CC BY
46
Section 8. Medical science
of tumor tissue [3; 4; 8]. However it is necessary to notice, that not always at women with a uterus myoma the thromboses, fortunately available in an organism a number of compensator mechanisms will develop. This results from the fact that on any pathological changes initially the organism answers with compensator the reactions, directed on protection of an organism from thrombogenesis. In process of progressing of pathological processes or against joining of concomitant factors (for example, age after 40 years, operative intervention, extragenital disease and i. e.) compensator mechanisms pass to decompensate mechanisms which are shown with chronic form disseminated intravascular coagulation (DIC). As show our dates, the preoperative haemostasis system is characterized with expressed changes of chronic form of DIC, which have noted at patients aged after 40 years. Despite on spent thromboprophylaxis with UFH, operative intervention at women from group I aggravated available complex infringements of haemostasis, which at them it has been revealed on
admitting, increasing of danger of development thrombotic complications in the postoperative period. Although, size of uterine myoma, volume, duration of operative performance were similar in both groups
Conclusion. Thus, as show our dates, the preoperative haemostasis system is characterizing with chronic form of DIC. Especially, these changes more significantly noted at patients aged after 40 years. Followingly, women elderly after 40 years are believe in thrombotic dangerous, carrying out of the expanded operative interventions allows to note them high group of the risk of development of thrombotic complications, demanding corresponding specific thromboprophylaxis. Thus, preventive maintenance with UFH at the present contingent patients does not allow to the result of coagulation potential in initial level, which at them were before operation. Hence, it is necessary to apply other methods of pharmacological preventive maintenance, for example low-molecular heparin.
References:
1. Amin A. N., Lin J., Thompson S., et al. Inpatient and outpatient occurrence of deep vein thrombosis and pulmonary embolism and thromboprophylaxis following selected at-risk surgeries.//Ann Pharmacother. - 2011. - V 45 (9) - P. 1045-52.
2. Jeffrey I. Weitz Unanswered questions in venous thromboembolism.//Thrombosis Research. - 2009. - S. 123., V. 4. - P. S2-S10.
3. Lee A. D., Stephen E., Agarwal S., Premkuma P. Venous Thrombo-embolism in Indiar.//Eur J Vasc Endovasc Surg. -2009. - V. 37. - P. 482-485.
4. Falcone Marco, Serra Pietro. Massive pulmonary embolism in a woman with leiomyomatous uterus causing pelvic deep venous thrombosis.//Ann Ital Med Int. - 2013. - V 20. - P. 104-107.
5. Nao S., Norihito Y., Tatsuru O., Noriyuki Y. Risk factors for perioperative venous thromboembolism: A retrospective study in Japanese women with gynecologic diseases.//Thrombosis Journal. - 2012. - V 43. - P. 8-17.
6. Nao S., Fumio K., Atsushi H., Takeshi H., Sachiko E. Intermittent pneumatic compression for prevention of pulmonary thromboembolism after gynecologic surgery.//Thrombosis Journal. - 2013. - V 45. - P. 3:18.
7. Samama M. M., William H. Risk factors for perioperative venous thromboembolism: A retrospective study in Japanese women with gynecologic diseases.//Thrombosis Journal. - 2012. - V 8. - P. 48-54.
Rakhimov Bakhodir, Tashkent Medical Academy, assistant, the department of hygiene of children and adolescents and hygiene of nutrition E-mail: [email protected]; [email protected]
Identification of risk factors for obesity in children and adolescents living in Tashkent city
Abstract: This article analyzes the identification of risk factors for obesity in children and adolescents living in Tashkent city in order to form the following prophylactic measures to prevent obesity in children and adolescents at an early age.
Keywords: children and adolescents, body mass index, obesity, risk factors, relative risk.
Obesity is a major public health problem in the twenty-first century. The use of integral approach to solving this problem will allow to take into account all its aspects — malnutrition, physical activity, as well as socio-economic and socio-political factors in this area [1, 12-44; 2, 32-36]. Considering them in terms of epidemic spread of obesity as a problem that goes beyond time and national borders,
in particular, an alarming increase in the frequency of obesity among children and adolescents, we can assume that the problem is a threat to the health and well-being of future generations [7, 29-33; 8, 277-284].
