Complex diagnosis of childhood obesity

Detection of overweight and complex diagnosis of obesity in children consists of four stages of medical examination.

  1. The primary screening stage.
  2. Stage of primary clinical and laboratory examination.
  3. Stage of in-depth clinical and laboratory examination.
  4. Stage of differential diagnosis and diagnosis verification

The term “obesity” is used in body mass index (BMI) of a child exceeding 30 kg / m2.

The primary screening stage

Detection of overweight or obesity in children include medical history (present illness; past illnesses; of a family, including endocrinology, social, nutritional status and physical activity), physical (measurement of anthropometric parameters and blood pressure), and laboratory methods to identify risk factors for the complicated or secondary forms of obesity.

Anamnestic risk factors:

1. Anamnesis of disease

  • Birth of a child of a large or small weight for gestational age;
  • Early moving from breastfeeding to bottle or mixed feeding (up to 4 months of child’s life);
  • Overweight diagnosis at an early age (up to 6 years old) with BMI assessment;
  • Delay in the neuro-psychological development, the presence of traumatic brain injury, neuroinfections, vegetative disorders and headaches;
  • Symptom of hyperphagia (bulimia);
  • Sleep apnea, daytime sleepiness;
  • Pain syndrome (abdominal – gall bladder disease, pain in the knee or hip joints – dysplasia);
  • Medication use (steroids, oral contraceptives).
Childhood Obesity

2. Family anamnesis

The presence in family members of the first and second degrees of relationship:

  • Carbohydrate metabolism disorders (type 2 diabetes, gestational diabetes), cardiovascular diseases (heart attack, stroke, hypertension);
  • Overweight and obesity;
  • Cancer (breast, colon);
  • Dyslipidemia.

3. Social anamnesis

  • Family composition (incomplete);
  • Parents’ education (incomplete secondary and secondary);
  • Alcohol consumption; smoking; use of antidepressants, amphetamines, narcotic and other stimulants;
  • The presence of depression, eating disorders.

4. Food anamnesis

  • Consumption of highly-calorie food products, fast food, sweets, salts;
  • Condition of food intake (irregular, mainly in the evening).

5. Anamnesis of physical activity

  • Low physical activity at home, school/kindergarten;
  • Average time spent on computer (game consoles) or TV.

Physical diagnosis

1 Anthropometric measurements

  • Measurement of mass and length of the body;
    BMI calculation

2 Clinical examination to exclude certain symptoms

Laboratory and instrumental methods of examination

1. Measurement of blood pressure

2. Laboratory examination of the patient with overweight/obesity during the primary visit includes a biochemical blood test with determination of glucose concentration, aspartate aminotransferase (AST), alanine aminotransferase (ALT), cholesterol, triglycerides (TG).

3. Electrocardiography (ECG)

Additional methods of examination

1. Ultrasound examination of the internal organs (liver, pancreas, kidney, gall bladder).

  • Diagnosis of overweight or obesity in a patient, the presence of risk factors is an indication for clinical and laboratory examination at the second stage.
  • Stage of primary clinical and laboratory examination.

Physical methods of examination

1. Anthropometric measurements

  • Waist circumference in children to avoid abdominal form of obesity: waist circumference > 90 percentile aged 15 years and older, > 80 cm in girls, > 94 cm in boys.

2. Clinical examination to exclude certain symptoms

Laboratory and instrumental methods of examination

1. Identification of carbohydrate metabolism disorders is conducted on the basis of evaluation of the results of fasting glucose and a standard 2-hour oral glucose tolerance test (OGTT) (according to the criteria of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus, WHO, 1999).

2. Determination of the concentration of thyroid stimulating hormone (TSH), free thyroxine to prevent hypothyroidism.

Additional methods of examination

1. Thyroid ultrasound.
2. Consultation of an ophthalmologist (ocular fundus), a neurologist.

Diagnosing the second or more degree of obesity (morbid forms), the presence of clinical signs of insulin resistance, dysmorphic symptoms and tall / short stature (to exclude genetic syndromes), hirsutism and menstrual irregularities (to exclude polycystic ovary syndrome, hypercorticoidism), mental retardation are indications for the examination at the third stage to exclude the secondary forms of obesity and comorbidities.

Stage of in-depth clinical and laboratory examination

Laboratory methods of examination

1. Biochemical blood test with the determination of cholesterol level, triglycerides, low-density lipoprotein (LDL), high-density lipoprotein (HDL), atherogenic index.

2. Hormonal blood test with the determination of the level of immunoreactive insulin (IRI) fasting and after 2 hours during glucose tolerance test (GTT).

Additional methods of examination

1. Determination of the concentration of sex hormones: estradiol, progesterone, testosterone, follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin – in girls during menstrual disorder, hypogonadism, acceleration of puberty; testosterone, FSH, LH – in boys with the signs of delay or acceleration of puberty.

2. Ultrasound of adrenal glands, pelvic organs, breast, testicles.

3. Ambulatory blood pressure monitoring (ABPM).

4. Echocardiography.

5. Computed tomography of the adrenal glands, magnetic resonance tomography of the brain (pituitary gland).

6. Consultation of an ophthalmologist (ocular fundus, visual field), neurologist, cardiologist, obstetrician-gynecologist, neurosurgeon, psychotherapist, geneticist.

Diagnosing the complicated forms of obesity in a patient in its early manifestation or in monogenic forms of the disease, clinical and laboratory signs of hypercortisolism, hypogonadism, polycystic ovary syndrome, genetic syndromes is the indication for further examination of the patient at the fourth stage.

Stage of differential diagnosis and diagnosis verification

Laboratory and instrumental methods of examination

1. Hormonal examinations:

  • Determination of leptin concentration (in obesity occurrence in early childhood, in monogenic or morbid forms of obesity), adiponectin (in the risk of developing the metabolic syndrome or secondary disorders in obesity (arterial hypertension, insulin resistance, impaired glucose metabolism, dyslipidemia);
  • Adrenocorticotropic hormone, circadian cortisol profile, small and large dexamethasone suppression test (in suspicion of hypercortisolism);
  • Dehydroepiandrosterone sulfate (in symptoms of polycystic ovary syndrome, hypogonadism);
  • Insulin-like growth factor-1, insulin-like binding protein-3 (in monogenic forms of obesity, short stature, acceleration of bone age, hypogonadotropic hypogonadism);

2. Dual-energy X-ray absorptiometry to determine body composition

Additional methods of examination

1. Revealing psychological maladjustment according to the results of psychological tests and questionnaires: a test of family education by Eidemiller (parents) and their children (food preference questionnaire (EAT-26 (Eating Attitudes Test)), used as a screening method to reveal eating disorders) by Eysenck, Spielberger, Luscher.

2. DNA-typing of patients and their parents with morbid and monogenic forms of obesity, early occurrence of the disease for a number of candidate genes (leptin gene LEP, leptin receptor gene LEPR, adiponectin gene ADIPOQ, insulin gene INS, interleukin 6 gene (IL-6), tumor necrosis factor TNF-a gene.

The optimal amount of researches is determined by anamnestic data and indicators of clinical and laboratory examination.

According to the examination results, stratification of the risk of complicated forms of the disease is conducted in patients with overweight and obesity. For the development of the factors of risk stratification of patients depending on the puberty stage: prepubertal (Tanner stage 1), early puberty (Tanner stage 2-3), late puberty (Tanner stage 4-5) were used most informative, anamnestic, clinical, metabolic and hormonal indicators.

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