Current Obesity Reports

, Volume 8, Issue 4, pp 472–479 | Cite as

Metabolic Syndrome in Children and Adolescents: Diagnostic Criteria, Therapeutic Options and Perspectives

  • Paul Weihe
  • Susann Weihrauch-BlüherEmail author
Metabolism (M Dalamaga, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Metabolism


Purpose of Review

This review summarizes our current understanding of the metabolic syndrome (MetS) in children and adolescents. Special emphasis is given towards diagnostic criteria and therapeutic options.

Recent Findings

Consistent diagnostic criteria to define MetS in childhood and adolescence are not available to date. There is common agreement that the main features defining MetS include (1) disturbed glucose metabolism, (2) arterial hypertension, (3) dyslipidemia, and (4) abdominal obesity. However, settings of cut-off values are still heterogeneous in the pediatric population. Additional features that may define cardiometabolic risk, such as non-alcoholic fatty liver disease (NAFDL) or hyperuricemia, are not considered to date.


Prevalence of childhood obesity has more than doubled since 1980, and 6–39% of obese children and adolescents already present with MetS, depending on the definition applied. There is common agreement that a consistent definition of MetS is urgently needed for children to identify those at risk as early as possible. Such definition criteria should consider age, gender, pubertal stage, or ethnicity. Additional features such as NAFDL or hyperuricemia should also be included in MetS criteria. Lifestyle modification is still the main basis to prevent or treat childhood obesity and MetS, as other therapeutic options (pharmacotherapy, bariatric surgery) are not available or not recommended for the majority of affected youngster.


