medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-17-152-161medsovet-6497Research ArticleГАСТРОЭНТЕРОЛОГИЯGASTROENTEROLOGYПотеря веса у ребенка с ожирением - положительная динамика или нет?Weight loss in an obese child: positive changes or not?https://orcid.org/0000-0002-4296-3345ВашураА. Ю.VаshuraA. Yu.

Вашура Андрей Юрьевич - кандидат медицинских наук, врач-диетолог, заведующий отделом научных основ питания и нутритивно-метаболической терапии лечебно-реабилитационного научного центра «Русское поле».

117997, Москва, ул. Саморы Машела, д. 1

Andrey Yu. Vashura, Cand. Sci. (Med.), Nutritionist, Head of the Department of Scientific Basics of Nutrition and Nutritive Metabolic Therapy of the Medical and Rehabilitation Research Center "Russian Field".

1, Samora Mashel St., Moscow, 117997

avashura@gmail.comНациональный медицинский исследовательский центр детской гематологии, онкологии и иммунологии имени Дмитрия РогачеваРоссияNational Medical Research Center for Children’s Hematology, Oncology and Immunology named after Dmitry RogachevRussian Federation202131102021017152161Copyright © Вашура А.Ю., 20212021Вашура А.Ю.Vаshura A.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6497

Масса тела, индекс массы тела и их изменения с возрастом ребенка - одни из ключевых показателей в педиатрии. По величине этих показателей оценивается нутритивный статус и проводится диагностика нутритивных нарушений - ожирения и белково-энергетической недостаточности. Вместе с тем масса тела и ее изменения лишь условно отражают массу жира и величину безжировой массы (особенно скелетно-мышечного компартмента). В условно здоровой популяции, где были получены соответствующие референсы, изменения индекса массы тела могут с большей степенью достоверности отражать изменения тканевого состава тела. У детей же с хроническими заболеваниями, и/или с метаболическими нарушениями, и/или в онкопедиатрии чувствительность индекса массы тела как показателя нутритивного статуса значительно ниже и изменчива. Это происходит из-за отклонений от «нормального» состава тела. В итоге дефицит безжировой массы тела может сопровождаться избытком жировой массы. Саркопения, имеющая негативные последствия для организма ребенка, может маскироваться ожирением. Поэтому такое состояние - саркопеническое ожирение - являет собой огромную проблему. С одной стороны, за счет сосуществования двух нутритивных нарушений у одного пациента. А с другой - за счет недооценки в педиатрической практике. Последняя имеет причину в частом понимании массы тела ребенка как безоговорочного и самостоятельного показателя. Это может нести драматические последствия для развивающегося и растущего организма ребенка. Поэтому потеря веса у ребенка с ожирением еще не означает однозначно положительную динамику.

Weight, BMI and its changes with age are one of the key indicators in pediatrics. The values of these indicators are the main parameters for assessing nutritional status (NS) and defining nutritional disorders - obesity and protein-energy malnutrition. At the same time, body weight and its changes only conditionally reflect the mass of fat and the amount of fat-free mass (especially the compartment of skeletal muscles). In the healthy population (in which the relevant references had been obtained), the changes of BMI can significantly reflect the changes of body composition. In children with chronic diseases (and/or with metabolic disorders, and/ or in oncopediatrics) the sensitivity of BMI as an indicator of NS is significantly lower and variable. This is due to deviations from the “normal” body composition existing in these patients. As a result, a deficit of fat-free mass can be accompanied by an excess of fat mass. Sarcopenia, which has negative consequences for the child, can be masked by obesity. Therefore, this condition, sar-copenic obesity, represents a huge problem. On the one hand, due to the coexistence of two nutritional disorders in one patient. On the other hand, due to underestimation in pediatrics. The latter is the consequence of frequent understanding of the child’s body weight as an unconditional and independent indicator. This can have dramatic consequences for the development and growth of the child. Therefore, weight loss in an obese child does not yet mean positive dynamics.

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The authors declare that there are no conflicts of interest present.