In Summary

Once seen only among adults, diseases such as Type 2 diabetes are being diagnosed in children. The culprits? Unhealthy diets and growing waistlines, JOAN SALMON talks to health experts.

When she was two, Maxine Kateregga, now 15 fell ill and started vomiting, feeling constantly thirsty and sleepy. “I also frequently asked my sister for sugary foods and drinks. Being sick and the last born, I guess she gave them to me out of sympathy,” she recollects. Little did her sister know that Kateregga had diabetes.
On her first day in Primary Seven, while waiting for the bus at home, she fainted. She was taken to hospital and after several tests, the doctor said she had ketones and her sugar levels were extremely high. “I was in that state for a week and was disoriented when I finally woke up. I could not understand why I was in hospital,” Kateregga says adding that this is when the doctors told the family that she had diabetes.
Her life has changed drastically since then, “I never had to worry about my blood sugar but now I take medicine twice daily to control it. I previously ate whatever I wanted but was advised to stop taking sweet things such as candy, chocolate as well as soda,” she says. Katerega was also advised to lose weight lest her condition worsens.
“Although I was not a workout enthusiast, I now make time to either walk or exercise. I have also started playing lawn tennis and I have lost weight. I also eat smaller food portions thrice a day with lots of fruits and vegetables,” she says. Kateregga adds that with time, she was told that she has Type 2 diabetes and all the changes, though difficult to adopt have helped her manage the disease. She is thankful for her family’s support because she says she could have cheated or given up but they have been there to the point of adopting healthier lifestyles too.
Although, for the most part, diseases among childhood are similar to those in adults, Dr Sabrina Bakeera-Kitaka, a paediatric and adolescent health specialist at the Department of Paediatrics, Makerere University College of Health Sciences, says there are several differences. For example, certain health issues such as precocious puberty, acute nephritis (inflammation of the kidney) are unique and common among children yet infrequent in adults.

Dr Kitaka also points out that some ailments such as gout, and hypertension (high blood pressure of unknown cause) are common in adults and not in children. That said, infectious disorders remain the leading cause of death. Some of these include measles, chicken pox and mumps.
Dr Boniface Ssegujja, a paediatrician at Naalya Children’s Clinic, adds that the prevalence of most of these has been lowered by immunisation. However, society is now grappling with diseases that were predominantly found in adults but now affect children.

Type 2 diabetes
This is when one’s body cannot control blood sugar because either the body is not producing enough insulin or its sensitivity to insulin is low hence being insulin resistant. Typically, children suffer from Type 1 diabetes because their bodies are not producing insulin. On the other hand, Type 2 diabetes is where one’s body cannot control blood sugar because either the body is not producing enough insulin or is insulin resistant and was common among adults.

However, lately, several children are suffering from this type of diabetes. Dr Ssegujja says one of the leading causes of Type 2 diabetes is obesity, “Many are severely overweight and one in four obese children will have Type 2 diabetes. This is because obesity increases the chances of a child getting Type 2 diabetes four fold,” he says.


He adds that some of the factors that lead to obesity in children is poor diet where children are fed on high sugar foods such as ice-cream and pastries which are loaded with calories. “While these calories are meant to give them energy, in excess, they are stored by the body leading to insulin resistance,” Dr Ssegujja explains.

Most children also live sedentary lifestyles where they are drawn to video games and watching TV. However, according the World health Organisation (WHO), children and young people (5-17 years) must engage in physical activity such sports, chores, recreation, physical education, or planned exercise, in the context of family, school, and community activities. In order to improve cardiorespiratory and muscular fitness, bone health, and cardiovascular and metabolic health biomarkers, WHO recommends that children accumulate at least 60 minutes of moderate- to vigorous-intensity physical activity daily.
The organisation suggests that most of the daily physical activity should be aerobic while vigorous-intensity activities should be incorporated to strengthen muscle and bone, at least three times per week.

Fatty liver
According to chicagotribune.com, an online portal, more children are being diagnosed with hyperlipidaemia, or high fat levels in the blood because unlike previously, doctors now are testing children for this. It is, therefore, recommended that children also go for wellness visits so that a lipid profile is done to get a cholesterol profile.
When a child (or adult) eats excessive amounts of calories, particularly from refined carbohydrates, the blood sugar rises. The liver attempts to reduce the blood-sugar levels by taking sugar up from the bloodstream. This extra sugar is converted to glycogen and stored.
However, when the storage capacity of the liver is full, the extra sugar the liver takes out of the blood is converted to fatty acid and triglycerides. The fatty acid tends to accumulate in the liver, causing fatty liver disease, also called non-alcoholic steatohepatitis, or NASH, while the triglycerides are deposited into the blood, raising the blood triglyceride level. Fatty liver disease can lead to depleted liver function, and the consequence of high triglycerides is cardiovascular disease, among other things.

Arthritis
Everyone’s joints have cartilage that ensures smooth movement. However, when there is excess pressure on one’s bone it gets worn out due to wear and tear. Therefore, arthritis is due to the inflammation of one’s joints. Among children, Dr Ssegujja pegs the disease to excess weight, beyond what their bones can support. Nonetheless, arthritis is also familial so a child from a family where some people have had arthritis is also at risk of getting it. This type of arthritis is called rheumatoid arthritis.

Osteoporosis
While there is importance attached to what children eat, even what they do not eat is very important. Therefore, eating disorders among very young children are a contributing factor to the increased number of children with osteoporosis, according to Dr Kitaka. Osteoporosis means permeable bones and is a bone disease that occurs when the body either makes too little bone, loses too much bone, or both. With time, the bones become weak. In minor cases, a fall could result into broken bones but in severe cases, even a minor bump or sneeze could cause bone breakage. Dr Kitaka says if a child is not getting enough calcium or dairy servings a day coupled with vitamin D, they may fail to gain the required amount of bone they ought to in their early years. In the early years, children ought to be adding 40 to 60 per cent of bone mass and short of that, their risk of fractures heightens.

Prevention
Prevention is better than cure, so, parents and guardians need to ensure lifestyle changes among their children. For example, these children ought to live a more active rather than sedentary lifestyle to ward off obesity. Besides that, a balanced diet with lots of vegetables and fruits and less sugary foods is ideal.
Dr Boniface Ssegujja, a paediatrician at Naalya Children’s Clinic, also advises against excess starch such as pasta, potatoes and white bread, in favour of whole-grain foods and flour, “The key to avoiding unhealthy weight gain is moderation of the food eaten, even for the healthiest food.”

Dealing with the aiLments
Dr Boniface Ssegujja, a paediatrician at Naalya Children’s Clinic, says previously, most killers of children were infectious diseases but with immunisation, they are now being prevented. “So with these greatly reduced in number, lifestyle diseases are seemingly in the limelight,” he explains. He adds that routine medical checks as well as those done before children go to school have revealed the presence of such diseases among children.
It is, therefore, without asking that early diagnosis of such diseases is important, more so for those that have them within their lineage. In so doing, treatment is accessed earlier which avoids excess damage to the child. More to that, the child’s health is bettered and life prolonged.