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Het metabool syndroom bij kinderen met overgewicht en obesitas in Amsterdam-West

Welke definitie identificeert kinderen met een hoog risico?

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Tijdschrift voor Kindergeneeskunde

Samenvatting

Doel. Inventariseren van de prevalentie van het metabool syndroom (MetS) bij kinderen in een polikliniek kindergeneeskunde van een Amsterdams ziekenhuis.

Patiënten en methode. De gegevens van 305 kinderen (3-18 jaar) met overgewicht en obesitas, bij wie prospectief een orale glucosebelastingstest verricht was, werden diagnostisch geëvalueerd volgens eenzelfde gestandaardiseerd protocol. De ernst van overgewicht en de aanwezigheid van het MetS en insulineresistentie werden vastgesteld. Van het MetS was sprake indien twee van de volgende afwijkingen aanwezig waren: gestoord glucosemetabolisme, laag HDL-cholesterol, hoge triglyceriden of hypertensie; waarbij gebruik werd gemaakt van voor leeftijd aangepaste referentiewaarden (MetS-I) dan wel afkapwaarden voor volwassenen (MetS-II).

Resultaten. Van de kinderen (gemiddelde leeftijd 10±3 jaar; 79,0% van niet-Nederlandse afkomst) had 11,1% overgewicht, 34,4% matige, 31,5% ernstige en 23,0% morbide obesitas. 21,0% had MetS-I en 23,3% had MetS-II. MetS-II (meer dan MetS-I) was geassocieerd met de ernst van overgewicht. Naast het MetS kwam insulineresistentie (55,7%) veelvuldig voor. Belangrijke determinanten voor zowel MetS-I als -II waren insulineresistentie en verhoogd ALAT en voor MetS-II tevens middelomvang en leeftijd.

Conclusie. Bij kinderen met overgewicht en obesitas werd een hoge prevalentie van het MetS (zowel volgens de definitie met pediatrische referentiewaarden als de definitie met afkapwaarden voor volwassenen) en insulineresistentie vastgesteld.

Summary

Objective. To evaluate the prevalence of the metabolic syndrome (MetS) in obese and overweight children referred to a community paediatric outpatient-clinic.

Patients and methods. Results of 305 children (3-18 years), who prospectively underwent a glucose-tolerance test, were diagnostically evaluated according to a standardized protocol. The degree of obesity and the prevalence of the metabolic syndrome (MetS) and insulin resistance were determined. MetS was diagnosed in case two or more of the following disorders were present: glucometabolic disorder, low HDL-cholesterol, high triglycerides or hypertension; using reference values adjusted for paediatric populations (MetS-I) or reference values used in adults (MetS-II).

Results. Out of 305 children (mean age 10±3 yrs; 79.0% non-Dutch), 11.1% were overweight, 34.4% had moderate, 31.5% severe and 23.0% morbid obesity, whereas 21.0% had MetS-I and 23.3% had MetS-II. MetS-II (more than MetS-I) was associated with the severity of obesity. Insulin resistance (55.7%) was highly prevalent. Important determinants of MetS-I and -II were insulin resistance and elevated ALT, with additionally waist circumference and age for MetS-II alone.

Conclusion. High prevalences of MetS (according to the definition which uses paediatric reference values, and the definition which uses reference values for adults) and insulin resistance were found in overweight and obese children.

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    I. A. von Rosenstiel

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  1. M. van Vliet
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  2. M. Diamant
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  3. H. D. W. van der Lei
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  4. H. Budde
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  5. I. A. von Rosenstiel
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Correspondence to I. A. von Rosenstiel.

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Mw. drs. M. van Vliet, arts-onderzoeker; mw. drs. H.D.W. van der Lei, arts-onderzoeker (thans: afdeling Kindergeneeskunde, VUmc, Amsterdam); dhr. drs. H. Budde, kinderarts; mw. drs. I.A. von Rosenstiel, kinderarts-intensivist, afdeling Kindergeneeskunde, Slotervaartziekenhuis, Amsterdam. Mw. dr. M. Diamant, internist-endocrinoloog, vasculair geneeskundige, afdeling Endocrinologie/Diabetescentrum, VU medisch centrum, Amsterdam.

Correspondentieadres: Mw. drs. I.A. von Rosenstiel, afdeling Kindergeneeskunde, Slotervaartziekenhuis, Postbus 90440, 1006 BK Amsterdam.

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van Vliet, M., Diamant, M., van der Lei, H.D.W. et al. Het metabool syndroom bij kinderen met overgewicht en obesitas in Amsterdam-West. KIND 77, 2–10 (2009). https://doi.org/10.1007/BF03086345

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