childhood obesity
Introduction
Introduction to Pediatric Obesity The standard for pediatric obesity generally refers to two standard deviations of body weight over the same sex, the average body weight of healthy children of the same age or the same height, or more than 20% of the average body weight of the same age and same sex. Clinically, obesity caused by excessive diet is called simple obesity. In recent years, the incidence of simple obesity has increased in China. Obesity in childhood can be adult obesity, hypertension, coronary heart disease. And the pioneering disease such as diabetes, so it is a chronic metabolic abnormal disease, it should be paid attention to and prevent it early. basic knowledge The proportion of illness: 10% Susceptible people: children Mode of infection: non-infectious Complications: black acanthosis, diabetes,
Cause
Causes of childhood obesity
(1) Causes of the disease
Simple obesity is caused by the combination of genetic and environmental factors. Genetic factors play a small role. Environmental factors play an important role. Family life (family aggregation) and individual behavior patterns are the main dangers among environmental factors. factor.
1. Genetic and environmental factors Obese people have a certain family tendency. Parents of obese children often show obesity symptoms. About one third of them are related to parental obesity. If both parents exceed normal weight, the offspring are 2/ 3 Obesity occurs. In addition, diseases with genetic predisposition are also common obesity symptoms, such as hepatic glycogen accumulation.
2. Eat more children from childhood to grow more food, energy intake is too much, consumption is reduced, especially accustomed to the intake of greasy food, obesity can occur in a long time.
(1) Unreasonable feeding: If the solid food is added too early (1 to 2 months after birth) and the weaning is too early, it is a feeding mode that promotes simple obesity in infants and young children. In recent years, the incidence of childhood obesity The increase trend is closely related to the unreasonable diet and excessive nutrient intake given by parents. The staple food intake, high meat consumption, low fruit and vegetable yields, and the survey of nutrition and health of Chinese residents show that the dietary structure of urban residents in China is not reasonable. Excessive intake of meat and oil, and low intake of cereals. In 2002, the daily intake of oil per person per capita increased from 37g in 1992 to 44g, and the fat supply ratio reached 35%, exceeding the World Health Organization. The recommended upper limit of 30%.
(2) Excessive appetite: excessive appetite and fast eating are a feeding feature of obese children.
3. Less active children lack appropriate physical exercise, plus the factors of eating more, the reduction of activities and the imbalance of intake and discharge, it is easier to form obesity, obese children often do not like activities, the more inactive, the more fat, the formation Vicious circle.
4. Increased number of fat cells and hypertrophy In the critical period of adipose tissue cell proliferation and cell expansion (late pregnancy, early postpartum and adolescence), poor lifestyle, behavioral characteristics as a risk factor contributed to the formation of simple obesity.
At the first 3 months of pregnancy, the cell level is malnourished, the overdose is 3 months after pregnancy, the weight gain during pregnancy is too large, and the speed is too high. It is a risk factor for obesity during pregnancy, the number of fat cells increases gradually and ages and fat. The degree of accumulation is related. People who have been obese since childhood are obese, and the number of fat cells in the body is significantly increased. In the slow and persistent obesity, there are both fat cells and fat cells, and the body of an obese person. Fat cells can be more than three times more abundant than normal human fat cells.
5. The motivational factors of loving parents play an important role in over-feeding of obese children. Love is a factor that cannot be ignored. The traditional patriarchal social customs and some traditional cultural concepts (excessive restraint of children's activities, etc.) are A low-income motivation factor for high prevalence of severe obesity in boys, low-income families are an important source of persistent obesity in the future.
(two) pathogenesis
Various intrauterine factors have a greater influence on the size of fetal fat cells, but rarely affect the number of fetal fat cells. The amount of fat contained in newborns depends on the size of the cells rather than the number of them. In the later stage, the adipose tissue is further developed. The number of fat cells increases, 30 weeks pregnant to 18 months after birth is the first active period of adipose tissue development. At this time, fat cells are most active in response to various external factors, and fat tissue grows 6 to 8 months after birth. Rapidly, 8 to 15 months after birth is a relatively stable period. After the period to the pre-school period, there is little increase. There is almost no growth in 3 to 6 years old. Girls begin to accumulate fat during puberty, and are called adipose tissue from about 12 years old. The second active period of development, which may be due to the effect of estrogen on fat cells, when fat cells increase to a certain extent (currently estimated when the weight of adipose tissue exceeds 25% of body weight) may stimulate fat cell division, resulting in fat The number of cells increases dramatically, producing obesity. In the second trimester, early postpartum and adolescence are critical periods for the proliferation and cell expansion of adipose tissue cells (critical per Iod), during this critical period, the above lifestyle and behavioral characteristics as a risk factor contributed to the formation of simple obesity.
