As pediatric obesity rates have climbed, so have the risks for children to develop diabetes and cardiovascular diseases that were formerly more common in adults.
Physicians use the term "metabolic syndrome" to describe and treat adults who have a specific cluster of at least three out of five diagnostic criteria, including excessive body weight in an abdominal distribution, high blood pressure, elevated fasting blood glucose, high triglyceride levels, and low levels of "good" cholesterol, or high-density lipoprotein (HDL). The presence of metabolic syndrome in adults, is known to increase their risk for cardiovascular disease and type 2 diabetes. However, in children, there is a great deal of controversy as to how to define metabolic syndrome and whether the concept is even relevant.
To provide guidance, the American Academy of Pediatrics (AAP) will publish a clinical report, "The Metabolic Syndrome in Children and Adolescents: Shifting the Focus to Cardiometabolic Risk Factor Clustering." The report on how to screen and treat children at increased cardiometabolic risk will be published in the August 2017 Pediatrics and published online July 24.
"We know that genetics and environment play a role in obesity and metabolic risk," said Sheela N. Magge, MD, MSCE, FAAP, lead author of the clinical report. "We would like to help pediatricians focus on the most important risks that pose life-long challenges."
The AAP recommends that rather than focus on a particular definition of metabolic syndrome, pediatricians focus on identifying children with multiple cardiometabolic risk factor clustering by screening for those risks – central obesity, high blood pressure, prediabetes, high triglycerides, and low HDL-cholesterol. Children with multiple risk factors should be targeted for interventions.
Other comorbidities to screen for include obstructive sleep apnea, polycystic ovarian syndrome and fatty liver disease. Individual risk factors and comorbidities should be treated as indicated. Because there is no evidence for medication treatment of pediatric metabolic syndrome as a whole, weight loss through healthy diet and physical activity remains a mainstay of treatment for metabolic syndrome.
"The factors leading to obesity are complex, and there are no easy solutions," said Sarah Armstrong, MD, FAAP, a co-author of the report. "But pediatricians can help ensure that obesity does not have metabolic consequences by screening for known obesity-associated risks like hypertension, dyslipidemia, and prediabetes."
Even small amounts of weight loss can offer big benefits. Decreasing body mass index by 5 to 10% offers metabolic benefits, according to research.
"Metabolic health in childhood lays the foundation for lifelong metabolic health in adulthood," said Elizabeth Goodman, MD, FAAP, who co-authored the report. "Pediatricians can help improve lifelong health by identifying children who are at greater risk for heart disease and diabetes earlier in life."