An important specificity of the last decade is the increase in the number and change in the balance of risk factors affecting the health of children and adolescents, the effective
78
Identification of risk factors for obesity in children and adolescents living in Tashkent city
identification of which will target the prevention of obesity. Risk factors are those that determine the health affecting it negatively. They favor the occurrence and development of diseases. Risk factor is a sign that somehow related with the occurrence of the disease in the future.
For the development of the disease the combination of risk factors and immediate causes of the disease is necessary. It is often difficult to isolate the causes of the disease, since they may be related by several reasons. There are major, so-called high risk factors, which are common to a wide variety of diseases: smoking, physical inactivity, overweight, unbalanced diet, hypertension, psycho-emotional stress, and so on. They distinguished are primary and secondary risk factors as well [9, 361-364; 11, 456-460]. The primary factors are the factors which are affecting the health: unhealthy lifestyle, environmental pollution, family history, poor performance of health services and so on. The secondary risk factors include the diseases that burden for other diseases: diabetes, atherosclerosis, hypertension and so on [12, 644; 13,17-26; 14, 3-19].
Aim: to identify the risk factors for obesity in children and adolescents living in Tashkent city.
Materials and Methods: There observed 32 girls and 26 boys aged between 11 to 15 years, diagnosed with exogenous constitutional obesity degree I-II within three-four years living in Tashkent city. The children were examined in the clinic of the Republican Specialized Scientific and Practical Medical Center of Endocrinology (RSSPMCE) Ministry of Health of Republic of Uzbekistan. Patients with obesity are at the outpatient monitoring. The diagnosis based on medical history, anthropometric data and inspection of hygienists, pediatricians and endocrinologists. Nutritional status and wellbeing, activity and mood of patients were evaluated during outpatient examination. Anthropometric studies included bioimpedance monitoring body composition with the determination of its mass, body mass index (BMI), waist circumference, and the value of the hips (WC/VH); the amount of fat mass. The measurements were carried out using Martin anthropometry, caliper and standard medical scales.
In order to assess the importance of risk factors for obesity in children, we carried out mathematical analysis of the prevalence of major risk factors to the calculation of the relevant indices.
With the help of a questionnaire we studied the diet, physical activity, leisure, bad habits, and data on the family financial situation, education and occupation of parents. Questionnaires were made, according to the requirements applicable to sociological research.
Sociological research in families with obese children (the case), and the families with healthy children (control) by the “case-control” method and pairs of copies to study the social and hygiene, biological and other factors that influence on the formation of obesity in children was conducted.
The information was collected by questionnaire and the copy data of the medical records of children with obesity. Control group comprised the data of 50 children with normal
weight (healthy). The study group included 58 children with excess body weight (obesity). Further, we identified the prevalence of these factors in the study and control groups using mathematical and statistical techniques. The relative risk ratios were calculated in their comparison. Moreover, by analyzing the ratio of the highest level of relative risk to the most minimum level in each gradation factors we calculated weights, i. e. ranking places that each factor took leading to the development of obesity in children [3, 223; 4, 16].
To determine the risk of obesity in children they used one of the modern methods of evidence-based medicine and clinical epidemiology: the case-control and indicator of the relative risk [4, 16]. The method of “case-control” considers the frequency of exposure of risk factors. The principal study design “case-control” is that the first sample population based on the selected two comparable (in materials and characteristics) groups of patients but one (cases) with the disease and the other one (control) — without the disease under study. Then in both groups retrospectively the frequency of exposure of the factor under study was determined.
Obtained data allow calculating the odds ratio of having a risk factor for the development of the disease, which is equivalent to relative risk.
Research made by case-control with the right design has several advantages: a well-suited for the study of diseases with long latency periods, as well as rare diseases, effective in time and cost, makes possible to evaluate large numbers of potential etiological factors.
To identify a reasonable relationship between the risk factor and the disease, it is necessary that the control group was comparable to that in the whole group of cases, except for the presence of disease. Cases and controls should be collected in the same or similar environment. The option of cases and controls are selected from the population of individuals with disabilities among a certain part of the population or a random sample of the entire population is carried out. This avoids the biases.