Prevention
Pediatric obesity prevention
Pre-pregnancy/pregnancy prevention Pre-pregnancy nutrition preparation and protection are not only related to the promotion of normal fetal development, but also play an important role in preventing obesity after birth. Adipocytes have a "memory" function, both in embryonic and postnatal. Abnormal nutritional stimuli (nutrition deficiencies or overnutrition) during growth and development can cause fat cells to undergo excessive stimulation after re-stimulation in the later period. Obesity may occur in different forms, and the nature may be interference. The apoptotic process of adipose tissue is weakened, and the volume and number of fat cells are increased to form obesity. During this period, the nutrition and eating imbalance are prevented, and eating and drinking are prevented.
Avoid nutrient intake during the first 3 months of pregnancy. Avoid over-nutrition and weight gain over 3 months after pregnancy. High-heat, high-fat foods are not so-called tonics. Vitamins, trace elements, and minerals are more fat than fat. Beneficial, high-quality protein must be added, suitable heat is an important prerequisite to avoid obesity in the future.
2. Infant and child prevention mainly emphasizes breastfeeding, according to the actual needs of infants and young children, moderate feeding, avoid feeding solid food in the first 3 months after birth, if the child has become obese at 4 months after birth, should pay attention to Avoid continuing to consume excessive calories, especially in the case of obese children after 6-8 months of life, reduce the amount of milk, replace it with fruits and vegetables; use whole rice to replace the fine products, and from the parents' motivation Don't use food as a symbol of reward or punishment for young children's behavior.
3. Preschool prevention is mainly to develop good eating habits, not to be partial to sugar, high fat, high calorie food.
4. Early prevention of adolescence and adolescence is a dangerous period. Especially for girls, in addition to the increase in fat mass in physical development, it is also a critical period in psychological development. The vast majority of young people pursue slimness. Under this kind of psychological pressure, it will cause many misunderstandings and one-sided pursuit of dieting and weight loss. During this period, we should strengthen the correct education of nutrition knowledge and food choices, give individual guidance to young people who are already obese and possibly obese, and encourage their parents to participate. Help children to arrange their lives together.
Complication
Pediatric obesity complications Complications, black acanthosis, diabetes
In infants, obese children are prone to respiratory infections, and severely obese children are prone to skin infections such as furunculosis, lintertrigo and acanthosis nigricans, and are susceptible to joint load-bearing parts such as femoral condyle dislocation in adolescence. In the case of injurious diseases, pancreatitis is sometimes seen in girls, and diabetes can be developed in the later stages. Insulin metabolism in childhood obesity has characteristic changes, and in some obese children, diabetes is seen.
Symptom
Symptoms of childhood obesity Common symptoms Weight gain severe obesity Fat excess fatigue Abdominal skin appears white... Secondary obesity Shortness of breath Baby overweight Alternative eclipse anorexia puberty obesity
1. The general performance often has a history of family obesity; good intelligence, subcutaneous fat plump, even distribution, body fat accumulation in the breast, abdomen, buttocks and shoulders are significant, abdominal skin appears white, pink or purple lines; limbs Obesity, especially above the arms and buttocks, no endocrine disorders and metabolic disorders; often fatigue, shortness of breath or leg pain during activities, clumsy movements, knee valgus or flat feet.
2. Excellent appetite The children have excellent appetite, strong appetite, and the food intake is much higher than that of ordinary children. They like to eat starch, sweets and high-fat foods, and do not like to eat light food such as vegetables.
3. Body weight/body fat exceeds the reference population value. The physical growth of the body is rapid, but the bones are normal or older than the same age, the body weight exceeds the same sex, the average height of normal height is more than 20%, or the body weight exceeds the average height of healthy children. 2 standard deviations in body weight (M 2SD); or those with a body mass index greater than 23.
