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The Informed Parent

Metabolic Syndrome: A Child’s Slip Into Adult Medical Issues

by Shanna R. Cox, M.D., F.A.A.P.
Published on Nov. 21, 2005

The epidemic of childhood obesity is now a well-known national problem. The media, schools and government have paid significant attention to this alarming rise in our children's weight. There continues to be considerable discussion on preventive strategies and counseling that pediatricians, teachers and parents may provide. At the same time there is a whole population of children that are falling into a relatively new diagnosis of metabolic syndrome. Differing statistics estimate that between 20-40 percent of children are obese by BMI standards. Of these children a subset, likely those that are most obese, are meeting adult standards for metabolic syndrome and its associated risks.

Metabolic Syndrome is being actively investigated by multiple nationwide organizations. The National Cholesterol Education Program defines metabolic syndrome in a person who meets three-out-of-five of the following criteria: abdominal obesity, high fasting glucose, high triglycerides, low HDL (good cholesterol), and hypertension. These factors are associated as well with insulin resistance. Insulin resistance is the primary factor correlated with development of Type II Diabetes. All of these factors, independently and together, elevate an individual's risk for significant cardiovascular disease.

These issues have been part of adult medical literature for many years. The big news is that these adult problems are now also pediatric problems. But it is not the diagnosis that is difficult. These are well-known medical entities, with well-known outcomes. The question is when to expect these outcomes in children. Since children are developing these symptoms as early as seven years of age, will they develop concurrent problems of coronary artery disease, myocardial infarction, or stroke as adolescents? Nationwide pediatric organizations are looking to develop models that will fit childhood metabolic syndrome and will identify differences in rate or result of medical morbidity and mortality.

We can calculate weight, height and BMI directly during a routine physical visit. Now specialists are also considering asking clinicians to screen overweight children with a laboratory test that would require a fasting blood draw. Researchers believe that an elevated fasting insulin and/or glucose level may highlight those children that are at highest risk for the rapid development of metabolic syndrome. By identifying these individuals, guidelines may be developed to aggressively intervene a prevention of lifetime morbidities. Children particularly at risk are those that have parents who are obese, are of Hispanic origin, or have a familial history of hypercholesterolemia. Ask your pediatrician if your child's weight is healthy at each physical visit. Actively limit their exposure to sugared beverages as these items have been shown to have a strong linear correlation with obesity.

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