Metabolic Syndrome in Children and Adolescents: a Critical Approach Considering the Interaction between Pubertal Stage and Insulin Resistance

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Web End = Curr Diab Rep (2016) 16: 8

DOI 10.1007/s11892-015-0695-1

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Web End = PEDIATRIC TYPE 2 DIABETES (PS ZEITLER, SECTION EDITOR)

Metabolic Syndrome in Children and Adolescents: a Critical Approach Considering the Interaction between Pubertal Stage and Insulin Resistance

Thomas Reinehr1

Published online: 8 January 2016# Springer Science+Business Media New York 2016

Abstract Pediatricians increasingly diagnose the metabolic syndrome (MetS) in recent years to describe cardiovascular risk and to guide management of the obese child. However, there is an ongoing discussion about how to define the MetS in childhood and adolescence. Since insulin resistancethe major driver of MetSis influenced by pubertal stage, it is questionable to use definitions for MetS in children and adolescents that do not take into account pubertal status. A metabolic healthy status in prepubertal stage does not predict a metabolic healthy status during puberty. Furthermore, cardiovascular risk factors improve at the end of puberty without treatment. However, having a uniform internationally accepted definition of the MetS for children and adolescents would be very helpful for the description of populations in different studies. Therefore, the concept of MetS has to be revisited under the influence of puberty stage.

Keywords Puberty . Definition . Metabolic Syndrome . Intervention . Obesity

Introduction

The increasing prevalence of obesity in childhood and adolescence poses a growing problem [1]. Obese children tend not only to become obese adults [1] but obesity is associated with

a wide range of serious complications already in childhood [2]. As in adulthood, obesity in childhood contributes to an increased prevalence of cardiovascular risk factors, such as hypertension, hypertriglyceridemia, low HDL-cholesterol, and impaired glucose metabolism [26]. The prevalence of these abnormalities is increasing in a parallel manner with the degree of overweight (Table 1). Obese children and adults without cardiovascular risk factors have been classified as metabolic healthy obese (MHO) [79]. A total of 6 % to 40 % of obese adults [10, 11] and 6 % to 36 % of obese children [8, 1214] are metabolically healthy.

The clustering of obesity, hypertension, dyslipidemia, and impaired glucose tolerance is associated with atherosclerosis and cardiovascular diseases...