PERINATOLOGIYA I PEDIATRIYA. 2014. 3(59):41-46; doi 10.15574/PP.2014.59.41 
 

Selective leptin resistance conception in arterial hypertension formation in сhildren with general obesity 
 

N.M. Gromnatska

Danylo Halitskiy Lviv National Medical University, Lviv, Ukraine

Purpose — investigation was done with the aim to study of character and mechanisms of leptinemia and selective leptin resistance influence on arterial hypertension formation in children with general obesity.

Patients and methods. 133 children aged from 9 to 18 years were selected and distributed to 3 groups: 28 children with general obesity and normal blood pressure (1 group), 40 children with general obesity and arterial hypertension (2 group), 40 children with normal body mass and blood pressure (control group). Anthropometry data, blood pressure, total leptin, aldosterone, cortisol, renin in blood, heart rate variability were studied.

Results. It was estimated that in children with general obesity and normal blood pressure leptin concentration in blood [12.0 (8.5–20.9) ng/ml] was sensitively higher than in children with normal mass and blood pressure [2.3 (0.7–8.7) нг/мл] (р=0.001) and rather sensitively increased with arterial hypertension formation [17.0 (9.2–39.4) ng/ml] in comparison with children of control group. It was determined that hyperleptinemia and selective leptin resistance in generally obese children take place in arterial hypertension formation. The possible mechanism of leptinemia and selective leptin resistance influence on arterial hypertension formation is relative increase of sympathetic autonomic nervous system activity which was proved by decrease of general heart beat variability according to RRNN, SDNN and decrease of parasympathetic autonomic nervous system activity according to RMSSD, pNN50, HF, LF/HF ratio. The humoral mechanism of leptinemia and selective leptin resistance influence on arterial hypertension formation in children with general obesity was not proved.

Conclusions. Hyperleptinemia and selective leptin resistance are essential pathogenetic factors in general obesity and arterial hypertension comorbidity formation by relative activation of sympathetic and decrease of the parasympathetic nervous system activity, that must be acknowledged in prevention and treatment of obesity and arterial hypertension in children.

Key words: hyperleptinemia, selective leptin resistance, general obesity, arterial hypertension, autonomic nervous system, children.

REFERENCES

1. Бобрикович ОС, Цимбаліста ОЛ. 2012. Гіперлептинемія у дітей та підлітків Прикарпаття з проявами МС. Перинатология и педиатрия 3(51): 46—48.

2. Бондар ПМ, Скрипник НВ. 2010. Метаболічний синдром: патогенез, діагностика і лікування. Ендокринологія 5(2): 295—304.

3. Загородна ПС. 2009. Дослідження рівня лептину та порушень функції ендотелію в жінок із ранніми проявами метаболічного синдрому в перименопаузі. Сімейна медицина 3: 61—62.

4. Косыгина АВ, Васюкова ОВ. 2009. Новое в патогенезе ожирения: адипокины жировой ткани. Проблемы эндокринной патологии 55(1): 44—50.

5. Морено ИГ, Неудахин ЕВ, Гурьева ЕН и др. 2010. Метаболический синдром у детей и подростков: вопросы патогенеза и діагностики. Педиатрия 89(4): 116–119.

6. Морозова ТЕ, Латыйпова ЕР. 2013. Больной с ожирением: влияние на биомаркеры как инструмент персонализированного подхода к терапии. Рос кардиологический журнал 3(101): 94—99.

7. Протоколи надання медичної допомоги дітям за спеціальністю «Дитяча ендокринологія». Наказ МОЗ України від 27.04.2006 р. № 254. За ред. НБ Зеленської. http://www.moz.gov.ua

8. Дубровская МИ, Мухина ЮГ, Гуманова НГ и др. 2009. Ранние предикторы метаболического синдрома у детей с заболеваниями верхних отделов пищеварительного тракта, имеющих избыточную массу тела. Кардиоваскулярная терапия и профилактика 8(5): 50—56.

9. Боцюрко ВІ, Костіцька ІО, Бабенко ІГ, Скрипник НВ. 2006. Роль лептинорезистентності у розвитку метаболічного синдрому (огляд літератури). Ендокринологія 11(1): 64—70.

10. Скибчик ВА, Скибчик ЯВ. 2007. Проблема лептинемії при серцевоGсудинних захворюваннях. Укр мед часопис 6(62): 45—50.

11. Цветкова ОА, Грачева ЕВ. 2013. Коррекция метаболического синдрома и эндотелиальной дисфункции ингибитором АПФ — Диротоном (лизиноприлом). РМЖ 33: 1621—1625.

