Opinion statement
Metabolic syndrome is a constellation of interrelated risk factors of metabolic origin that often accompany obesity and consist of atherogenic dyslipidemia, elevated blood pressure, impaired glucose tolerance, a prothrombotic state, and a proinflammatory state. Using a modification of the criteria by the National Cholesterol Education Program Adult Treatment Panel III, metabolic syndrome in children and adolescents can be clinically diagnosed when three or more of the following are present: body mass index ≥ 2 z score, systolic or diastolic blood pressure greater than 95th percentile, triglyceride level greater than 95th percentile, and/or high-density lipoprotein cholesterol less than 5th percentile and impaired glucose tolerance (fasting glucose > 110 mg/dL [6.1 mmol/L]). The prevalence of the metabolic syndrome in adolescents has been shown to be 4% overall, but it is 30% to 50% in overweight adolescents. In the United States, 18% to 22% of children and adolescents are overweight; the prevalence of a metabolic syndrome phenotype among US adolescents has also been increasing significantly over the past decade. All of the features of metabolic syndrome are risk factors for atherosclerosis, and metabolic syndrome has been shown to constitute risk for atherosclerotic cardiovascular disease in adults. In children and adolescents with metabolic syndrome, biomarkers of an increased risk of adverse cardiovascular outcomes are already present. Therefore, there is need for prevention and treatment of metabolic syndrome in this population. The mainstay of the treatment is dietary intervention and promotion of active lifestyle to achieve and maintain optimum weight, normal blood pressure, and normal lipid profile for the height and age. The pharmaceutical intervention is usually not required and its long-term outcome has not been studied. There is need for large studies for the management and long-term outcomes of metabolic syndrome in children and adolescents if the future tides of cardiovascular and other associated complications of metabolic syndrome are to be turned around.
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References and Recommended Reading
Reaven GM: Banting lecture 1988. Role of insulin resistance in human disease. Diabetes 1998, 37:1595–1607.
ReFronzo RA, Ferrannini E: Insulin resistance. A multifaceted syndrome responsible for NDDM, obesity, hypertension, dyslipidemia and atherosclerotic cardiovascular disease. Diabetes Care 1991, 14:173–194.
National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III): Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report [no authors listed]. Circulation 2002, 106:3143–3421.
Grundy SM, Cleeman JI, Daniels SR, et al: Diagnosis and management of the metabolic syndrome. An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005, 112:2735–2752.
Grundy SM: Metabolic syndrome: connecting and reconciling cardiovascular and diabetes worlds. J Am Coll Cardiol 2006, 47:1093–1100.
Ridker PM, Buring JE, Cook NR, Rifai N: C-reactive protein, the metabolic syndrome, and the risk of incident cardiovascular events: an 8-year follow-up of 14,719 initially healthy American women. Circulation 2003, 107:391–397.
Ridker PM, Wilson PW, Grundy SM: Should C-reactive protein be added to metabolic syndrome and to assessment of global cardiovascular risk? Circulation 2004, 109:2818–2825.
Alberti KGMM, Zimmet P, Shaw J: The metabolic syndrome—a new worldwide definition. The IDF Epidemiology Task Force Consensus Group. Lancet 2005, 366:1059–1062.
Cook S, Weitzman M, Auinger P, et al: Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination Survey, 1988–1994. Arch Pediatr Adolesc Med 2003, 157:821–827. Important reference article for epidemiologic study on metabolic syndrome in children and adolescents.
Weiss R, Dziura J, Burgert TS, et al: Obesity and the metabolic syndrome in children adolescents. N Engl J Med 2004, 350:2362–2374. Important reference article and insight on the prevalence of metabolic syndrome in children and adolescents.
Ronnemaa T, Knip M, Lautala P, et al: Serum insulin and other cardiovascular risk indicators in children, adolescents and young adults. Ann Med 1991, 23:67–72.
Duncan GE, Li SM, Zhou X-H: Prevalence and trends of a metabolic syndrome phenotype among U.S. adolescents, 1999–2000. Diabetes Care 2004, 27:2438–2443.
