Integrated clinical and metabolic assessment of children with obesity and arterial hypertension

Abstract

Introduction. Childhood and adolescent obesity is one of the most important medical and social challenges in modern pediatrics and pediatric cardiology. The increasing prevalence of abdominal obesity is accompanied by a growing incidence of arterial hypertension, insulin resistance, dyslipidemia, and early cardiovascular disorders. Despite numerous studies, the relationships between clinical, metabolic, and cardiovascular alterations in obese children remain insufficiently understood, emphasizing the need for a comprehensive assessment of cardiometabolic risk factors. Objective. To investigate the clinical and metabolic characteristics of children with obesity, evaluate the relationships between anthropometric parameters, disorders of carbohydrate and lipid metabolism, arterial hypertension, and cardiovascular changes, and determine the structure of metabolic syndrome components in pediatric patients. Materials and Methods. A prospective clinical and laboratory study included 55 children aged 10–18 years with exogenous constitutional obesity. The control group consisted of 20 age-matched healthy children. All participants underwent comprehensive clinical examination, anthropometric assessment, body mass index calculation, waist circumference and waist-to-hip ratio measurements, blood pressure evaluation, electrocardiography, and biochemical investigations including carbohydrate and lipid metabolism parameters, serum uric acid, immunoreactive insulin, and HOMA-IR index determination. Statistical analysis included correlation analysis between clinical and laboratory variables. Results and Discussion. Children with abdominal obesity and arterial hypertension demonstrated an earlier onset of the disease, accelerated physical growth and pubertal development, a higher prevalence of functional cardiovascular abnormalities, and persistent elevation of arterial blood pressure. Disorders of carbohydrate metabolism were detected in approximately one-third of the patients and were accompanied by elevated HOMA-IR values, indicating insulin resistance. Hypertriglyceridemia, increased total cholesterol and low-density lipoprotein cholesterol, together with reduced high-density lipoprotein cholesterol, were significantly more common in children with abdominal obesity. Serum uric acid concentrations were increased and showed significant positive correlations with body mass index and blood pressure. Correlation analysis demonstrated close associations between obesity severity, carbohydrate and lipid metabolism disorders, hyperuricemia, and cardiovascular abnormalities, confirming the common pathogenetic mechanisms underlying metabolic syndrome and cardiovascular disease in obese children. Conclusion. Children with abdominal obesity, particularly those with concomitant arterial hypertension, exhibit the most pronounced clinical, metabolic, and cardiovascular abnormalities. The development of insulin resistance, dyslipidemia, hyperuricemia, and functional cardiovascular changes is closely associated with increasing obesity severity and elevated blood pressure. These findings highlight the importance of early identification of metabolic syndrome components and comprehensive assessment of cardiometabolic risk factors to prevent long-term cardiovascular complications in obese children.