Characteristics of autonomic status and school anxiety in schoolchildren with increased body mass index

BACKGROUND: In the Russian Federation, the incidence of obesity continues to grow among the child population. Vegetative imbalance and chronic stress play an important role in the pathogenesis of obesity and related health disorders. Timely identification of disorders of psycho-vegetative disorders and their correction in overweight children require an integrated approach of medical and pedagogical workers.

AIM: To reveal the features of the vegetative status, the level of school anxiety in students with an increased body mass index.

MATERIALS AND METHODS: Children with different body mass index (BMI) underwent a comparative analysis of the mean values and structure of revealed violations of cardiointervalography (heart rate variability, HRV) parameters, laboratory test parameters (plasma antioxidant activity, plasma malondialdehyde, triglycerides, total cholesterol, cortisol, magnesium and serotonin) and test parameters School Anxiety Scale of Phillips.

RESULTS: The prevalence of overweight was 23.1%. The observation group consisted of 47 schoolchildren with a body mass index (BMI) +1–2 SD the comparison group consisted of 156 children with a normal BMI at the age of 10–15 years. The groups were comparable in terms of sex and age (p=0.629–0.771). Analysis of background HVR indices revealed a decrease in the values of parameters characterizing the activity of the parasympathetic division of the autonomic nervous system (ANS), with a simultaneous increase in the indicators of the sympathetic division of the ANS in the observation group relative to the comparison group (p=0.001–0.023); similar results were obtained during the orthostatic test. The cumulative assessment of CIG indicates a lower activity of the parasympathetic division in the regulation of the state of rest and a greater activity of the sympathetic division of the ANS in response to a stress factor in children with an increased BMI value. The children of the observation group showed higher levels of malondialdehyde (p = 0.041), triglycerides (p<0.001) and cortisol (p=0.093) with lower values of magnesium and serotonin (p=0.074–0.076). The analysis of the level of school anxiety showed that in children of the observation group the average level and frequency of the prevalence of high values of the indicator of general anxiety are higher in 1.3 and 2.5 (p=0.005), fear of self-expression — in 1.3 and 1.8 (p=0.080–0.086), fear of the situation of knowledge testing — by 1.5 (р=0.002) and 2.1 (p<0.001), the level of general anxiety — by 1.2 (р=0.090) and 2.3 times (p=0.036) relative to the comparison group. In the course of the mathematical analysis, the results were obtained indicating the relationship between the parameters of the vegetative and psychological status.

CONCLUSION: The problem of excess nutrition remains an urgent issue of modern health care. Excess body weight is accompanied by the activation of the sympathoadrenal system with an increase in the level of school anxiety and all together forms a vicious circle. Excessive nutrition in school-age children requires an integrated approach of specialists in the medical and psychological-pedagogical sphere.

1. Statistical materials. The incidence of the child population of Russia (0–14 years) in 2019. Part V, part VI. Moscow: 2020. (In Russ.).

2. Golubev NA, Ogryzko EV, Shelepova EA, Zalevskaya OV. Morbidity of children by diseases of the endocrine system, itania’s diseases substance exchange within the national project of «health» of the Russian Federation. Current problems of health care and medical statistics. 2019;3:376-389 (In Russ.).

3. Sharapov AN. Neuroendocrine aspects of stress and behavioral disorders in adolescents. New research. 2017;4(53):15-33. (In Russ.).

4. Curtis BM, O’Keefe JH. Autonomic Tone as a Cardiovascular Risk Factor: The Dangers of Chronic Fight or Flight. Mayo Clin Proc. 2002;77(1):45-54. doi: https://doi.org/10.4065/77.1.45

5. Krasnoperova OI, Smirnova EN, Chistousova GV, et al. Determinants of obesity in children and adolescents. Obesity and metabolism. 2013;10(1):18-21. (In Russ.). doi: https://doi.org/10.14341/2071-8713-5066

6. Mazurina NV, Leskova IV, Troshina EA, et al. Obesity and stress: endocrine and social aspects of the problem in the modern russian society. Obesity and metabolism. 2019;16(4):18-24. (In Russ.). doi: https://doi.org/10.14341/omet9975

7. Pervanidou P, Chrousos GP. Stress and obesity/metabolic syndrome in childhood and adolescence. Int J Pediatr Obes. 2011;6(1):21-28. doi: https://doi.org/10.3109/17477166.2011.615996

