DOI: https://doi.org/10.1210/jc.2016-2573

Ожиріння в дітей: визначення, лікування, профілактика. Клінічні практичні настанови Ендокринологічного Товариства. Частина 4

N. B. Zelinska

Анотація


Асоціації-­співавтори. Європейське Ендокринологічне Товариство і Педіатричне Ендокринологічне Товариство. Ці настанови профінансовано Ендокринологічним Товариством.

Мета. Сформулювати клінічні практичні настанови щодо визначення, лікування і профілактики ожиріння в дітей.

Учасники. Ендокринологічне Товариство обрало учасниками шість експертів, методиста й укладача медичних текстів.

Докази. Ці науково обґрунтовані настанови розроблено з використанням принципу градації рекомендацій, оцінки та експертизи ступеня їх обґрунтованості (Grading of Recommendations, Assessment, Development, and Evaluation — GRADE) для опису як ступеня переконливості рекомендацій, так і якості доказової бази. Робоча група врахувала дані двох систематичних оглядів і використала найкращі доступні свідчення інших опублікованих систематичних оглядів і окремих досліджень.

Процес узгодження. Одна групова зустріч, кілька конференц­зв’язків, а також спілкування електронною поштою забезпечили досягнення консенсусу. Комітет Ендокринологічного Товариства, його члени, організації­-співавтори вивчили та прокоментували попередні проекти цих рекомендацій.

Висновки. Дитяче ожиріння залишається постійною серйозною проблемою здоров’я у світі, що викликає стурбованість, оскільки вражає приблизно 17 % дітей і підлітків у США і загрожує здоров’ю дорослих і тривалості їх життя. Дитяче ожиріння бере початок у генетичній сприйнятливості, на яку впливають чинники навколишнього середовища, починаючи in utero і надалі впродовж дитинства та юності. Ендокринна етіологія ожиріння рідкісна й зазвичай супроводжується ознаками затримки зростання. Ожиріння в дітей зазвичай супроводжується супутніми захворюваннями і тривалими ускладненнями здоров’я; скринінг на супутні ожирінню захворювання слід проводити на регулярній основі задля вчасного їх виявлення, до виникнення серйозніших ускладнень. Генетичний скринінг на рідкісні синдроми показаний тільки за наявності специфічних анамнестичних або клінічних ознак. Психологічні впливи дитячого ожиріння на пацієнта і його родину вимагають проведення скринінгу на стан психічного здоров’я і в разі потреби — консультування. Профілактика дитячого ожиріння шляхом пропагування здорового харчування, активності й навколишнього середовища має бути основною метою, оскільки досягнення ефективних тривалих результатів зі зміною способу життя після виникнення ожиріння дуже складне. Хоча окремі дослідження поведінкової та фармакотерапії повідомляють про деякі успіхи, необхідні додаткові дослідження доступних і ефективних методів профілактики й лікування ожиріння в дітей. Використання препаратів для схуднення в дитячому та підлітковому віці має бути обмежене до клінічних випробувань. Збільшується кількість свідчень, що демонструють ефективність баріатричної хірургії в найтяжчих випадках ожиріння у підлітків старшого віку, у яких не вдалося досягти ефекту зміною способу життя, проте використання хірургічного лікування потребує досвідчених команд з ресурсами для тривалого подальшого спостереження. Підлітки, які отримують лікування ожиріння зміною способу життя або з використанням медикаментів, або баріатричної хірургії, потребують спільного планування, щоб допомогти їм ефективно перейти під нагляд у дорослому віці з продовженням необхідного моніторингу, підтримки і втручань. Перехідні програми з ожиріння є невід’ємною частиною допомоги, ефективність яких вимагає подальшого дослідження. Незважаючи на значне зростання кількості досліджень дитячого ожиріння від часу першої публікації цих настанов 8 років тому, необхідне подальше вивчення генетичних і біологічних чинників, які посилюють ризик збільшення маси тіла і впливають на відповідь на терапевтичні втручання. Також необхідно більше досліджень для кращого розуміння генетичних і біологічних чинників у людини з ожирінням, які призводять до маніфестації однієї супутньої хвороби порівняно з другою або взагалі не зумовлюють супутніх хвороб. Крім того, пріоритетним має бути продовження досліджень найефективніших методів профілактики і лікування ожиріння, а також методів зміни екологічних і економічних чинників, що призведуть до глобальних культурних змін у раціо­ні харчування і фізичній активності. Особливої уваги потребує визначення шляхів досягнення системних змін у харчовому середовищі й загальній щоденній активності, а також методів здорової зміни індексу маси тіла.

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