Obesity Childhood Adolescence Metabolic syndrome Definition Therapy 


Compliance with Ethical Standards

Conflict of Interest

All authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Zimmet P, Alberti G, Kaufman F, Tajima N, Silink M, Arslanian S, et al. The metabolic syndrome in children and adolescents. Lancet. 2007;369(9579):2059–61.PubMedGoogle Scholar
  2. 2.
    Weihrauch-Blüher S, Schwarz P, Klusmann J-H. Childhood obesity: increased risk for cardiometabolic disease and cancer in adulthood. Metabolism. 2019;92:147–52.PubMedGoogle Scholar
  3. 3.
    Lennerz BS, Moss A, von Schnurbein J, Bickenbach A, Bollow E, Brandt S, et al. Do adolescents with extreme obesity differ according to previous treatment seeking behavior? The Youth with Extreme obesity Study (YES) cohort. Int J Obes. 2019;43(1):103–15.Google Scholar
  4. 4.
    Sorof J, Daniels S. Obesity hypertension in children. Hypertension. 2002;40(4):441–7.PubMedGoogle Scholar
  5. 5.
    Forouzanfar MH, Afshin A, Alexander LT, Anderson HR, Bhutta ZA, Biryukov S, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1659–724.Google Scholar
  6. 6.
    •• GBD Obesity Collaborators, Afshin A, Forouzanfar MH, Reitsma MB, Sur P, Estep K, et al. Health Effects of Overweight and Obesity in 195 Countries over 25 Years. N Engl J Med. 2017;377(1):13–27 This paper has analyzed the development/prevalence of obesity among children and adolescents during the past 25 years. Emphasizes that a global strategy against overweight is needed. Google Scholar
  7. 7.
    Muhlig Y, Wabitsch M, Moss A, Hebebrand J. Weight loss in children and adolescents. Dtsch Arztebl Int. 2014;111(48):818–24.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Foster BA, Farragher J, Parker P, Sosa ET. Treatment interventions for early childhood obesity: a systematic review. Acad Pediatr. 2015;15(4):353–61.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Bjerregaard LG, Jensen BW, Angquist L, Osler M, Sorensen TIA, Baker JL. Change in overweight from childhood to early adulthood and risk of type 2 diabetes. N Engl J Med. 2018;378(14):1302–12.PubMedGoogle Scholar
  10. 10.
    Cook S, Weitzman M, Auinger P, Nguyen M, Dietz WH. Prevalence of a metabolic syndrome phenotype in adolescents. Arch Pediatr Adolesc Med. 2003;157(8):821.PubMedGoogle Scholar
  11. 11.
    Alberti KGM, Zimmet P, Shaw J. The metabolic syndrome—a new worldwide definition. Lancet. 2005;366(9491):1059–62.PubMedGoogle Scholar
  12. 12.
    Cook S, Weitzman M, Auinger P, Nguyen M, Dietz WH. 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(8):821–7.PubMedGoogle Scholar
  13. 13.
    Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, Yeckel CW, et al. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med. 2004;350(23):2362–74.PubMedGoogle Scholar
  14. 14.
    de Ferranti SD, Gauvreau K, Ludwig DS, Neufeld EJ, Newburger JW, Rifai N. Prevalence of the metabolic syndrome in American adolescents: findings from the Third National Health and Nutrition Examination Survey. Circulation. 2004;110(16):2494–7.PubMedGoogle Scholar
  15. 15.
    Zimmet P, Alberti KG, Kaufman F, Tajima N, Silink M, Arslanian S, et al. The metabolic syndrome in children and adolescents - an IDF consensus report. Pediatr Diabetes. 2007;8(5):299–306.PubMedGoogle Scholar
  16. 16.
    Mancini MC. Metabolic syndrome in children and adolescents - criteria for diagnosis. Diabetol Metab Syndr. 2009;1(1):20.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Ahrens W, Moreno LA, Mårild S, Molnár D, Siani A, De Henauw S, et al. Metabolic syndrome in young children: definitions and results of the IDEFICS study. Int J Obes. 2014;38(S2):S4–S14.Google Scholar
  18. 18.
    Präventionsforschung L-If. mets-score 2019 [January 5, 2019]. Available from:
  19. 19.
    Reinehr T, De Sousa G, Toschke AM, Andler W. Comparison of metabolic syndrome prevalence using eight different definitions: a critical approach. Arch Dis Child. 2007;92(12):1067–72.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Weihrauch-Blüher S, Vilser C. Syndromale Formen der Adipositas. Adipositas - Ursachen, Folgeerkrankungen, Therapie. 2018;12(04):168–75.Google Scholar
  21. 21.
    Bluher S, Molz E, Wiegand S, Otto KP, Sergeyev E, Tuschy S, et al. Body mass index, waist circumference, and waist-to-height ratio as predictors of cardiometabolic risk in childhood obesity depending on pubertal development. J Clin Endocrinol Metab. 2013;98(8):3384–93.PubMedGoogle Scholar
  22. 22.
    Hsieh SD, Ashwell M, Muto T, Tsuji H, Arase Y, Murase T. Urgency of reassessment of role of obesity indices for metabolic risks. Metabolism. 2010;59(6):834–40.PubMedGoogle Scholar
  23. 23.
    Brambilla P, Bedogni G, Moreno LA, Goran MI, Gutin B, Fox KR, et al. Crossvalidation of anthropometry against magnetic resonance imaging for the assessment of visceral and subcutaneous adipose tissue in children. Int J Obes. 2006;30(1):23–30.Google Scholar
  24. 24.
    Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140(3):e20171904.PubMedGoogle Scholar
  25. 25.
    Allard P, Delvin EE, Paradis G, Hanley JA, O'Loughlin J, Lavallee C, et al. Distribution of fasting plasma insulin, free fatty acids, and glucose concentrations and of homeostasis model assessment of insulin resistance in a representative sample of Quebec children and adolescents. Clin Chem. 2003;49(4):644–9.PubMedGoogle Scholar
  26. 26.
    Gustafsson D, Unwin R. The pathophysiology of hyperuricaemia and its possible relationship to cardiovascular disease, morbidity and mortality. BMC Nephrol. 2013;14(1):164.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Bussler S, Penke M, Flemming G, Elhassan YS, Kratzsch J, Sergeyev E, et al. Novel insights in the metabolic syndrome in childhood and adolescence. Horm Res Paediatr. 2017;88(3-4):181–93.PubMedGoogle Scholar
