Clinical and laboratory findings in adolescents in 'Cigotica' programme from 2008 to 2012

INTRODUCTION: Obesity is becoming an increasingly important public health problem due to a drastic increase in its frequency, not only in adult but also at the pediatric and adolescent age, which directly and indirectly influences population morbidity, life expectancy and mortality. In response to the obesity epidemic in Serbia in 2008, the Center for the prevention, treatment and rehabilitation of obesity in children and adolescents was formed as well as 'CIGOTICA' Programme at the Special Hospital 'Zlatibor'. The characteristics of programs 'CIGOTICA' Programme is a multidisciplinary approach to the treatment of obese children, which includes specific training, dietary intervention with the reduction of total daily caloric intake, physical activity, clinical control and psychological support, change in behaviour and lifestyle. OBJECTIVE: To identify the complications of obesity and metabolic risk factors in adolescents participating in CIGOTICA Programme. METHOD: Anthropometric, clinical and biochemical parameters were analyzed in 1,000 adolescents (468 girls and 532 boys), of average 15.30 years of age (range 12 to 18) with primary obesity. The research was conducted at the Center for the Prevention and treatment of obesity in children and adolescents at the Special Hospital 'Cigota' from 27 July, 2008 to 1January, 2012. Hospitalization lasts 21 days. The criterion for obesity is the body mass index (BMI)> +2 SD. In addition to clinical examination, blood pressure was measured. Triglycerides, total, HDL and LDL cholesterol, uric acid and glucose were measured on the second day of hospitalization after 12 hours of fasting. RESULTS: Abdominal obesity defined as OS> P90 was diagnosed in all examinees (100%). 28% of adolescents had hypertension. Acanthosis nigricans was present in 51.4% of adolescents. Triglyceride values were high in 7.8% of patients, lower levels of HDL h were observed in 22.9% of the examinees, and high cholesterol was present in 5.8% of patients. Two risk factors for metabolic syndrome were observed in 27.6%, and metabolic syndrome was present in 18.3% of patients. 8.9% examinees had a glucose disorder (0.3%). Orthopedic complications were observed in 82% of the examinees. Polycyistic ovary syndrome were observed in 12% of adolescents. CONCLUSION: Complications occur in a large number of obese adolescents, which indicates the seriousness of the problem of obesity and the need for more effective prevention programmes. Short-term effects of Cigotica programme are encouraging, and the effectiveness of the multidisciplinary approach to obesity treatment will be evaluated by the current research which analyses sustainability of the achieved results

Effect of age, sex and the insulin regiment on insulin needs in children and adolescents suffering from diabetes mellitus type 1

INTRODUCTION: The purpose of this study was to generate insulin dose (ID) percentiles for children and adolescents with type 1 diabetes mellitus (DM1) having the opportunity to assess this important parameter in relation to age and sex. Individual intensive substitution of insulin is vital for achieving optimum metabolic control in children and adolescents suffering from type 1 diabetes. AIM OF THE STUDY: The aim of this study is: to examine the basic factors which determine daily insulin needs; to establish average insulin doses of the examinees of different ages and sexes and to present them in the form of figures - percentile tables. METHODS: Medical documentation of 100 examinees (55 girls and 45 boys), ages 2-18 were analyzed at the Children's University Hospital in Belgrade in the period between August 1994 and August 2002. All the examinees achieved a satisfactory metabolic control of diabetes after the period of the remission of the disease. The examinees had the conventional insulin therapy (KITh) and intensive therapy (IITh), and they were all using humane insulins. RESULTS: On the basis of the data analysis it has been established that the average insulin dose at ages 3-9 is 0.8 IJ/kg/24h in both sexes, and that from the age of 10 the need for insulin considerably increases with metabolic control deteriorating at the same time. Insulin needs are the greatest during adolescence, especially in girls (1.20 IJ/kg/24h). The ranges of insulin doses show that every child needs an individual approach and estimate of insulin needs. CONCLUSION: It has been concluded that daily insulin needs grow with the growth of chronological age (0.8 before adolescence and 1.16 IJ/kg/24h in adolescence) and that girls get greater insulin doses than boys, especially during adolescence. Insulin needs shown in percentiles (P5 - P95) and presented in the form of figures enable fast and simple visualization of the range of insulin doses at different ages (figures 2 and 3). It is evident that there is a considerable deterioration of metabolic control during adolescence

Prader Willy’s syndrome diagnosed in extremely obese female adolescent

Introduction: Nutritional obesity is the most common cause of obesity (95%) in childhood and adolescence. Morbid obesity (5%), which usually begins at an early age, can be caused by monogenic disorders, various genetic syndromes, endocrine diseases-disorders, central nervous system lesions or iatrogenic causes. Presentation of the patient: A female adolescent aged 13 is presented who was due to obesity referred to the Center for the Prevention and Treatment of Obesity in children and adolescents at the Special Hospital “Cigota” at Mt. Zlatibor. Low height/stature and dysmorphic features: a face with a narrow bifrontal diameter, almond-shaped eyes, strabismus, small hands and feet, delay in puberty development and lagging in psychomotor development have indicated the morbid obesity. Anamnestic data on hypotonia and difficulty in feeding, psychomotor lagging behind, obesity since the third year of age, triggered a suspicion of Prader Willy’s syndrome. The suspicion of this syndrome was confirmed by a molecular DNA analysis which indicated a deletion on the long arm 15q11.2. Conclusion: Obesity, endocrinolopathies, retardation in psychomotor development and behavioral disorders in people with Prader Willy’s syndrome require a complex multidisciplinary treatment. Early diagnosis and adequate treatment prevent the occurrence of complications and improve the quality and length of life of the patients

