White, pink, or purple streaks on the skin of the abdomen

Introduction Pediatric obesity usually shows a history of family obesity, good intelligence, fullness of subcutaneous fat, even distribution, body fat accumulation is prominent in the breast, abdomen, buttocks and shoulders, white, pink or purple lines appear on the abdomen skin.

Cause

(1) Causes of the disease

Simple obesity is caused by a combination of genetic and environmental factors. Genetic factors play a small role, and environmental factors play an important role. Family lifestyles (family aggregation) and personal behavior patterns are the main risk factors for environmental factors.

1. Genetic and environmental factors

Obese people have a certain family tendency. Parents of obese children often show obesity symptoms, and about one third of them are related to parental obesity. If both parents exceed normal weight, 2/3 of the offspring are obese. In addition, diseases with genetic predisposition are also common obesity symptoms, such as hepatic glycogen accumulation.

2. Eat more

Children develop more food from childhood, energy intake is too much, consumption is reduced, especially accustomed to eating greasy food, obesity can occur in a long time.

(1) Unreasonable feeding: If the solid food is added too early (1 to 2 months after birth) and the weaning is too early, it is a feeding mode that promotes simple obesity in infants and young children. In recent years, the increasing incidence of childhood obesity has been closely related to the unreasonable diet and excessive nutrient intake given by parents. The amount of staple food, meat is high, and the amount of fruits and vegetables is low. The survey of nutrition and health of Chinese residents shows that the dietary structure of urban residents in China is not reasonable. Excessive intake of meat and oil, low intake of cereals. In 2002, the daily oil intake per person of urban residents increased from 37g in 1992 to 44g, and the fat supply ratio reached 35%, exceeding the 30% ceiling recommended by the World Health Organization.

(2) Excessive appetite: excessive appetite and fast eating are a feeding feature of obese children.

3. Less movement

The lack of appropriate physical exercise in children, coupled with the factors of eating more, the reduction of activities and the imbalance between intake and discharge, are more likely to form obesity. Obese children often do not like activities, the more inactive they become fatter, forming a vicious circle.

4. Increase in the number of fat cells and hypertrophy

In the critical period of adipose tissue cell proliferation and cell expansion (late pregnancy, early postpartum and adolescence), poor lifestyle and behavioral characteristics contribute to the formation of simple obesity as a risk factor.

At the first 3 months of pregnancy, the cell level is malnourished. Overdose 3 months after pregnancy, overdose, excessive weight gain during pregnancy, and excessive speed. It is a risk factor for pregnancy during obesity. The increasing number of fat cells is related to the increase of age and the degree of fat accumulation. People who are obese from childhood are obviously obese, and the number of fat cells in the body is obviously increased. However, the slow and persistent obesity has the fat of fat cells. With the increase of fat cells, an obese person's systemic fat cells can be more than three times more abundant than normal human fat cells.

5. Love

Parental motivational factors play an important role in overfeeding obese children. Love is a factor that cannot be ignored. The traditional social patriarchal social customs and some traditional cultural concepts (over-constrained children's activities, etc.) are a non-underestimable motivation factor for the high detection rate of severe obesity among boys. Low-income families are an important source of persistent obesity in children for some time to come.

(two) pathogenesis

Various intrauterine factors have a greater impact on the size of fetal fat cells, and rarely affect the number of fetal fat cells. The amount of fat in a newborn depends on the size of the cells rather than the amount. Further development of adipose tissue in the late stage is mainly due to an increase in the number of adipocytes. 30 weeks of pregnancy - 18 months after birth is the first active period of adipose tissue development. At this time, fat cells are most active in response to various external factors. Adipose tissue grows rapidly 6 to 8 months after birth, and is relatively stable during 8 to 15 months after birth. It increases little from the later stage to the pre-school period, and there is almost no increase in 3 to 6 years old. The girl begins to accumulate fat again during puberty. Starting from the age of 12, it is called the second active period of adipose tissue development, which may be due to the effect of estrogen on fat cells.

When fat cells are increased to a certain extent (currently estimated when the weight of adipose tissue exceeds 25% of body weight), it may stimulate the division of fat cells, resulting in a sharp increase in the number of fat cells and obesity. In the late trimester, early postpartum, and puberty are critical periods of proliferation and cell expansion of adipose tissue cells. During this critical period, the above lifestyle and behavioral characteristics contributed to the formation of simple obesity as a risk factor.

an examination

Related inspection

Abdominal vascular ultrasound examination of laparoscopic ascites

Clinical manifestation

1. General performance

Often family history of obesity; good intelligence, subcutaneous fat plump, even distribution, body fat accumulation in the milk, abdomen, buttocks and shoulders is significant, abdominal skin appears white, pink or purple lines; limbs obesity, especially The arms and hips are noticeable. No endocrine disorders and metabolic disorders; often fatigue, shortness of breath or leg pain during activity, awkward movements, knee valgus or flat feet.

2. Excellent appetite

Children's appetite is excellent, appetite is strong, food intake is much higher than that of ordinary children, and they like to eat starchy, sweet and high-fat foods, and do not like to eat light food such as vegetables.

3. The weight/body fat exceeds the threshold value of the reference population value

Physical growth and development, but the bones are normal or older than children of the same age, the body weight exceeds the same sex, the average height of normal height is more than 20%, or the body weight exceeds the standard deviation of the average body weight of the normal body 2 standard deviation (M 2SD); or body mass index More than 23 people.

4. Sexual development

Sexual development is generally early or normal. Because the boy has too much fat in the thigh and perineum, the penis can be hidden in the adipose tissue, which is small and actually falls within the normal range.