8. van der Valk ES, Savas M, van Rossum EFC. Stress and Obesity: Are There More Susceptible Individuals? Curr Obes Rep. 2018;7(2):193-203. doi: https://doi.org/10.1007/s13679-018-0306-y

9. Lindberg L, Hagman E, Danielsson P, et al. Anxiety and depression in children and adolescents with obesity: a nationwide study in Sweden. BMC Med. 2020;18(1):30. doi: https://doi.org/10.1186/s12916-020-1498-z

10. Prakhin ЕI, Gurov VА, Ponomareva EV. Psychosomatic characteristics of children according to the results of medical pedagogical monitoring of health-forming activities in schools. Hygiene and Sanitation. 2018;97(7):635-641. (In Russ.). doi: https://doi.org/10.18821/0016-9900-2018-97-7-635-641

11. Endocrinology: national leadership. Ed. by Dedov II, Melnichenko GA. Moscow: GEOTAR-Media; 2019. 1112 p. (In Russ.).

12. Russian Association of Endocrinologists. Methodical recommendations «Assessment of the physical development of children and adolescents». Moscow; 2017. 98 p. (In Russ.).

13. Russian medical society in arterial hypertension. Association of children’s cardiologists of Russia. Clinical recommendations «Diagnostics, treatment and prevention of arterial hypertension in children and adolescents». Moscow; 2020. 36 p. (In Russ.).

14. Baevskiy RM, Ivanov GG, Chireykin LV, et al. Analysis of heart rate variability when using various electrocardiographic systems (methodological recommendations). Journal of Arrhythmology. 2001;24:65-86. (In Russ.).

15. Mikhaylov VM. Heart Rate Variability: The Experience of the Practical Application of the Method. Ivanovo; 2002. (In Russ.).

16. Raigorodsky DYa. Practical psychodiagnostics. Techniques and tests. Tutorial. Samara: Publishing House «BAHRAKH-M»; 2001. (In Russ.).

17. Narkevich AN, Vinogradov KA. Methods for determining the minimum required sample size in medical research. Social aspects of population health. 2019;65(6):10. (In Russ.). Av. at: http://vestnik.mednet.ru/content/view/1123/30/lang,ru/

18. Namazova-Baranova LS, Yeletskaya KA, Kaytukova EV, Маkarova SG. Evaluation of the Physical Development of Children of Secondary School Age: аn Analysis of the Results of a Cross-Sectional Study. Pediatric pharmacology. 2018;15(4):333-342. (In Russ.). doi: https://doi.org/10.15690/pf.v15i4.1948

19. Bolotova NV, Averyanov AP, Zakharova NB, et al. The state of lipid peroxidation and antioxidant protection in obese children. Journal «Pediatria» named after G.N. Speransky. 2006; 85(4):11-14. (In Russ.).

20. Gromova OA, Fedotova LE, Grishina TR, et al. The role of magnesium in the formation of metabolic syndrome, correction of overweight and obesity in children and adolescents. Journal «Pediatria» named after G.N. Speransky. 2014;93(2):123-133. (In Russ.).

21. Zagrebaeva OYu. The role of serotonergic system in the developing of obesity. Meditsinskie novosti. 2016;259(4):15-17. (In Russ.).

22. Shirvanova FV, Karimova DN. Features of the manifestation of school anxiety. St. Petersburg educational bulletin. 2019;1(29):74-79. (In Russ.).

23. Garifulina LM, Kholmuradova ZE, Lim MV, Lim VI. Psychological status and eating behavior in obese children. Science and educationissues. 2020;110(26):45-50. (In Russ.).

24. Adamovskaya ON, Dogadkina SB, Ermakova IV, et al. Characteristics of the reaction of the autonomic nervous, cardiovascular and endocrine systems to cognitive load in primary schoolchildren with different levels of anxiety and neuroticism. Science for education today. 2021;11(1):151-173. (In Russ.). doi: https://doi.org/10.15293/2658-6762.2101.09

25. Garanina ZhG, Rusyaykina NS. Psychological features of school anxiety in teenagers. Ogarev-Online. 2020;11(148):2. (In Russ.). Av. at: http://journal.mrsu.ru/arts/psixologicheskie-osobennosti-shkolnoj-trevozhnosti-podrostkov. Link active on 25.09.2021.