4. Sexual developmental development is generally early or normal. The boy has too much fat in the thigh and perineum. The penis can be hidden in the adipose tissue, which is small and actually belongs to the normal range.
5. Aerobic capacity injury Obesity children often have no other discomfort in clinical, but obvious obesity aerobic capacity damage, maximum tolerance time, maximum oxygen consumption is significantly reduced; maximum heart rate, minute ventilation, carbon dioxide production, work volume is significantly increased The indicators of anaerobic threshold are low, showing the phenomenon of anaerobic threshold left shift, the heartbeat of obese children during exercise, shortness of breath, easy external appearance and behavioral habits that do not like to participate in physical activity.
Some obesity can be complicated by high blood pressure. Extremely obese children can be restricted by thoracic and diaphragmatic activities, making breathing fast, alveolar ventilation reduced, hypoxemia, cyanosis, concurrent red blood cells, heart enlargement and congestive Heart failure, the so-called pulmonary dyspnea syndrome (pickwickian syndrome), can be life-threatening.
6. Psychological depression and injury personality, temperament, personality, potential development and future development of ability, interpersonal communication have a negative impact, the suppression of their own body size, poor self-evaluation, easy to be degraded during interpersonal communication, taken Nickname, even being discriminated against, heavy mental stress and psychological conflict, loss of self-confidence, becoming lonely, adolescents suffering from obesity or eager to lose weight caused many intense psychological conflicts, and some even committed suicide.
Examine
Pediatric obesity check
1. Anthropometric indicators such as waist circumference, hip circumference, large/calf circumference, arm circumference, subcutaneous fat thickness, etc., excessive behavioral deviation.
2. Serum cholesterol increases triglyceride, cholesterol is mostly increased, and severe -lipoprotein can also be increased.
3. Endocrine disorders often have hyperinsulinemia, blood sugar is increased, sexual development is often earlier, blood growth hormone levels are reduced, so the final height is often slightly lower than normal children, obese girls are prone to various menstrual disorders.
4. The immune function is reduced, especially the number of T and B lymphocytes is reduced, the cellular immune function is significantly decreased, the delayed skin reaction can be negative, and the neutrophil function is reduced.
5. Decreased aerobic capacity of the lungs, decreased cardiopulmonary function, often occur obesity - poor qi dysfunction syndrome (or pickwickian syndrome), increased thoracic dilatation and diaphragmatic movement, decreased lung ventilation, decreased lung function, and significantly lower lung capacity than normal children In the activity, the mental reserve is used in advance, the function to the heart is insufficient, the ventilation function is lowered, and the aerobic capacity is lowered.
6. ECG.
7. Chest cardiocardial insufficiency syndrome (pickwickian syndrome) in patients with enlarged heart or congestive heart failure.
Diagnosis
Diagnosis and diagnosis of childhood obesity
diagnosis
Obesity can be judged from the appearance, the nutritional history has excessive eating, overeating/biased high calorie, high fat food, etc., milk feeding, premature feeding of solid food, etc., behavioral habits are more food, less physical activity, possessive Strong, clinical symptoms and signs have progressive weight gain, behavioral deviation and general body fat generally increased.
1. Standard height and weight method
(1) The formula for calculating the standard weight:
13~12 months baby weight (kg) = (month age +9)/2
22 to 6 years old weight (kg) = age × 2 + 8
37 to 12 years old weight (kg) = (age × 7-5) / 2
(2) Indexing: Generally, children's weight gain exceeds the same sex. If the average height of normal children is 20% or the average body weight of the same height is 2 standard deviations (M+2SD), obesity can be diagnosed; more than 20% ~29%, or more than 2 to 3 standard deviations for mild obesity, more than 30% to 39% or more than 3 to 4 standard deviations for moderate obesity, more than 40% to 59% or greater than 4 standard deviations For severe obesity, more than 60% is extremely obese.
(3) Height and weight: The height of the child is <125cm, and the height and weight are developed together, that is, the height increases by 3.8cm and the body weight increases by 1kg. The standard weight (kg) is calculated as: 3+[height (cm)-50]/3.8.
(4) Foreign Broca formula: standard weight (kg) = height (cm)-100, China's commonly used Broca improved:
1 male adult weight (kg) = height (cm) - 105; or Pingtian formula: [height (cm) - 100] × 0.9.