The selection of an appropriate control group is critical. This group should include individuals who might be selected as cases if they had developed the disease, but not all of the population who have no the disease under study. That is, the control group should be as similar to individuals from the group of cases, apart from the presence of the studied condition. It is also important to think about the number: it is recommended to comply with the ratio of1: 1, the maximum statistical power is created at this ratio.
If the relative risk (RR) of 1.0, which means that there is no difference in risks (incidence is the same in each group).
RR = 2.0 means that the risk of to be ill in this group of individuals exposed to the factor action is twice higher than in those in the group which is non- exposed to the factor.
RR = 1.6 means that the risk of be ill in people in the group exposed to the factor action is 1.6 times higher than in those in group not exposed to the factor action (or risk up to 60 % percent higher in the group exposed to the action of factors).
79
Section 8. Medical science
RR > 1 indicates preventive effect risk factor when the risk factor has protective effect rather than harmful.
Results: Our data revealed an excess of body weight in 32 girls and 26 boys from 11 to 15 years. On examination the body mass in girls was 61.8 ± 6.9 boys 70.5 ± 7.1. The predominance of obesity in girls at school-age children and adolescents clearly revealed, where the sex ratio reaches 2:1. In this case, a predisposing factor is the expression of large subcutaneous fat in girls in neonatal and puberty period.
It is known that obesity is increasingly dominated in the urban population. According to A. I. Kliorin, in the early 70s obesity was recorded in 28 % of citizens and 22.3 % of the villagers. We followed 32 girls and 26 boys living in Tashkent. These statistics related mainly to the child population, and probably reflected the hypodynamic lifestyles of an urban child and his easier access to high-calorie refined products.
Ifwe talk about the epidemiology of different types (forms) of obesity, the most common is exogenous-constitutional (or simple) form of obesity, the weight of which is 75-97 % of cases [6, 315-316]. Our patients (28 girls and 23 boys aged 11 to 15 years), diagnosed with exogenous constitutional obesity degree I-II in children from three to four years, in three boys and four girls — obesity of III degree.
It has been established genetic predisposition to obesity, which is confirmed by epidemiological studies. Mechanisms for genetic effects may be related to differences in somatic type, cellular composition of adipose tissue, hyperphagia, taste sensitivity, hyperglycemia, hyperinsulinism, hypome-tabolism and differences in enzymatic lipolysis and lipo-genesis [6, 315-316]. The risk of developing obesity in the child reaches 80 %, if it is available to both parents. The risk is about 50 % if only the mother is obese, 40 % with obesity in the father, and about 7-9 % in the absence of obesity in parents. 42 % of mothers of adolescents who were under our observation, were identified obesity II degree, 18 % both of parents were revealed obesity II degree, 20 % were observed exogenous constitutional obesity degree I-II, 20 % of parents were found no obese.
Special questionnaire of teenage girls (6 adolescents) and their parents revealed the presence of particularities in the organization of their feeding, nutrition and feeding behavior.
We surveyed emotion-genic feeding disorders in 13 boys and 16 girls (aged 14-15 years). With this type of eating disorders the stimulus to food intake becomes not a hunger but an emotional discomfort: people eat not because they are hungry, but because they are restless, anxious, angry, are in a bad mood, depressed, bored, lonely, and so on [5, 128-132; 7, 29-33; 8, 277-284]. Talking with the girls it was revealed that they were often anxious associated with being overweight, feeling aversion to themselves, the appearance of secondary sexual characteristics, and they were often alone. In boys, the emotion of eating disorders was associated with the preparation for the exam, an exam failure, bad relations with friends, especially the girls. Of the surveyed 12 boys and 21 girls were found disorders of daily meal taking
they observed the night eating syndrome. First, this form was described by A. Stoonkard in 1959 and quite often run in clinical practice [10, 366-371]. According to obese patients, it was determined that they could not fall asleep without an excessive amount of food eaten. Their sleep was shallow, anxious, and restless, they woke up at night several times and took again some food (cookies, candy, cake, etc.).
