Metabolic Syndrome in Children and Adolescents: Diagnostic Criteria, Therapeutic Options and Perspectives
- 159 Downloads
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.
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.
KeywordsObesity 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
- 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
- 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.•• 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
- 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.Präventionsforschung L-If. mets-score 2019 [January 5, 2019]. Available from: https://www.bips-institut.de/en/research/software/mets-score.html.
- 20.Weihrauch-Blüher S, Vilser C. Syndromale Formen der Adipositas. Adipositas - Ursachen, Folgeerkrankungen, Therapie. 2018;12(04):168–75.Google Scholar
- 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
- 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
- 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
- 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
- 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.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
- 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
- 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
- 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.•• 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