Cardiovascular and Metabolic Complications – Diagnosis and Management in Obese Children
The world at present is facing a burden of rising prevalence of obesity in children and adolescents. The developing countries are particularly facing the dual burden on under-nutrition and obesity. This is associated with appearance and clustering of cardiometabolic abnormalities at an early age with development of chronic complications early and possible decrease in life span of these children and adolescents. In adults this clustering has been termed as ‘metabolic syndrome’ with definitions that can be used universally. However, in children and adolescents there is no consensus on a uniform definition of metabolic syndrome that can be applicable across the age groups and various ethnicities. Further, as childhood is a period of growth and development, changes in body composition and insulin sensitivity that occur with puberty may influence the thresholds of components used to define metabolic syndrome. Children of South Asian ethnicity appear to be more predisposed to develop abnormalities of metabolic syndrome, possible due to their adverse body fat patterning and genetic influences. The definition of pediatric metabolic syndrome proposed by International Diabetes Federation is useful across different ethnicities. Presence of at least one component of metabolic syndrome should lead to detailed screening for other components and complications. A multimodality approach including therapeutic lifestyle changes targeted at the individual, family and community is essential for management. Pharmacotherapy for individual components may be required if initial management strategies fail to achieve the goals.
KeywordsChildhood obesity Asian Indians Insulin resistance Metabolic syndrome
The author acknowledges Prof. Vandana Jain for sharing her unpublished data for the manuscript.
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- 2.Singhal N, Misra A, Shah P, Rastogi K, Vikram NK. Secular trends in obesity, regional adiposity and metabolic parameters among Asian Indian adolescents in north India: a comparative data analysis of two selective samples 5 years apart (2003, 2008). Ann Nutr Metab. 2010;56:176–81.CrossRefPubMedGoogle Scholar
- 4.Ajala O, Mold F, Boughton C, Cooke D, Whyte M. Childhood predictors of cardiovascular disease in adulthood. A systematic review and meta-analysis. Obes Rev. 2017. https://doi.org/10.1111/obr.12561.
- 14.Esmaillzadeh A, Mirmiran P, Azizi F. Clustering of metabolic abnormalities in adolescents with the hypertriglyceridemic waist phenotype. Am J Clin Nutr. 2006;83:36–46; quiz 183-4.Google Scholar
- 21.Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120:1640–5.CrossRefPubMedGoogle Scholar
- 28.Goodman E, Daniels SR, Morrison JA, Huang B, Dolan LM. Contrasting prevalence of and demographic disparities in the World Health Organization and National Cholesterol Education Program Adult Treatment Panel III definitions of metabolic syndrome among adolescents. J Pediatr. 2004;145:445–51.CrossRefPubMedGoogle Scholar
- 44.Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics. 2011;128:S213–56.Google Scholar