Metabolic Syndrome in Pediatrics: Old Concepts Revised, New Concepts Discussed
Section snippets
Identifying children with MS
Although there is no complete agreement on the fine definition of MS in youth, given the limitations described above, the cornerstones of its definition still remain and need to be identified by pediatricians.
BMI is a predictor of coronary artery disease (CAD) risk factors among children and adolescents,15, 16 and its utility has been endorsed by International Obesity Task Force and the Centers for Disease Control (CDC).17, 18, 19 The cut-off points of the CDC, based on a distribution approach,
Metabolic phenotype of children and adolescents with MS
Because insulin resistance represents one of the most important pathogenetic primers in the development of MS, all patients should be investigated for insulin resistance. Weiss and colleagues5 have demonstrated how the increase of insulin resistance parallels the increase of the risk of MS in obese children and adolescents. In this latter study, a strong loading of insulin resistance to obesity and glucose metabolism factor and moderate loading to the dyslipidemia factor has been shown.5 Some
Impaired glucose tolerance and T2D in youth
The β-cell response to insulin resistance occurring in obese children and adolescents is by producing a vigorous state of hyperinsulinemia, which will maintain normal values of glucose levels. In the long run, however, β-cell function may deteriorate in some, and the insulin secretion will be not sufficient to maintain glucose levels within the normal range.
According to the American Diabetese Association criteria, T2D is defined as fasting plasma glucose levels higher than 126 mg/dL or plasma
Association between fatty liver and MS
The intrahepatic fat accumulation induced by insulin resistance causes the development of nonalcoholic fatty liver disease (NAFLD), which is a clinic pathologic condition of emerging importance in obese children.80 NAFLD encompasses the entire spectrum of liver conditions, ranging from asymptomatic steatosis with elevated or normal aminotransferases to steatohepatitis (nonalcoholic steatohepatitis or NASH) and advanced fibrosis with cirrhosis.81, 82 Concurrent with the worldwide epidemic
Conclusions and future perspectives
Given the relatively recent occurrence of MS in childhood, long-term follow-up studies are not available yet. However, it is reasonable to think that the metabolic derangement observed in obese children will have dramatic repercussions on their health earlier than that observed in adults, with a consequent worsening of the prognosis in terms of morbidity and mortality when they are still youth. To date, we know that the physician has few arrows in his or her quiver to fight this disease. The
Acknowledgments
The authors are grateful to all of the adolescents who participated in the studies, to the research nurses for the excellent care given to our subjects, and to Aida Groszmann, Andrea Belous, and Corduta Todeasa for their superb technical assistance.
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Portions of this article were previously published in the Endocrinology and Metabolism Clinics of North America, 38:3.
This study was supported by grants from the National Institutes of Health: R01-HD40787, R01-HD28016 and K24-HD01464 to S. Caprio; M01-RR00125 to the Yale Clinical Research Center and R01-EB006494 to the Bioimage Suite.