Pediatric Metabolic Syndrome
Pediatric Metabolic Syndrome
Metabolic syndrome (MetS) is a constellation of cardiometabolic risk factors including central obesity, hypertension, dyslipidemia, and glucose intolerance that increases the risk for cardiovascular disease and type 2 diabetes mellitus.
Key Points
- Prevalence: 3-4% in general pediatric population; up to 30-50% in obese children
- Age consideration: Can present as early as 6 years of age
- Gender distribution: Slightly higher prevalence in males
- Strong genetic and environmental components
Pathophysiology
- Central obesity leads to insulin resistance
- Adipose tissue dysfunction causes chronic inflammation
- Insulin resistance affects multiple organ systems:
- Liver: Increased gluconeogenesis and lipogenesis
- Muscle: Decreased glucose uptake
- Adipose tissue: Increased lipolysis
- Pancreas: Increased insulin production
Diagnostic Criteria (IDF Consensus for Children and Adolescents)
Ages 6-10 years:
- Waist circumference ≥90th percentile
- Further measurements recommended if family history of MetS, T2DM, dyslipidemia, CVD, hypertension, or obesity
Ages 10-16 years (must meet all criteria):
- Waist circumference ≥90th percentile
- Plus any two of the following:
- Triglycerides ≥150 mg/dL
- HDL-C <40 mg/dL
- Blood pressure ≥130/85 mmHg
- Fasting glucose ≥100 mg/dL
Clinical Assessment
- Detailed family history
- Physical examination:
- Height, weight, BMI calculation
- Waist circumference measurement
- Blood pressure (using age-appropriate cuff)
- Acanthosis nigricans assessment
- Laboratory evaluation:
- Fasting lipid profile
- Fasting glucose
- HbA1c
- Liver function tests
- Consider oral glucose tolerance test if indicated
Risk Factors
Non-modifiable Risk Factors
- Genetic predisposition
- Family history of:
- Type 2 diabetes
- Cardiovascular disease
- Hypertension
- Ethnicity (higher risk in Hispanic and African American children)
- Low birth weight
- Maternal gestational diabetes
Modifiable Risk Factors
- Obesity
- Sedentary lifestyle
- Poor dietary habits:
- High intake of processed foods
- Excessive sugar consumption
- Limited fruits and vegetables
- Sleep deprivation
- Stress
Management Approach
Lifestyle Modifications (Primary Intervention)
- Dietary Changes:
- Reduce processed food intake
- Limit sugar-sweetened beverages
- Increase fiber intake
- Portion control education
- Regular meal timing
- Physical Activity:
- 60 minutes daily moderate-to-vigorous activity
- Reduction in screen time
- Incorporation of both aerobic and resistance exercises
- Behavioral Interventions:
- Family-based approach
- Goal setting
- Self-monitoring
- Stress management
Medical Management
- Regular monitoring of:
- Blood pressure
- Lipid profile
- Glucose levels
- BMI and waist circumference
- Pharmacological Intervention (if indicated):
- Metformin for insulin resistance
- Antihypertensives if persistent elevation
- Statins for severe dyslipidemia
Complications and Long-term Outcomes
Cardiovascular Complications
- Early atherosclerosis
- Left ventricular hypertrophy
- Increased arterial stiffness
- Higher risk of early cardiovascular events
Metabolic Complications
- Type 2 diabetes mellitus
- Nonalcoholic fatty liver disease
- Polycystic ovary syndrome in females
Psychological Impact
- Depression
- Anxiety
- Low self-esteem
- Social isolation