In a survey of children and their parents it was revealed that at the time of the survey the daily diet dominated potatoes (roasted) in 70.2 %, sweets and pastries in 61.3 %, pasta and dumplings in 48.5 %. Many children call these products as favorite ones. 36.6 % of children ate at night before sleeping. It was also found that from early infancy, they often ate before going to bed, after full satiety they had a normal sleep. According to the authors [8, 277-284; 9, 361-364], night eating syndrome at obesity can be attributed to an embodiment of the ontogenetic psycho-physiological immaturity. It was also determined that physical inactivity characterizes most obese children. Only 10.89 % of them visit sports clubs, whereas those in the control group 50 % of the children (p = 0.000). And, unfortunately, 96.03 % of children play on computer or watch TV more than 3 hours every day. There is no doubt that food as a form of providing building material and energy for the whole growth process and the development of a child is very important for his future health.
It is well known, the existence of familial forms of obesity in which the inheritance factor is reached 25 %, which indicates a relatively high contribution of genetic factors to the development of this syndrome. 4 % of the surveyed had the family form as “constitutional-exogenous obesity”.
The quality of food of the surveyed was certainly different. According to the questionnaire, the diet of obese children was characterized by a predominance of bread, flour, cereals and confectionery, the high content of saturated fats, salt and sugar in the diet with low norms of nutritional standards for fresh fruits and vegetables (deficiency of dietary fibers in the diet was 80 %). In study group the content of meat and meat products (sausages, etc.) in the diets were significantly higher than normal. Within a week teenagers with obesity consumed fast food (hamburgers, hot dog, French fries, etc.) without any limitations.
One of the factors that determine the development of obesity is physical activity that plays a significant role in the formation and functioning of healthy body. 55 % of boys and 38 % girls preferred watch TV shows and movies to regularly physical exercises, 23 % did not engage in physical activity at all and 34 % spent their time on computer for hours.
The socio-economic status of the family affected on formation of obesity in children as well. According to the research studies carried out in the northeastern regions of Brazil it was confirmed the hypothesis about the relationship of malnutrition in childhood and obesity in adults with very low incomes. The similar results were obtained in the UK. Children from families with high material incomes had no excess body weight [13, 17-26]. However, our results had other direction.
80
Identification of risk factors for obesity in children and adolescents living in Tashkent city
The estimation of the economic status of surveyed children and adolescents with obesity showed that 85 % lived without any material difficulties. Middle-income households were reported in 12 %. The educational level of parents is also one of the leading factors in the development of children and adolescents. Most mothers (78.0 %) of obese children had secondary education. One in five respondents of the surveyed women had no profession. A significant part of the fathers surveyed had secondary education (82.0 %).
Therefore, according to our research, the risk factors associated with the development of obesity should include genetic predisposition, parental obesity, nutrition and eating behavior, the level of physical development, family economic status, educational level of parents and others.
According to obtained data, we estimated the significance of risk factors for obesity in children.
Table 1. presents socio biological factors identified by questionnaire.
Table 1. - Socio-biological factors
Factor Grading factor Case R1 Control R2 AR R1\R2 Relative risk RR
The social situation of parents worker (employed in manual labor) 37.7 40.8 0.92 1
The employee (engaged in mental work) 19.6 16.1 1.22 1.32
Housewife 42.7 43.1 0.99 1.07
Pregnancy of the mother proceeded toxemia, with the threat of miscarriage 24.6 10.0 2.5 2.9
Normal 75.4 90.0 0.84 1
Labors Artificial (cesarean section) 23.3 10.1 2.3 2.73
Natural 76.4 89.9 0.84 1
The child was born For term 79.4 82.2 0.96 1.05
Premature 13.3 13.1 1.0 1 1
Prolonged 7.3 4.7 1.5 1.56
Feeding of the child Artificial 12.4 6.5 1.9 2.23
Natural 72.2 84.3 0.85 1
Mixed 9.2 1.65 1.94 15.4
The health status of a child under 3 years of age often ill 2.8 1.9 1.47 1.77
Rarely sick 85.9 84.6 1.01 1.21
Not sick 11.3 13.5 0.83 1
Comorbidity diseases in parents including: obesity III — degree Yes 5.4 1.4 3.85 4.05
No 94.6 98.6 0.95 1
II — degree Yes 4.9 2.33 2.1 2.4
No 95.1 97.9 0.97 1
I — degree Yes 8.4 4.2 2.0 2.08
No 92.6 95.8 0.96 1
According to Table 1, the study of social status of parents identified the relative risk (RR) 1.32, that was — the employees. In the study of pregnancy toxemia with the threat of miscarriage — RR was 2.9. In mothers who had artificial labors RR — 2.73. At artificial feeding RR was higher — 2.23. RR in children who were often ill — 1.77. Identification of comorbidity diseases in parents, including obesity degree III RR was 4.05, obesity degree I — 2.08, obesity degree II — 2.4.
