index 35%). When examining blood serum, the level of griglycerides was 0.95 mmol / L, insulin was 6.97 μI / ml, glucose - 4.5 mg / dl. The Caro index was 11.6 (normal). Thus, the patient has a gynoid type of obesity, there is no metabolic syndrome.

2. Patient M., 16 years old, was hospitalized with a diagnosis of hypothalamic syndrome of puberty, obesity of the second degree. Complained of overweight, headaches, increased blood pressure. A pathological increase in body weight was noted from the age of 13, weather increases of 10-15 kg / year, from 15 years there was an increase in blood pressure to 160 mm Hg. The premorbid background is not burdened. When analyzing the genealogical history, a pathology of the cardiovascular system (stroke) was recorded. Anthropometric indicators: weight - 98 kg, height - 185 cm, BMI - 28.8 kg / m ² , excess body weight - 36.6% (2 degree of obesity), the value of RT at the level of the elbow bend was 99 cm, which exceeds 90 percentile and the accepted standard for men above 94 cm, which indicates abdominal obesity. OT at the navel level is 105 cm, which also exceeds 90 percentile and the accepted standard for men (abdominal obesity). Physical examination revealed an excessive distribution of the subcutaneous fat layer, skin-trophic syndrome (the presence of follicular keratosis in the arms and striae on the stomach and back) and arterial hypertension syndrome. During the daily monitoring of blood pressure, an increase in the mean systolic blood pressure was recorded in the daytime and at night (the variability index was 75% and 60%, respectively). When examining blood serum, the level of triglycerides was 1.22 mmol / L, insulin was 60.8 μIU / ml, glucose - 4.3 mg / dl. The Caro index was 1.27 (insulin resistance). The patient is determined by abdominal obesity, arterial hypertension, so he is threatened by the development of metabolic syndrome.

Thus, the foregoing confirms the usefulness of the proposed method, which is based on the measurement of RT at the level of the elbow bend to more accurately determine the type of obesity.

Table Diagnosis of abdominal obesity in children Age Abdominal Obesity (OT) 6-10 years OT ≥90 percentile distribution of OT depending on gender and age (appendix) 10 - <16 years old OT> 90 percentile distribution of OT depending on gender and age > 16 years old Male gender FROM ≥94 cm; Female gender FROM ≥80 cm

application Percentile distribution of the waist circumference (cm) in boys and girls aged 2 to 18 years Age years The boys Girls one 10th 25th 50th 75th 90th 10th 25th 50th 75th 90th 2 42.9 46.9 47.1 48.6 50.6 43.1 45.1 47.4 49.6 52,5 3 44.7 48.8 49.2 51,2 54 44.7 46.8 49.3 51.9 55,4 four 46.5 50.6 51.3 53.8 57.4 46.3 48.5 51,2 54,2 58.2 5 48.3 52,5 53.3 56.5 60.8 47.9 50,2 53.1 56.5 61.1 6 50.1 54.3 55,4 59.1 64,2 49.5 51.8 55 58.8 64 7 51.9 56.2 57.5 61.7 67.6 51.1 53.5 56.9 61.1 66.8 8 53.7 58.1 59.6 64.3 71 52.7 55.2 58.8 63,4 69.7 9 55.5 59.9 61.7 67 74.3 54.3 56.9 60.7 65.7 72.6 10 57.3 61.8 63.7 69.6 77.7 55.9 58.6 62.5 68 75,5 eleven 59.1 63.6 65.8 72,2 81.1 57.5 60,2 64,4 70.3 78.3 12 60.9 65.5 67.9 74.9 84.5 59.1 61.9 66.3 72.6 81.2 13 62.7 67.4 70 77.5 87.9 60.7 63.6 68,2 74.9 84.1 fourteen 64.5 69.2 72.1 80.1 91.3 62.3 65.3 70.1 77,2 86.9 fifteen 66.3 71.1 74.1 82.8 94.7 63.9 67 72 79.5 89.8 16 68.1 72.9 76,2 85,4 98.1 65.5 68.6 73.9 81.8 92.7 17 69.9 74.8 78.3 88 101.5 67.1 70.3 75.8 84.1 95.5 eighteen 71.7 76.7 80,4 90.6 104.9 68.7 72 77.7 86.4 98.4

Source

Zimmet P, Alberti KG., Kaufman F, Tajima N, Silink M, Arslanian S, Wong G., Bennett P., Shaw J, Caprio S; IDF Consensus Group. Metabolic syndrome in children and adolescents - an IDF consensus report. Pediatr Diabetes. 2007; 8 (5): 299-306.

Claims (1)

A method for determining the type of obesity in children, taking into account the waist volume indicator (OTP) at the navel level, characterized in that the patient additionally measures the waist volume at the elbow level (OLS) and sets the gynoid type of obesity in the case when the OTP and OLS indicators indicate about different types of obesity, and establish the abdominal type, when the indicators of OTP and OLS indicate one abdominal type of obesity.