Dandona P, Aljada A, Chaudhuri A, et al: Metabolic syndrome: a comprehensive perspective based on interactions between obesity, diabetes, and inflammation. Circulation 2005, 111:1448–1454.
Mooradian AD, Haas MJ, Wong NC: Transcriptional control of apolipoprotein A-I gene expression in diabetes. Diabetes 2004, 53:513–520.
Tripathy D, Mohanty P, Dhindsa S, et al: Elevation of free fatty acids induces inflammation and impairs vascular reactivity in healthy subjects. Diabetes 2003, 52:2882–2887.
Hotamisligil GS, Shargill NS, Spiegelman BM: Adipose expression of tumor necrosis factor-alpha: direct role in obesity-linked insulin resistance. Science 1993, 259:87–91.
Xu H, Barnes GT, Yang Q, et al: Chronic inflammation in fat plays a crucial role in the development of obesity-related insulin resistance. J Clin Invest 2003, 112:1821–1830.
La Cava A, Alviggi C, Matarese G: Unraveling the multiple roles of leptin in inflammation and autoimmunity. J Mol Med 2004, 82:4–11.
Kubota N, Terauchi Y, Yamauchi T, et al: Disruption of adiponectin causes insulin resistance and neointimal formation. J Biol Chem 2002, 277:25863–25866.
Lakka HM, Laaksonen DE, Lakka TA, et al: The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 2002, 288:2709–2716. Important reference on association of metabolic syndrome with increased risk of cardiovascular disease mortality in adults.
Malik S, Wong ND, Franklin SS, et al: Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults. Circulation 2004, 110:1245–1250.
Alexander CM, Landsman PB, Teutsch SM, Haffner SM: NCEP-defined metabolic syndrome, diabetes, and prevalence of coronary heart disease among NHANES III participants age 50 years and older. Third National Health and Nutrition Examination Survey (NHANES III); National Cholesterol Education Program (NCEP). Diabetes 2003, 52:1210–1214.
Resnick HE, Jones K, Ruotolo G, et al: Insulin resistance, the metabolic syndrome, and risk of incident cardiovascular disease in nondiabetic American Indians: the Strong Heart study. Diabetes Care 2003, 26:861–867.
Klein BE, Klein R, Lee KE: Components of the metabolic syndrome and risk of cardiovascular disease and diabetes in beaver dam. Diabetes Care 2002, 25:1790–1794.
Koskinen P, Manttari M, Manninen V, et al: Coronary heart disease incidence in NIDDM patients in the Helsinki Heart Study. Diabetes Care 1992, 15:820–825.
Manson JAE, Colditz GA, Stampfer MJ, et al: A prospective study of maturity-onset diabetes mellitus and risk of coronary heart disease and stroke in women. Arch Intern Med 1991, 151:1141–1147.
McGill HC Jr, McMahan CA, Malcom GT, et al: Effects of serum lipoproteins and smoking on atherosclerosis in young men and women: the PDAY Research Group: Pathobiological Determinants of Atherosclerosis in Youth. Arterioscler Thromb Vasc Biol 1997, 17:95–106.
Celermajer DS, Sorensen KE, Gooch VM, et al: Noninvasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet 1992, 340:1111–1115.
Newman WP III, Freedman DS, Voors AW, et al: Relation of serum lipoprotein levels and systolic blood pressure to early atherosclerosis. The Bogalusa Heart Study. N Engl J Med 1986, 314:138–144.
Berenson GS, Srinivasan SR, Bao W, et al: Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. N Engl J Med 1998, 338:1650–1656.
Koenig W, Sund M, Frohlich M, et al: C-reactive protein, a sensitive marker of inflammation, predicts future risk of coronary heart disease in initially healthy middleaged men: results from the MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) Augsburg Cohort Study, 1984 to 1992. Circulation 1999, 99:237–242.
Ford ES: C-reactive protein concentration and cardiovascular disease risk factors in children: findings from the National Health and Nutrition Examination Survey 1999–2000. Circulation 2003, 108:1053–1058.