Table 2 shows lifestyle factors, i. e., nutrition and physical activity of children and adolescents with obesity.
As indicated in Table. 2, the child’s diet at one time exposed to the factor of two times higher versus to control, the relative risk (RR) is 2.31; when consumed sweets and cakes the RR is 2.16; going to school by transport — 3.08; no walking in the fresh air — 4.06; watching TV -2.3; activity with computer for 3 hours or more — 4,5; no help round the house — 2.67; satisfactory studying of the child — 3.4.
Based on the definition of socio-biological RR and lifestyle factors we distributed 10 leading factors contributing to the development of obesity in children and adolescents (Figure 1).
81
Section 8. Medical science
Table 2. - Child lifestyle factors: nutrition and physical activity
Factor Grading factor Case R1 Control R2 R1\R2 Relative risk
Child nutrition at one time Yes 14.3 27.7 0.51 1
No 85.7 72.2 1.18 2.31
Eating sweets Rarely 11.7 12.0 0.97 1
1-2 times per week 31.3 30.1 1.03 1.06
After a day 23.5 15.0 1.56 1.6
Every day 19.6 9.7 2.1 2.16
Eating bread/flat cake 1 slice (1\4th of bread/flat cake) 11.7 12.0 0.97 1
2 pieces (1\3rd of bread/flat cake) 31.3 30.1 1.03 1.06
3 pieces (1\2nd of bread/flat cake) 23.5 15.0 1.56 1.6
More than 3 pieces of bread/flat cake 19.6 9.7 2.1 2.16
Morning exercises Yes 91.7 95.8 0.95 1
No 8.3 4.2 1.9 2
Engagement in activities Yes 87.5 75.4 1.16 1
No 12.5 24.6 0.50 2.32
Going to school By transport 12.1 4.3 2.81 3.08
On walk 87.8 95.7 0.91 1.71
Staying outdoors Up to 1 hour 28.3 28.5 0.99 1.86
1-2 hours 9.8 15.8 0.62 1.16
3 hours or more 11.4 21.2 1 0.53
No 50.5 23.5 2.14 4.03
Watching TV Up to 1 hour 42.9 56.7 0.75 1
1-2 hours 19.5 15.1 1.29 1.72
3 hours or more 35.6 20.3 1.75 2.3
None 0.95 2.0 2.1 1.2
Computer exercises Up to 1 hour 26.2 441. 0.58 16.9
1-2 hours 30.5 20.5 1.48 2.96
3 hours or more 42.1 18.6 2.26 4.5
No 16.0 8.0 0.5 1
Activity round the house No help 85.9 69.5 1.23 2.67
Helps 14.1 30.5 0.46 1
Studying at school Excellent 32.4 38.6 0.83 1
Good 48.2 54.7 0.88 06
Satisfactory 19.4 6.7 2.89 3.4
Fig. 1. Arranges the leading factors contributing to the development of obesity in children
82
The study of the adsorption rate of carbohydrates in the dietary intake of children and adolescents with obesity
When determined the major factors contributing to the development of obesity in children and adolescents, on the basis of the relative risk it was revealed that the activity with the computer for 3 hours or more, parental obesity and inactivity instead of walking outdoors occupied the leading position.
Thus, summarizing the results of the research should be stated that children and adolescents with obesity are characterized by hypodynamic lifestyle, going to school by transport, not going in for sports, spending much time with computer, taking meals at one and the same time, eating sweets every day as well as parental obesity and feeding the baby with formula.
