The state of carbohydrate metabolism in children with gallstone disease

Cholelithiasis (cholelithiasis) has become increasingly common in childhood. Currently, the features of the clinical course have been studied, the criteria for the diagnosis and prevention of cholelithiasis in children have been worked out. However, the features of metabolic disorders are still not studied, among which not the least role in the genesis of the formation of gallstones is played not only by the exchange of lipids, but also carbohydrates.

The main role in the regulation of carbohydrate metabolism is played by insulin. The process of production of insulin in the body in the blood serum fully reflects the concentration of C-peptide. The ratio between insulin and C-peptide is not always constant. It may shift in one direction or another against the background of diseases of the internal organs, including the GI tract.

The analysis for C-peptide and insulin allows you to identify not only hypo — or hyperglycemia, but also to determine insulin resistance, calculate the HOMA index and, accordingly, make a forecast for the development of dyslipidemia. In this regard, it was of interest to study the state of carbohydrate metabolism (glucose, insulin, C-peptide) in children with cholelithiasis.

The purpose of the study. To improve the early diagnosis of the complicated course of cholelithiasis by studying the features of carbohydrate metabolism for practicing therapeutic tactics and preventive measures.

Materials and methods. Under our supervision at the Department of Pediatrics infectious diseases, faculty of postgraduate education of physicians of the Russian national research medical University of Minzdrav of Russia (head.DEP. — M. D., Professor L. A. Kharitonov), city children’s polyclinic № 122 (chief doctor — PhD Bragin A. I.) were 140 children aged from birth to 15 years. Carbohydrate metabolism was studied in 140 children of the study group. Boys were 62, average age 10.0±4.9, girls were 78, average age 8.8±4.5. The parameters of serum glucose, insulin, and C-peptide were evaluated. The Homeostatic Model Assessment (NOMA) Insulin resistance Index will be calculated using the formula: NOMA-IR = (fasting plasma glucose (mmol/l) x fasting serum insulin (mkED / ml))/22.5 (Cuartero B., 2007). The physical development of children was evaluated according to WHO standards (2006) using the WHO Anthro Plus program (2009). We evaluated the values of the average values of body weight(MT), height (body length, DT) and body mass index (BMI) in five groups of newborns. The nutritional status was determined by the values of the Z-score value. Mathematical calculation of the results was carried out on a personal IBM — compatible computer using the statistical program Statistica 6.0.

Results. In children with GI, there was a tendency to increase the NOME index, both in frequency and in absolute terms, from the age of 8 and persisted until the age of 15(0,65±0,14;0,42±0,04; 4,89±1,12; 4,86±0,44; according to the age periods, p< 0.005).

Conclusion. Thus, disorders of carbohydrate metabolism in children with GI depend on the child’s age and body weight. In overweight children, an increase in C-peptide, insulin, and the resistance index was observed, which suggests that children with GI occurring against the background of overweight at the age of 8–11 and 12–15 years are threatened by the formation of metabolic syndrome, diabetes mellitus, and arterial hypertension.

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