Specifics of functional activity of the immune system, carbohydrate and lipid metabolism in overweight and obese children with biliary dysfunction
Authors: Hrabovska O. I. , Tatarchuk O. M. , Zavhorodnia N. Y. 
Published: December 2021

Objective — to evaluate functional activity of the immune system, carbohydrate and lipid metabolism in children with biliary dysfunction against the background of overweight and obesity.
Materials and methods. At the SI «Institute Gastroenterology of the National Academy of Medical Sciences of Ukraine» observations were performed on 108 children with the mean age 12.5 ± 2.51 years. Based on the results of investigation of motor and evacuator gallbladder (GB) function and body mass index, the pediatric patients were divided into three groups: group I included 52 overweight children with gallbladder hypofunction and obesity; group II consisted of 42 overweight children with normal gallbladder function and obesity; group III (comparison group) included 14 children with normal weight and biliary normokinesia. Investigations included anthropometric measurements and ultrasound imaging of the abdomen. ELISA was used to determine blood serum levels of insulin, interleukin‑6 (IL), IL‑10, tumour necrosis factor‑a (TNF‑a).
Results. The following augmentation of the median levels was established when compared with group III: IL‑6 in 2.2 times (p < 0.05) and TNF‑a in 4.5 times (p < 0.05) in patients of group I, levels of IL‑6 in 2.3 times (p < 0.05) and TNF‑a in 4.3 times (p < 0.05) in patients of group II. The IL‑10 level in group I patients was lower in 2.5 times than in group II patients (p < 0.05), and in 4.4 times vs group III patients (p < 0.05). The serum insulin levels in children of groups I and II were in 2.2 times (p < 0.05) and 1.5 times (p < 0.05) lower, and HOMA‑IR index in 2.3 times (p < 0.05) and in 1.8 times (p < 0.05), respectively, in comparison with group III patients. The following blood serum levels vs group III were established: triglycerides (TG) increased in group I in 1.4 times (p < 0.001) and in group II in 1.5 times (p < 0.001); low density lipoproteins (LDL) and very low density lipoproteins (VLDL) were increased both in I and II groups in 1.2 times, (p < 0.01) and 1.5 times, (p < 0.001), respectively. The atherogenic index (AI) raised in 1.6 times (p < 0.001) in group I patients and in 1.5 times (p < 0.05) in group II patients compared to group III, whereas high density lipoprotein (HDL) levels were decreased in the I and II groups in 1.2 times (p < 0.01) in comparison with group III patients.
Conclusions. Regardless of the gallbladder functional state in overweight and obese pediatric patients, the abnormalities of the immune system indices have been established and, consequently, carbohydrate metabolism disorders (increased levels of insulin and index HOMA‑IR). The lipid metabolism disturbances have been established in the overweight and obese children with gallbladder hypofunction (significant increase in the levels of TG, LDL, VLDL, AI and decreased HDL levels). Correlation analysis in the groups of overweight and obese children with gallbladder hypofunction showed the presence of significant relationships between biliary sludge and IL‑6, TNF‑a levels, gallbladder volume and insulin and glucose levels, gallbladder hypofunction and levels of total cholesterol, HDL, LDL and as well as between the gallbladder dimensions and atherogenic index.