Consequently, the greater activity with the computer, and parental obesity are the leading risk factors for childhood obesity.
Thus, the prevalence of obesity in the human population, a large number of complications directly related to overweight (cardiovascular, metabolic and endocrine), the heterogeneity of its forms define the search of the criteria for early diagnosis and revealing the groups at risk of developing obesity and its early metabolic complications and the implementation of preventive measures to prevent them, and therefore, to improve the quality and duration of life.
Conclusions:
1. Preventive measures for the prevention of obesity in children and adolescents should be carried out at an early age.
2. Healthy lifestyle, balanced diet, physical activity should be included in the medical care of children.
References:
1. Global Strategy on Diet, Physical Activity and Health. Report of a WHO Expert Committee. - 2012. - P. 12:4.
2. Lobykina E. N., Khvostov O. I, Koltun V Z. et al. Science and organizational approaches to the promotion of knowledge about balanced diet.//Health of the Russian Federation. - 2007. - No. 7. - P. 32-36.
3. Mamatkulov B., La Mort, Rakhmanova N. A. Clinical epidemiology. Evidence-based medicine.//manual. - Tashkent, 2011. - P. 223.
4. Mamatkulov B., Avezova G. S., Kasimova D. A. The health of children and the use of evidence-based medicine methods in the study of risk factors: Scientific-methodical manual. - Tashkent, 2011. - P. 16.
5. Pavlov N. N., Kleschina Yu. V., Eliseev Yu. Yu. Assessment of dietary intake and nutritional status of today’s children and adolescents.//Man and his health. - 2011. - No. 1. - P. 128-132.
6. Peterkova V A., Remizov O. V Obesity.//Under edit. Dedova I. I., Melnichenko G. A. - Moskow: MIA, 2004. - No. 1 -P. 315-316.
7. Sorvacheva T. N., Peterkova V. A., Titova L. N. et al. The effectiveness of a low-carb diet in the treatment of obesity in children and adolescents.//Nutrition - 2007. - Vol. 76, No. 3. - P. 29-33.
8. Florencio T. M., Ferrerira H. S., de Franca A. P. et al.//Br.J. Nutr. - 2001. - Vol. 86, No. 2. - P. 277-284.
9. Gokbel H., Atlas S.//J. Sport. Med. - 1999. - Vol. 39, No. 4 - P. 361-364.
10. Holtz C., Smith T. M., Winters F. D.//J.Am. Osteopath. Assoc. - 1999. - Vol. 99, No. 7. - P. 366-371.
11. Kinra S., Nelder R. P., Lewendon G. J.//J. Epidemiol. Commun.Hlth. - 2000. - Vol. 54, No. 6. - P. 456-460.
12. Alpes D. H., Stenson W. F., Bier D. M. Manual of nutritional therapeutics. 4th edn. - Philadelphia: Lippincott Williams and Wilkins, 2001. - Р. 644.
13. Burrows A. R., Leiva B. L., Burgue A. M., et al. Insulin sensitivity in children aged to 16 years: Association with nutritional status and pubertal development.//Rev Med. Chil. - 2006. - Р. 17-26.
14. Weker H. Simple obesity in children. A study on the role of nutritional factors.//Med. Wieku Roz-woj. - 2006. - Р. 3-19.
Rakhimov Bakhodir, Tashkent Medical Academy, assistant, the department of hygiene of children and adolescents and hygiene of nutrition E-mail: [email protected]; [email protected]
The study of the adsorption rate of carbohydrates in the dietary intake of children and adolescents with obesity
Abstract: This article aims to study the rate of adsorption of carbohydrates in the dietary intake of children and adolescents who are obese in order to develop the follow-up measures for goal-directed correction of identified eating disorders, physical activity and prevention of obesity.
Keywords: children and adolescents, body mass index, obesity, dietary intake, glycemic index.
Today obesity is one of the common chronic relaps- by WHO experts, their number will exceed up to 300 mil-
ing diseases. In 1998, it was registered 250 million obese lion. According to epidemiological studies, in world devel-
patients in the world, and in 2025, according to estimates oped countries 25 % of teenagers are overweight, and 15 %
83
