Metabolic Syndrome in Children
- An epidemic of childhood obesity (often denied by the parents) has resulted in a dramatic rise in metabolic syndrome (MS) and diabetes, both precursors to heart disease. Pediatric MS is a strong predictor of adulthood MS, subclinical atherosclerosis (silent heart disease), and diabetes.1
- The prevalence of MS in children varies widely from 4% overall to as high as 30% in overweight US children.2, 3 Approximately one-third of obese children and one-half of severely obese children in the US have MS and are likely to become diabetic before 30 years of age.4, 5
- China is fast approaching the US with regard to pediatric obesity and MS with 10% of Chinese children being overweight and almost 7% obese. The prevalence of MS increases from 2% in normal weight children to 21% in overweight and 33% among obese children (Figure 057).6
- Obesity, especially abdominal obesity, and insulin resistance are directly related to the development of the MS and CVD risk in children and youth.7 MS and insulin resistance are closely related that the former may be an expression of the latter.
- Prediabetes and nonalcoholic fatty liver disease (NAFLD) are more common in children and adolescents with MS. Therefore children with MS should be evaluated for these 2 conditions.8
- Larger than average offspring of diabetic mothers as well as children exposed to maternal obesity are at significant risk of developing MS in childhood. Conversely higher offspring birth weight predicts the metabolic syndrome in mothers but not fathers.9 Given the increased obesity prevalence, these findings have implications for perpetuating the cycle of obesity, insulin resistance, and their consequences in subsequent generations.10
- Waist circumference (WC) in children (a surrogate for visceral adiposity) is a stronger predictor of onset of the MS in adulthood than all other measures of adiposity.7 Children initially in the top 25% for WC had at least five times the risk of MS as young adults compared to those in bottom 25%. 11
- Even if the child had a pretty low WC in childhood, a huge increase in WC is going to increase the risk of MS substantially. Each 10-cm increment in childhood WC was associated with a doubling of the risk of MS in adulthood.11, 12
- The dramatic increase in prevalence of childhood obesity, especially the WC, throughout the world could result in a dangerous increase in MS, diabetes, and CVD occurring in early adulthood.11, 12 When diabetes begins in childhood, the risk for accelerated atherosclerosis is increased beyond that seen in those who develop this diagnosis as adults. 13
Diagnosis of Metabolic Syndrome in Children
- MS in adults is defined as the clustering of interrelated cardiovascular risk factors including obesity, insulin resistance, inflammation and others. In children and adolescents, there is no universally accepted definition of the MS, although several definitions have been proposed, using criteria adapted from adult standards using gender and age-dependent normal values. The International Diabetes Federation (IDF) criteria for defining MS in children is given below.14
|
The IDF criteria for MS in children |
|
| 6-9 years | Obesity (defined as >90th percentile of WC, followed by further measurements as indicated by family history |
| 10-15 years | Obesity (defined as WC>90th percentile), followed by the adult criteria for triglycerides, HDL-C, blood pressure, and glucose. |
| > 16 years | Same criteria as adults |
| WC= waist circumference | |
- Obesity, weight gain and poor fitness are important risk factors for MS.15 Comprehensive behavioral modification in overweight children reduces body weight, improves body composition, and positively modifies many of the components of the MS within 3 months, and these effects are maintained if the behavior modification is continued.16 17 18In fact, there is no specific treatment for MS in children, other than reducing obesity, increasing physical activity, and treating the various components of the MS (hypertension or hyperlipidemia).
- There is growing evidence that efforts to prevent weight gain must begin in early life. Furthermore, low-birth weight followed by rapid excess weight gain in childhood and adolescence increase the risk of developing MS, diabetes and CVD.19 In small studies, metformin has been used effectively in adolescents with diabetes to decrease BMI and improve glucose tolerance.20, 21
Sources
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3. Duncan GE, Li SM, Zhou XH. Prevalence and trends of a metabolic syndrome phenotype among u.s. Adolescents, 1999-2000. Diabetes Care. Oct 2004;27(10):2438-2443.
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