Zietz B, Herfarth H, Paul G, et al: Adiponectin represents an independent cardiovascular risk factor predicting serum HDL cholesterol levels in type 2 diabetes. FEBS Lett 2003, 545:103–104.
Tounian P, Aggoun Y, Dubern B, et al: Presence of increased stiffness of the common carotid artery and endothelial dysfunction in severely obese children: a prospective study. Lancet 2001, 358:1400–1404.
Iannuzzi A, Licenziati MR, Acampora C, et al: Increased carotid intima-media thickness and stiffness in obese children. Diabetes Care 2004, 27:2506–2508.
Leeson CP, Whincup PH, Cook DG, et al: Cholesterol and arterial distensibility in the first decade of life: a population-based study. Circulation 2000, 101:1533–1538.
Daniels SR, Arnett DK, Eckel RH, et al: Overweight in children and adolescents: pathophysiology, consequences, prevention, and treatment. Circulation 2005, 111:1999–2012.
Dietz WH, Robinson TN: Overweight children and adolescents. N Engl J Med 2005, 352:2100–2109. Important reference article for the management of obesity in children and adolescents.
Barlow SE, Dietz WH: Obesity evaluation and treatment: expert committee recommendations. Pediatrics 1998, 102:e29.
Panel on Macronutrients, Subcommittees on Upper Reference Levels of Nutrients and Interpretation and Uses of Dietary Reference Intakes, and the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes: Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients). Washington, DC: National Academies Press; 2002.
Williams CL, Hayman LL, Daniels SR, Robinson TN, et al: Cardiovascular health in childhood: a statement for health professionals from the Committee on Atherosclerosis, Hypertension, and Obesity in the Young (AHOY) of the Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 2002, 106:143–160.
US Department of Agriculture: The Food Guide Pyramid for Young Children. Available at http:// www.cnpp.usda.gov/KidsPyra. Accessed June 16, 2006.
Carnethon MR, Gidding SS, Nehgme R, et al: Cardiorespiratory fitness in young adulthood and the development of cardiovascular disease risk factors. JAMA 2003, 290:3092–3100.
Epstein LH, Paluch RA, Gordy CC, Dorn J: Decreasing sedentary behaviors in treating pediatric obesity. Arch Pediatr Adolesc Med 2000, 154:220–226.
Summerbell CD, Ashton V, Campbell KJ, et al: Interventions for treating obesity in children. Cochrane Database Syst Rev 2003, 3:CD001872.
Epstein LH, Valoski A, Wing RR, McCurley J: Ten-year outcomes of behavioral family-based treatment for childhood obesity. Health Psychol 1994, 13:373–383.
Epstein LH, Myers MD, Raynor HA, Saelens BE: Treatment of pediatric obesity. Pediatrics 1998, 101:554–570.
Tonstad S, Thompson GR: Management of hyperlipidemia in the pediatric population. Curr Treat Options Cardiovasc Med 2004, 6:431–437.
Stein EA, Illingworth DR, Kwiterovich PO Jr, et al: Efficacy and safety of lovastatin in adolescents males with heterozygous familial hypercholesterolemia. A randomized controlled trial. JAMA 1999, 281:137–144.
McCridle BW, Ose L, Marais AD: Efficacy and safety of atorvastatin in children and adolescents with familial hypercholesterolemia or severe hyperlipidemia: a multicenter, randomized, placebo-controlled trial. J Pediatr 2003, 143:74–80.
Wiegman A, Hutten BA, de Grott E, et al: Statin therapy in hypercholesterolemic children. Long-term efficacy and safety [abstract]. Circulation 2003, 108(suppl):527.
Berkowitz RI, Wadden TA, Tershakovec AM, Cronquist JL: Behavior therapy and sibutramine for the treatment of adolescent obesity: a randomized controlled clinical trial. JAMA 2003, 289:1805–1812.
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Singh, G.K. Metabolic syndrome in children and adolescents. Curr Treat Options Cardio Med 8, 403–413 (2006). https://doi.org/10.1007/s11936-006-0045-3
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DOI: https://doi.org/10.1007/s11936-006-0045-3