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Childhood metabolic syndrome

With the improvement of living standard and the change of life style ,the prevalence of malnutrition has decreased ,while children and adolescent s’obesity caused by overnutrition is rising ,and type 2 diabetes and metabolic syndrome in children and adolescents have been increasing rapidly .

The metabolic syndrome, also known as "syndrome X," describes a cluster of cardiovascular risk factors that have been shown to predict the development of cardiovascular disease and type 2 diabetes . Some suggest that the cluster is driven by the consequences of peripheral insulin resistance , whereas others believe that obesity-related inflammation is the culprit . Many putative molecular mechanisms can provide excellent explanations for both theories regarding the primary driving mechanism of the clustering of cardiovascular risk factors and how each one accelerates atherogenesis .

Complexity of definitions of the metabolic syndrome in childhood

Several definitions of the metabolic syndrome in children have been proposed by various research groups and expert consensus , and the use of different definitions in the same patient cohort may result in different prevalence or prediction outcomes. All of the definitions share common features: First, all definitions include an obesity element (waist circumference or BMI), two "dyslipidemia”elements (elevated triglycerides and low HDL cholesterol), elevated blood pressure, and a component representing glucose metabolism (impaired fasting glucose or impaired glucose tolerance). All of these definitions are based on population-derived percentile thresholds for each component.

Stability of the diagnosis of metabolic syndrome in childhood

The stability of individual components of the syndrome from childhood to young adulthood has been shown to track "moderately well" with significant correlation coefficients of 0.4-0.6 for each component . Patterns of change in individual factors, defined as crossing the predefined thresholds between observations, have been shown to be more common in youth at risk (patients who a priori meet individual criteria) than in individuals at lower risk. Individual components of the syndrome have been shown to track from childhood to adulthood, emphasizing the importance of identifying abnormalities early in the life course .

Predictive value of the metabolic syndrome in childhood

It has been shown using several longitudinal cohorts that meeting the criteria of the metabolic syndrome in childhood predicts the development of cardiovascular disease and type 2 diabetes in adulthood . Similarly, having specific components of the syndrome in childhood predicts the presence of "softer" outcomes such as left ventricular hypertrophy or increased intimal-medial thickness in childhood and adulthood.

Should other components be included in the definition of the metabolic syndrome in childhood ?

The metabolic phenotype of obese children who meet the definitions of the metabolic syndrome is variable, yet some clinical and biochemical associations are

typically observed. Body fat distribution has a critical role in the determination of whole-body insulin sensitivity and its consequences. The relation of obesity and peripheral insulin resistance depends more on the lipid distribution (or "lipid partitioning") in specific fat depots rather than on the absolute amount of fat per se. Importantly , these distinctions are not reflected in BMI assessments.

Conclusions

Clustering of cardiovascular risk factors, the development of which is driven by adipocyte dysfunclion leading to subclinical inflammation and peripheral insulin resistance, is present in children and adults. Such clustering may be associated with specific morbidity in childhood and also predicts the presence of adverse outcomes in adulthood. Obesity per se in a child does not necessarily mean that the syndrome is present.

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