2 Female adult weight (kg) = height (cm) - 105; or equal to [height (cm) - 100] × 0.85.
2. Body mass index (BMI) BMI = weight (kg) / height (m)
WHO published in 1997: normal BMI is 18.5-24.9; 25 overweight; 2529.9 is pre-obesity; 30.034.9 is I degree obesity (moderate); 35.039.9 is II degree obesity (severe); 40 It is III degree obesity (very severe).
In 2000, the International Obesity Task Force proposed that the normal BMI range of Asian adults is 18.5-22.9; <18.5 is underweight; 23 is overweight; 2324.9 is pre-obesity; 2529.9 is I degree obesity; 30 genus II degree obesity.
At present, the diagnosis of obesity is mostly based on the method of BMI. BMI is a relatively accurate and widely accepted diagnostic method adopted by the world.
Obesity measurement: (measured body weight - height standard weight) / height standard weight × 100%.
Obesity is 20% to 29%, mild, 30% to 50% are moderate, and >50% are severe.
3. Skin pleat thickness The biceps, triceps, and scapular thickness of the biceps are measured with a caliper, normal 20 ~ 40mm, > P85 is obese, > P95 is highly obese, and limitations have been gradually used.
4. Waist circumference The University of Glasgow and a university in the Netherlands surveyed 5,800 men and 7,000 women aged 0-59. They divided the volunteers into three groups: small waist group: men's waist circumference <94cm, women <80cm; In the middle waist group: men are 94 ~ 102cm, women are 80 ~ 88cm; large waist group (central obesity): men's waist > 102cm, women > 88cm.
5. Waist-to-hip ratio (WHR) measure the diameter (waist circumference) of the midpoint between the lower edge of the rib and the anterior superior iliac spine and the diameter of the femur (hip circumference), and then calculate the ratio, normal adult WHR Men <0.90, women <0.85, more than this value is central (also known as intra-abdominal or visceral) obesity.
The results of the survey showed that the general health status of the small waist and middle waist group was better. The proportion of hyperlipidemia and hypertension patients in the large waist group was 2 to 4 times higher than that in the small waist group, and the proportion of diabetic patients was 4.3 times higher. The heart disease patients are 3.5 times more. Therefore, those with large waist circumference should pay attention to their health.
Anthropometric indicators such as waist circumference, hip circumference, large/calf circumference, arm circumference, and subcutaneous fat thickness are excessively increased. Laboratory tests: decreased aerobic capacity, decreased cardiopulmonary function, and behavioral deviation.
The body fat content increased significantly and the body mass index was consistent with obesity.
Differential diagnosis
Identification with secondary obesity, except for certain endocrine, metabolic, genetic, secondary obesity caused by central nervous system diseases or obesity caused by the use of drugs, from the history, symptoms, signs, tests can be identified, the main identification points The above diseases are pathological diseases, and simple obesity is a lifestyle disease.
1. Endocrine diseases, hypothyroidism, pituitary and hypothalamic lesions, adrenal hyperfunction, male gonads and diabetic children with obesity, but various endocrine diseases also have their own characteristics, easy to identify, related to endocrine and metabolism The pathological changes are not the early manifestations of simple obesity, nor the cause, the glucose tolerance curve, which can be distinguished from the functional hyperinsulinemia often seen in obese people, such as the possibility of suspected endocrine diseases. Can be combined with the condition to do endocrine function tests, skull X-ray, fundus examination.
Plasma immunoglobulin is also seen in obese children. The numbers of complement C3 and C4 and lymphocytes T and B are lower than those of non-obese children. At the same time, plasma copper and zinc levels are at a subclinical level, supplemented with zinc and copper. After the preparation, the menarche was significantly earlier in obese girls than in non-obese girls of the same age.
2. Obesity-related syndromes such as Prader-Willi syndrome, obesity, low muscle tone, short stature, small hands and feet, low intelligence, hypogonadism, strabismus and other symptoms, Laurence-Moon-Biedl syndrome Obesity, mental retardation, visual impairment, finger toe deformity and other symptoms.
3. Others may also develop obesity when growth disorders or physical activity are small, energy needs to be reduced, such as long-term bed rest when suffering from bone or nervous system diseases.
