Method for predicting development of idiopathic precocious development in obese girls under 9 years of age

Abstract

FIELD: pediatrics; endocrinology.SUBSTANCE: invention can be used to predict the development of idiopathic precocious development (IPD) in obese girls under 9 years of age. The method includes determining the patient's height and BMI. Then, bioimpedance analysis is performed and the basal metabolic rate (BM), percentage of adipose tissue, active cellular mass (ACM) and skeletal muscle mass (SMM), and the proportion of SMM are determined. In addition, X-rays of the hands are performed and bone age is determined using the Greulich atlas. Furthermore, with normal values of BM, percentage of body fat and ACM, elevated values of BMI, SMM, proportion of SMM, the presence of tall stature and bone age ahead of biological age by 1-3 years, the development of IPD is predicted in girls with obesity up to 9 years of age.EFFECT: method is simple, accessible, and allows for the effective prediction of the development of IPD in obese girls.1 cl, 2 ex

Description

[0001] The invention relates to medicine, in particular to pediatrics, endocrinology, gynecology, and can be used in predicting the development of idiopathic precocious puberty (iPPP) in obese girls under 9 years of age.

[0002] A method is known for predicting precocious puberty in children by molecular genetic analysis for the presence of MKRN3, DLK1 genes, epigenetic modifications in which are considered as the cause of precocious puberty [Genetics and epigenetics of precocious puberty / E.A. Sazhenova, S.A. Vasiliev, L.V. Rychkova [et al.] / / Genetics. - 2023. - Vol. 59, No. 12. - P. 1360-1371].

[0003] The disadvantages of this method include both the time and labor-intensive nature of molecular genetic testing, which requires complex and expensive equipment. Furthermore, this method does not take into account the possibility of developing an idiopathic form of precocious puberty.

[0004] The closest method to the claimed one is for predicting the risk of developing obesity in childhood. Risk factors are identified from the patient's medical history: a positive heredity for arterial hypertension, obesity, metabolic disorders (obesity and diabetes mellitus in first- and second-degree relatives), abnormal pregnancy (preeclampsia), low physical activity, carriage of the E4 isoform of the APOE gene, and carriage of the G allele of the PPARG gene. The risk of developing obesity is then determined using the formula (RU Patent No. 2018109042).

[0005] A disadvantage of the prototype method is that it requires expensive, time-consuming molecular genetic testing to determine carriage of the E4 isoform of the APOE gene and carriage of the G allele of the PPARG gene. Furthermore, it is not always possible to collect an informative medical history.

[0006] The objective of the present invention is to simplify and accelerate the prediction of the development of iPPR in girls with obesity.

[0007] The technical result of the set task is achieved by the fact that in the method for predicting the development of the idiopathic form of precocious puberty (iPPP) in girls with obesity up to 9 years old, the patient's height and BMI are determined, bioimpedancemetry is carried out and the value of the basal metabolism (BM), the percentage of adipose tissue, active cellular mass (ACM), skeletal muscle mass (SMM), the proportion of SMM are determined, radiography of the hands is carried out and the bone age is determined according to the Greulich atlas, then, with standard indicators of BM, the percentage of adipose tissue and ACM, increased values ​​​​of BMI, SMM, the proportion of SMM, the presence of tall stature and an advancement of the biological bone age by 1-3 years, the development of iPPP is predicted.

[0008] With an increase in androgen production, an increase in the volume of muscle fibers is observed, correspondingly, an intensive increase in muscle mass and, according to bioimpedance analysis, an increase in SMM and the proportion of SMM.

[0009] This is due to the fact that excess body mass, specifically fat cells, increases androgen production, which stimulates an increase in muscle fiber volume and, consequently, an intense increase in muscle mass, which is recorded as SMM by bioimpedance analysis. Therefore, the main weight gain occurs due to an increase in SMM, not adipose tissue. This is associated with normal fat mass values.

[0010] The method is as follows: BMI is calculated based on the patient's weight and height, and bioimpedance analysis is performed to assess body composition. An increase in BMI by 0.1 kg (>14.3 kg) increases the risk of iPPD by 1.2 times. A decrease in fat mass by 1% (>17 kg) increases the risk of iPPD by 1.75 times. A simultaneous decrease in fat mass (<17 kg) and an increase in BMI (>14.3 kg) increases the risk by 2.95 times.

[0011] Example 1. Girl V., 7 years old. Came to the St. Petersburg State Pediatric Medical University for examination on June 2, 2022, complaining of excess weight and breast enlargement: height 124 cm, weight 32.8 kg, BMI 21.33 (+2.14). According to a hand X-ray: 2 years ahead of biological age. According to bioimpedance analysis: SMM (kg) - 14.1, SMM share (%) - 45.3, basal metabolic rate - 1200, active cell mass - 18.5, fat mass (kg) - 17.9. Thus, with elevated BMI values, normal basal metabolic rate, body fat percentage, and ACM, increased SMM and SMM proportion, above-average height, and a bone age two years ahead of the chronological age, a high risk prognosis for developing iPPB was made. One year after the initial consultation (November 13, 2023), the girl remained at grade 1 obesity, and the prognosis was confirmed.

[0012] Example 2. Girl O., 7 years old. Came to the St. Petersburg State Pediatric Medical University for examination with complaints of excess weight on March 20, 2022. Height = 121 cm, body weight = 48 kg. BMI = 32.8 (+3.66). According to the hand X-ray, the bone age corresponds to the biological one. According to bioimpedance analysis: SMM (kg) - 8.3; SMM share (%) - 35; basal metabolic rate - 1024, active cell mass - 16.3, fat mass (kg) - 23.5. According to the X-ray, the bone age corresponds to the passport one. Thus, with elevated BMI and fat mass values ​​​​according to bioimpedance analysis, while the girl has normal values ​​​​of SMM, dSMM, basal metabolism and active cell mass, a low risk of developing iPPR is predicted. A year after the visit, the girl still had grade 3 obesity and the prognosis for the low risk of developing iPPR was confirmed.

[0013] The proposed method is a quick, simple, and informative test. It allows for the effective prediction of the development of iPPR in obese girls. The method is accessible to physicians of any specialty and does not require expensive equipment or extensive laboratory and instrumental testing.

Claims

A method for predicting the development of idiopathic precocious puberty (iPPP) in obese girls under 9 years of age, characterized in that the patient's height and BMI are determined, bioimpedance analysis is performed, and the basal metabolic rate (BM), percentage of adipose tissue, active cellular mass (ACM), skeletal muscle mass (SMM), and proportion of SMM are determined, hand radiography is performed, and bone age is determined using the Greulich atlas. Then, with standard values ​​of BM, percentage of adipose tissue, and ACM, elevated values ​​of BMI, SMM, and proportion of SMM, the presence of tall stature, and bone age that is 1-3 years ahead of biological age, the development of iPPP is predicted.