  28. 28.
    Kotnik P, Fischer Posovszky P, Wabitsch M. Endocrine and metabolic effects of adipose tissue in children and adolescents. Slov J Public Health. 2015;54(2):131–8.Google Scholar
  29. 29.
    Barraco GM, Luciano R, Semeraro M, Prieto-Hontoria PL, Manco M. Recently discovered adipokines and cardio-metabolic comorbidities in childhood obesity. Int J Mol Sci. 2014;15(11):19760–76.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Reinehr T, Stoffel-Wagner B, Roth CL. Adipocyte fatty acid-binding protein in obese children before and after weight loss. Metabolism. 2007;56(12):1735–41.PubMedGoogle Scholar
  31. 31.
    American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes—2018. Diabetes Care. 2018;41(Supplement 1):S13–27.Google Scholar
  32. 32.
    Al-Khudairy L, Loveman E, Colquitt JL, Mead E, Johnson RE, Fraser H, et al. Diet, physical activity and behavioural interventions for the treatment of overweight or obese adolescents aged 12 to 17 years. Cochrane Database Syst Rev. 2017;6:CD012691.PubMedGoogle Scholar
  33. 33.
    Hagman E, Hecht L, Marko L, Azmanov H, Groop L, Santoro N, et al. Predictors of responses to clinic-based childhood obesity care. Pediatr Diabetes. 2018;19(8):1351–6.PubMedGoogle Scholar
  34. 34.
    • Reinehr T, Lass N, Toschke C, Rothermel J, Lanzinger S, Holl RW. Which amount of BMI-SDS reduction is necessary to improve cardiovascular risk factors in overweight children? J Clin Endocrinol Metab. 2016;101(8):3171–9 This paper is very helpful for pediatricians and medical caretakers alike to advise parents of overweight/obese children which amount of weight loss is recommended to reduce cardiometabolic risk factors. BMI-SDS reduction -0,25 is helpful to improve hypertension and dyslipidemia. PubMedGoogle Scholar
  35. 35.
    Hoffmeister U, Molz E, Bullinger M, van Egmond-Fröhlich A, Goldapp C, Mann R, et al. Evaluation von Therapieangeboten für adipöse Kinder und Jugendliche (EvAKuJ-Projekt). Bundesgesundheitsblatt. 2011;54(5):603.Google Scholar
  36. 36.
    Weiss R, Shaw M, Savoye M, Caprio S. Obesity dynamics and cardiovascular risk factor stability in obese adolescents. Pediatr Diabetes. 2009;10(6):360–7.PubMedGoogle Scholar
  37. 37.
    Van Der Baan-Slootweg O, Benninga MA, Beelen A, Van Der Palen J, Tamminga-Smeulders C, Tijssen JGP, et al. Inpatient treatment of children and adolescents with severe obesity in the Netherlands. JAMA Pediatr. 2014;168(9):807.PubMedGoogle Scholar
  38. 38.
    Danielsson P, Kowalski J, Ekblom O, Marcus C. Response of severely obese children and adolescents to behavioral treatment. Arch Pediatr Adolesc Med. 2012;166(12):1103–8.PubMedGoogle Scholar
  39. 39.
    Mead E, Atkinson G, Richter B, Metzendorf MI, Baur L, Finer N, et al. Drug interventions for the treatment of obesity in children and adolescents. Cochrane Database Syst Rev. 2016;11:CD012436.PubMedGoogle Scholar
  40. 40.
    Atay Z, Bereket A. Current status on obesity in childhood and adolescence: prevalence, etiology, co-morbidities and management. Obesity Med. 2016;3:1–9.Google Scholar
  41. 41.
    Styne DM, Arslanian SA, Connor EL, Farooqi IS, Murad MH, Silverstein JH, et al. Pediatric obesity-assessment, treatment, and prevention: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2017;102(3):709–57.PubMedPubMedCentralGoogle Scholar
  42. 42.
    Strambi M, Giussani M, Ambruzzi MA, Brambilla P, Corrado C, Giordano U, et al. Novelty in hypertension in children and adolescents: focus on hypertension during the first year of life, use and interpretation of ambulatory blood pressure monitoring, role of physical activity in prevention and treatment, simple carbohydrates and uric acid as risk factors. Ital J Pediatr. 2016;42(1).Google Scholar
  43. 43.
    Pischon T, Sharma AM. Use of beta-blockers in obesity hypertension: potential role of weight gain. Obes Rev. 2001;2(4):275–80.PubMedGoogle Scholar
  44. 44.
    Copeland KC, Silverstein J, Moore KR, Prazar GE, Raymer T, Shiffman RN, et al. Management of newly diagnosed type 2 diabetes mellitus (T2DM) in children and adolescents. Pediatrics. 2013;131(2):364–82.PubMedGoogle Scholar
  45. 45.
    Ells LJ, Mead E, Atkinson G, Corpeleijn E, Roberts K, Viner R, et al. Surgery for the treatment of obesity in children and adolescents. Cochrane Database Syst Rev. 2015;6:CD011740.Google Scholar
  46. 46.
    •• Commission-on-ending-childhood-obesity. Report of the commission on ending childhood obesity. World Health Organisation. 2016:68. This is a worldwide consensus statement which actions have to be taken to reduce obesity. It shows that a combination of individual measures as well as proper policy strategies is needed. Google Scholar
  47. 47.
    Hawkes C, Smith TG, Jewell J, Wardle J, Hammond RA, Friel S, et al. Smart food policies for obesity prevention. Lancet. 2015;385(9985):2410–21.PubMedGoogle Scholar
  48. 48.
    Blüher S, Schwarz P. Metabolically healthy obesity from childhood to adulthood - does weight status alone matter? Metabolism. 2014;63(9):1084–92.PubMedGoogle Scholar
  49. 49.
    Weghuber D, Zelzer S, Stelzer I, Paulmichl K, Kammerhofer D, Schnedl W, et al. High risk vs. “metabolically healthy” phenotype in juvenile obesity – neck subcutaneous adipose tissue and serum uric acid are clinically relevant. Exp Clin Endocrinol Diabetes. 2013;121:384–90.PubMedGoogle Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Pediatrics I/Pediatric EndocrinologyUniversity Hospital of Halle-WittenbergHalle (Saale)Germany

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