Cigotica programme: Pediatric experiences

Introduction The alarming spread of obesity epidemic in children and adolsecents, as well as the absence of tested and efficient measures and programmes on obesity preven­tion indicate the necessity for the establishment of the Centre for the prevention, treatment and rehabilitation of obesity in children and adolescents and the 'Cigotica Programme' at the Special Hospital 'Zlatibor'. The advantage of the 'Cigotica' Programme is the multidisciplinary approach to treating obese children, which implies specific education, dietetic interventions with the reduction in the total daily calorie intake, physical activity, medical, educational and psychological support, change of behavior and lifestyle. Objective To define obesity complications, metabolic risk factors and treatment effects on body composition and metabolic parameters in adolescents participating in the 'Cigotica' Programme. Method 1,030 adolescents were examined (498 girls and 532 boys), aged 12 to 18, average age 15.45, diagnosed with primary obesity, hospitalized at the Centre for the prevention, treatment and rehabilitation of obesity in children and adolescents at the Special Hospital 'Zlatibor', in the period from 27/07/2008 to 03/10/2010. Hospitalization lasted 21 days. Obesity criterion was body mass index (BMI) > +2 SD . Body The Special Hospital for the Thyroid Gland and Metabolism Zlatibor mass, BMI, % of fat were obtained by means of Tanita scales for determining body composition using the impendence method. Apart from medical examination, blood pressure was also taken. The levels of triglycerides, total HDL and LDL cholesterols, uric acids and glycemia were determined on the second and twenty-first day of hospitalization after a 12-day fasting period. Results After the multidisciplinary treatment, the average reduction in body mass (p< 0.05 ) in all adolescents was 5.92 ± 2.71 kg, in boys - 6.24 ±3.24 kg, and in girls -5.86±2.4. During the 21-day hospitalization, the average BMI (p< 0.05) was reduced by -2.12 ± 0.31 in all examinees, in boys by -2.33 ± 48 and in girls by -2.04 ± 0.41 kg/m2. The BMI z-score was considerably lower in all examinees upon release and it was (p<0.05)-0.26 ±0.08, in girls 0.28 ±0.06 and in boys 0.31 ± 0.08. % of fat was considerably lower (p< 0.05) in all examinees -1.65 ± 0.23, in girls 1.72 ± 0.32 and in boys 1.50% ± 0.20. The waist circumference was reduced by -7.85 ±3.01 in all examinees, in girls -8.20 ± 4.3 and in boys -7.25 ± 2.6. Hypertension was observed in 28% of adolescents. Two factors of metabolic syndrome were present in 27.6%, and metabolic syndrome was present in 18.3% of the examinees. The disorder in sugar transport was observed in 8.9% of the examinees. Conclusion The effects of the 'Cigotica' Programme are very encouraging and they show that the multidisciplinary approach directed towards the reduction in energetic intake, education, change of lifestyle and habits related to nutrition and physical activity, leads to a considerable reduction in body mass, improvement in blood pressure, laboratory analyses, aerobic capacities and self-confidence in obese adolescents. There are obe­sity complications in a large number of adolescents, which indicates that the obesity problem has not been duly detected by parents or medical workers and that more efficient prevention programmes are needed. A great interest of children, parents, doctors and their participation in the 'Cigotica' Programme are going to contribute to raising awareness of obesity risks and the importance of health prevention in ado­lescents in our region

Effects of altitude to blood parameters

Reducing of partial pressure of oxygen in the air leads to a reduced arterial oxygen saturation and increases secretion of erythropoietin, wich stimulates erythropoiesis. Study included 63 healthy children aged 7 years, devided into 3 groups. I group consists of 21 children from suburb of altitude of 370 m, II group of 22 children from the village on 822 m, III group of 21 children from the town on 411 m. Complete blood count was determined on a Hematology analyzer HmX ( Beckman Coulter). Statistical analysis of data showed that children from II group have a higher average values of erythrocytes than children from the I (p0.05). Results show that stay in the village is useful for stimulation of erythropoiesis

The stigma of obesity in adolescence

Introduction/Objective. Obese children and adolescents are exposed to stigma and discrimination from peers, teachers and family which can lead to numerous health problems, including psychosocial problems. The aim of this study is to determine whether obese adolescents in Serbia are exposed to stigmatization and which are the most common forms of stigmatization they face. Methods. The study included 335 adolescents who were hospitalized for a treatment of obesity. During hospitalization weight and height were measured, and body mass index was calculated. Participants completed independently Questionnaire about weightbased stigmatization made for the purpose of this research. Questionnaire also included questions about sex, age of respondents, and about obesity of other family members. Results. Fifty-nine percent of participants experienced offence, 19% were teased, 47.5% were subject of a gossip, and 25% were excluded from peer group; 45% reported that other people had prejudice against them. Male adolescents significantly more often faced overt forms of stigmatization/discrimination compared to female adolescents. Nineteen percent of participants were stigmatized by health workers and 6% stated that their family is ashamed of their obesity. Conclusion. A significant percent of obese adolescents is exposed to a stigma due to their weight, most often to insults, gossip and social exclusion. Obese adolescents are most often exposed to stigmatization by peers, but there are a significant proportion of adolescents who are exposed to stigma from health workers