Measures against Pediatric Metabolic Syndrome

Young Ah Lee; Choong Ho Shin; Jung Sub Lim

doi:10.5124/jkma.2010.53.5.392

J Korean Med Assoc > Volume 53(5); 2010 > Article

Lee, Shin, and Lim: Measures against Pediatric Metabolic Syndrome

Original Article

J Korean Med Assoc 2010; 53(5): 392-406.

Published online: December 17, 2010

DOI: http://dx.doi.org/10.5124/jkma.2010.53.5.392

Measures against Pediatric Metabolic Syndrome

Young Ah Lee, MD, Choong Ho Shin, MD, Jung Sub Lim, MD

Department of Pediatrics, Seoul National University College of Medicine

Department of Pediatrics, Korea Cancer Center Hospital

Corresponding author : Choong Ho Shin E - mail : chshinpd@snu.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The incidence of metabolic syndrome (MS) has increased significantly worldwide including Korea over the past decade. Recent studies have shown that the MS develops during childhood and is highly prevalent among overweight children and adolescents. Thus, it is important for physicians to be acquainted with the definition, diagnostic criteria, epidemiology, and pathophysiology of MS for early identification and management of the MS in children and adolescents, which would be helpful to decrease the burden of type 2 diabetes and cardiovascular disease in adults. The aim of this review is to provide adequate guidelines for screening and managing strategies on MS based on recent findings. Proper and effective control of MS needs close cooperation among patients, physician, family members, school, society, and government, and it should be based on a thorough evaluation of medical system on obesity and MS.

Key words: Metabolic syndrome; Child; Adolescent; Primary Health Care; Obesity; Insulin resistance; Mass screening

Table 1.

Definition of the risk group and metabolic syndrome in children and adolescents

	International Diabetes Federation			modified NCEP-ATP III
	6~9.9^∗ (yrs)	10~15.9 (yrs)	above 16 (yrs)	modified NCEP-ATP III
Obesity (WC)	≥ 90th percentile	≥ 90th percentile or adult cutoff if lower	≥ 90 cm (Asian male) ≥ 80 cm (Asian female)	≥ 90th percentile (age, gender, ethnicity specific)
TG (mg/dL)		≥ 150	≥ 150 or Thx for high TG	≥ 110
HDL-C (mg/dl)		< 40	< 40 (male) or < 50 (female) or Tx for low HDL	< 40
BP (mmHg)		SBP ≥ 130 or DBP ≥ 85	SBP ≥ 130 or DBP ≥ 85 or Tx for hypertension	≥ 90th percentile (age, gender, height specific)
FPG (mg/dL)		FPG ≥ 100^†or known T2DM	FPG ≥ 100^†or known T2DM	≥ 110
Diagnosis		central obesity plus 2 or more of 4 factors	3 or more of 5 factors

∗ Metabolic syndrome can't be diagnosed, but further measurements should be made if there is a family history of metabolic syndrome, T2DM, dyslipidemia, cardiovascular disease, hypertension and/or obesity

† For clinical purposes, but not for diagnosing the Metabolic syndrome, if FPG 100~125 mg/dL and not known to have diabetes, an oral glucose tolerance test should be performed

Abbreviations: WC, waist circumference; TG, triglycerides; Tx, treatment; HDL-C, HDL-cholesterol; SBP, systolic blood pressure; DBP, diastoilic blood pressure; FPG, fasting plasma glucose; T2DM, type 2 diabetes mellitus

Table 2.

Screening recommendation for risk factors of metabolic syndrome

	National screening		Societies' recommendation
	USPSTF	NSC	AAP	Other
BMI	Grade B^∗ (45)		Routinely	Routinely
Fasting lipid	Grade I^†(46)	no report	BMI ≥ 85 percentile (48, 60) or
profile		recommend only in FHC (47)	one or more risks (48) - FH of hypertension, early CVD, strokes - unknown family history - hypertension - cigarette smoking - diabetes mellitus
Fasting plasma glucose	no report	no report	BMI ≥ 95 percentile (60) or BMI 85~94 percentile with one or more risks^‡ (60) - FH of hypertension, early CVD, strokes - hypertension - hyperlipidem	BMI > 85 percentile with two more risks (62) - FH of T2DM in 1st-or 2nd-degree relative - ethnicity like Asian American - AN, hyperthension, dyslipidemia, PCOS, SGA - maternal diabetes or GDM during child's gestation
AST/ALT	no reported	no reported	BMI ≥ 95 percentile (60) or BMI 85~94 percentile with one or more risks^‡ (60)

∗ Grade B: The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial

† Grade I: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined

‡ Suggested risk factors are identical for screening of fasting plasma glucose and AST/ALT Abbreviations : USPSTF, U.S. Preventive Services Task Force; NSC, National Screening Committee; AAP, American Academy of Pediatrics; FHC, familial hyperchole-sterolemia; FH, family history; CVD, cardiovascular deaths; AST, aspartate aminotransferase; ALT, alanine aminotransferase; PCOS, polycystic ovary syndrome; AN, acanthosis nigricans

Table 3.

Life style recommendation for preventing or improving the metabolic syndrome

Recommendation	Reference
Balance dietary calories with physical activity to maintain normal growth	77
Encourage high fiber intake like vegetables and fruits Encourage whole grain intake	79 78
Eat polyunsaturated fatty acids^∗ rather than food enriched saturated fat and trans fatty acids	76
Reduce the sugar-sweetened beverages and foods	77
Reduce time spent in sedentary activities^† to 1~2 h per day	80
Encourage at least 60 minutes of moderate to vigorous physical activity daily	81, 85

∗ especially omega-3 fish oil

† activities such as watching television, playing video games, or using computers for recreation

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