12. Чайченко ТВ. 2013. Адипоцитарна дисфункція як патогенетична основа метаболічного синдрому у дітей. Перинатология и педиатрия 2(54): 120—124.

13. Шляхова НВ. 2011. Роль лептину та адипонектину у формуванні інсулінорезистентності у дітей пубертатного віку, що страждають на ожиріння. Проблеми ендокринної патології 4: 52—59.

14. Venner AA, Doyle-Baker PK, Lyon ME et al. 2009. A meta-analysis of leptin reference ranges in the healthy paediatric prepubertal population. Ann Clin Biochem 46: 65—72. http://dx.doi.org/10.1258/acb.2008.008168 ;PMid:19103960

15. Fonseca-Alaniz MH, Takada J, Alonso-Vale MI, Lima FB. 2007. Adipose tissue as andocrine organ: from theory to practice. J Pediatria (RioJ) 83(Suppl 5): S192–203.

16. Alberti KG, Zimmet PZ, Shaw J. 2005. IDF Epidemiology Task Force Consensus Group: Metabolic Syndrome: a new worldwide definition. Lancet 366: 1059—1062.

17. Farroogi IS, Matarese G, Lord GM et al. 2002. Beneficial role of leptin on obesity, T-cell hyporesponsiveness and neuroendocrine/metabolic dysfunction of human congenital leptin deficiency. J Clin Invest 110(8): 1093—1103.

18. Centers for Disease Control and Prevention. Healthy weight. 2008. http:// www.cdc.gov /nccdphp/dnpa/healthy weiht. Accessed November 5

19. Cole TJ, Bellizi MC, Flegal KM, Dietz WH. 2000. Establishing a standart definition for child overweight and obesity worldwide: international survey. BMJ 320: 1—6.

20. El-Haschimi K, Lehnert H. 2003. Leptin resistance or why leptin fails to work in obesity. Exp Clin Endocrinol Diabetes 111(1): 2–7.

21. 2007. Expert Committee Recommendations Regarding the Prevention, Assessment and treatment of child and adolescent overweight and obesity: Summary Report. Pediatrics 120 (Suppl 4): 164—192.

22. Magni P, Liuzzi A, Ruscica M et al. 2005. Free and bound plasma leptin in normal weight and obese men and women: relationship with body composition, resting energy expenditure, insulin-sensitivity, lipid profile and macronutrient preference. Clin Endocrinol (Oxf) 62: 189—196.

23. 1996. Heart Rate Variability. Standarts of measurement, physiological interpretation and clinical use // Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology: Membership of the Task Force listed in the Appendix. Eur Heart J 17: 334–381.

24. Katsuki Y, Sumida H, Urakawa H. 2003. Increased visceral fat and serum levels of triglycerides are associated with insulin resistance in Japanese metabolically obese, normal weight subjects with normal glucose tolerance. Diabetes Care 26: 2341—2344.

25. Kovela DI, Orbetzova MM, Atanassova PK. 2013. Adipose tissue hormones and appetite and body weight regulators in insulin resistance. Folia Med (Plovdiv) 55(1): 25—32.

26. Hamidi A, Fakhzreadeh H, Moayyeri A, Heshmat R et al. 2006. Metabolic syndrome and leptin concentration in obese children. India J Pediatr 73(7): 593—596. http://dx.doi.org/10.1007/BF02759924

27. Miegle K, Stepan H, Fasshauer M. 2012. Leptin, adiponectine and other adipokines in gestational diabetes mellitus and preeclampsia. Clinical Endocrinology 76 (Is 1) Pub online doi.10.1111/j1365–2265.2011.

28. Park HS, Lee MS, Park JY. 2004. Leptin and metabolic syndrome in Korean adolescents: Factor analysis. Ped Int 46: 697—703.

29. Gutin B, Ramsey L, Barbeau P et al. 1999. Plasma leptin concentrations in obese children: changes during 4-month period with and without physical trainings 1'2'3. Am J Clin Nutr 69(3): 388–394.

30. Scarpellini E, Tack J. 2012. Review obesity and metabolic syndrome: an inflammatory condition. Dig Dis 30(2): 148—153. http://dx.doi.org/10.1159/000336664 ; PMid:22722429

31. Houseknecht KL, Baile CA, Matteri RL, Spurlock ME. 1998. The biology of leptin: a review. J Anim Sci 76(5): 1405—1420.

32. The Fourth Report on Diagnosis, Evaluation and Treatment of High Blood Pressure in Children and Adolescents. National Institute of Health, National Institute of Heart, Lung and Blood. Revised 2005 [Electronic resource]. — Access mode: http: www.nhlbi.nih.gov/health. —Title from screen.