5. Aerobic capacity damage

Obesity children often have no other discomfort in clinical, but obvious obesity aerobic capacity damage, maximum tolerance time, maximum oxygen consumption is significantly reduced; maximum heart rate, minute ventilation, carbon dioxide production, work volume is significantly increased; anaerobic threshold The indicators are low, showing the phenomenon of no-oxygen threshold left shift. Obese children have heartbeat, shortness of breath, tired external appearance and behavioral habits that do not like to participate in physical activity.

Some obesity can be complicated by high blood pressure. Extremely obese children can be restricted by thoracic and diaphragmatic activities, making breathing fast, alveolar ventilation reduced, hypoxemia, cyanosis, concurrent red blood cell enlargement, heart enlargement and congestive Heart failure, the so-called pulmonary dyspnea syndrome (pickwickian syndrome), can be life-threatening.

6. Psychological depression and injury

Personality, temperament, personality, potential development, and future development of ability and interpersonal relationships have a negative impact. The suppression of one's body shape is large, and the self-evaluation is poor. Interpersonal communication is vulnerable to degeneration, nicknames, and even discrimination. Heavy mental stress and psychological conflicts, loss of self-confidence and becoming lonely. Adolescents are suffering from obesity or eager to lose weight, causing many intense psychological conflicts, and some even commit suicide.

an examination

Obesity can be judged from the appearance. The history of nutrition has excessive eating, overeating/biased high fever cards, and high fat foods. Milk feeding, premature feeding of solid food, etc. Behavioral habits are more food, less physical activity, and strong possessiveness. Clinical signs and symptoms have progressive weight gain, behavioral bias and general body fat increase.

1. Standard height and weight method

(1) The formula for calculating the standard weight:

13~12 months baby weight = (month age +9)/2

22 to 6 years old weight = age × 2 + 8

37 to 12 years old weight = (age × 7-5) / 2

(2) Indexing: Generally, children with more than 20% of the same sex, the average height of normal height, or 2 standard deviations (M+2SD) of the average weight of healthy children can diagnose obesity; more than 20% ~29%, or more than 2 to 3 standard deviations for mild obesity, more than 30% to 39% or more than 3 to 4 standard deviations for moderate obesity, more than 40% to 59% or greater than 4 standard deviations For severe obesity. More than 60% are extremely obese.

(3) Height and weight: Foreign Broca formula: standard weight = height (cm)-100, China's commonly used Broca improved:

1 male adult weight = height (cm) - 105; or Pingtian formula: [height (cm) - 100] × 0.9.

2 female adult weight = height (cm) - 105; or equal to [height (cm) - 100] × 0.85.

2. Body mass index (BMI)

WHO published in 1997: normal BMI is 18.5-24.9; 25 overweight; 2529.9 is pre-obesity; 30.034.9 is I degree obesity (moderate); 35.039.9 is II degree obesity (severe); 40 It is III degree obesity (very severe).

In 2000, the International Obesity Task Force proposed that the normal BMI range for Asian adults was 18.5-22.9. At present, the diagnosis of obesity is mostly based on the method of BMI, which is a relatively accurate and widely accepted and accepted diagnostic method.

Obesity measurement: (measured body weight - height standard weight) / height standard weight × 100%. Obesity is 20% to 29%, mild, 30% to 50% are moderate, and >50% are severe.

3. Skinfold thickness

The thickness of the pleats at the biceps, triceps, and subscapular sites was measured with a caliper, normal 20 to 40 mm, >P85 was obese, and >P95 was highly obese. Limitations have been gradually reduced.

4. Waist circumference

5. Waist-to-hip ratio (WHR)

The University of Glasgow and a university in the Netherlands surveyed 5,800 men and 7,000 women aged 0-59. They divided the volunteers into three groups: small waist group: men's waist 102cm, women > 88cm. The diameter (waist circumference) of the midpoint between the lower edge of the rib and the anterior superior iliac spine and the diameter of the femur trochanter (hip circumference) were measured, and the ratio was calculated. The results of the survey showed that the general health status of the small waist and middle waist group was better. The proportion of hyperlipidemia and hypertension patients in the large waist group was 2 to 4 times higher than that of the middle and small waist group, and the proportion of diabetic patients was 4.3 times higher. The heart disease patients are 3.5 times more. Therefore, people with large waists should pay attention to their health.

Differential diagnosis

Differential diagnosis of white, pink or purple lines on the abdomen skin:

1. Skin pattern: Since the volume of bones and muscles or fat increases too fast, exceeding the prolonged speed of the skin, the elastic fibers of the dermis are pulled off to form such a pattern.

2, skin purple lines: skin purple lines refers to the skin has purple, silk, and different sizes of skin, often distributed in the lateral side of the hip, the inner and outer thighs, underarms, armpits and lower abdomen, mostly high Characteristic changes associated with cortisolemia.

3, obesity: As the volume of bones and muscles or fat increases too fast, beyond the prolonged speed of the skin, the elastic fibers of the dermis are pulled off to form this pattern. People who are overweight can see this situation, and many people in development can appear even if they are not very fat. Even if the weight loss succeeded in restoring the original body shape, the growth pattern could not be eliminated. It began to be red, gradually darkened over time, and finally turned into white stripes. If you don't get fat any longer, you can become a narrow white stripe. If some drugs that increase skin elasticity and promote collagen growth during weight gain or during pregnancy may reduce or avoid growth lines to a certain extent, there is currently no good way to reinforce them. This situation has no effect on health, so there is no need for treatment.

diagnosis:

1. The body fat content increased significantly, and the body mass index was consistent with obesity. Anthropometric indicators such as waist circumference, hip circumference, large/calf circumference, arm circumference, and subcutaneous fat thickness are excessively increased.

2, laboratory examination: decreased aerobic capacity, decreased cardiopulmonary function, behavioral bias.

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