Treating Metabolic Syndrome In Kids
Doctors should treat the individual components of metabolic syndrome (MetS) in children and help them improve diet and exercise, according to the new American Heart Association scientific statement “Progress and Challenges in the Metabolic Syndrome in Children and Adolescents” published online in Circulation: Journal of the American Heart Association.
View the study here
According to the National Cholesterol Education Program’s Adult Treatment Panel III, MetS is the clustering in adults of at least three of these risk factors:
• abdominal obesity (waist circumference more than 35 in. for women; 40 in. for men)
• high triglycerides (greater than or equal to 150 mg/dL)
• low HDL (“good”) cholesterol (men less than 40mg/dL; women less than 50 mg/dL)
• high blood pressure (greater than or equal to 130/85 mm Hg)
• high fasting glucose (greater than or equal to 100 mg/dL)
“Similar clustering appears to occur in children and adolescents, particularly those who are overweight and obese; however, in young people the diagnosis of metabolic syndrome is less clear cut,” said Julia Steinberger, M.D., M.S., chair of the statement writing group and associate professor of pediatrics and director of Pediatric Echocardiography and Preventive Cardiology at the University of Minnesota Children’s Hospital in Minneapolis.
The American Heart Association said diagnosing MetS in children or adolescents is problematic for several reasons, including:
• Pediatric MetS is defined differently around the world, and there is no consensus on the cutoff for abnormal values in children.
• The MetS diagnosis is unstable in children and adolescents because of variations due to age, gender, race, ethnicity and the progression of puberty.
• There’s sparse data on how a pediatric diagnosis of MetS tracks into adulthood.
“The adverse risk factors and the connections between them that eventually lead to the metabolic syndrome begin in childhood,” Steinberger said.
As a result, the writing group concluded that using the term “metabolic syndrome” as a diagnosis in childhood is less useful than stressing that clinicians should recognize high-risk children, measure and treat the individual components of the syndrome, and concentrate on interventions to improve diet and exercise.
“Much of the increased risk is tied to more children being overweight or obese,” said Stephen Daniels, M.D., a co-author of the paper, as well as a spokesperson for the American Heart Association’s efforts at reducing childhood obesity. “The obesity epidemic is taking its toll, and we’re seeing more kids developing conditions and diseases typically associated with adults.” Daniels is Chairman of the Department of Pediatrics at the University of Colorado in Denver.
Between 1974 and 2006, the number of obese children increased from 4 percent to 17 percent in those ages 6 to 11 years old, and from 6.1 percent to 17.6 percent in adolescents 12 to 19 years old, according to the American Heart Association. Obesity in children is defined by a body mass index-for-age value at or above the 95th percentile of the 2000 CDC growth charts.
“We can say that childhood obesity is our biggest problem,” Steinberger said. “It’s been shown that when diet and exercise are improved in overweight children, the structure and function of blood vessels improves — even in the absence of weight loss.”
She said the statement seeks to rectify the lack of long-term research on the syndrome by providing a road map for future research. The statement includes a list of research questions to clarify the extent to which pediatric components of the syndrome might develop into adult MetS.