Progress and Challenges in Metabolic Syndrome in Children and Adolescents
Authors: Julia Steinberger, Stephen R. Daniels, Robert H. Eckel, Laura Hayman, Robert H. Lustig, Brian McCrindle, Michele L. Mietus-Snyder
Journal: Circulation (2009)

Cardiovascular Risk in Children from the Atherosclerosis, Hypertension, and Obesity in the Young Committee (Council on Cardiovascular Disease in the Young) and the Diabetes Committee (Council on Nutrition, Physical Activity, and Metabolism). 1 Since the writing of the above document, substantial new information has emerged in children on the clustering of obesity, insulin resistance, inflammation, and other risk factors and their collective role in conveying heightened risk for atherosclerotic cardiovascular disease (ASCVD) and type 2 diabetes mellitus (T2DM).A constellation of these interrelated cardiovascular risk factors in adults has come to be known as the metabolic syndrome (MetS), a construct useful both in clinical and research areas.Most recently, the American Heart Association and the National Heart, Lung, and Blood Institute produced a consensus statement intended to provide up-to-date guidance on the diagnosis and management of the MetS in adults. 2 The aim of this statement is to provide not a definition of the MetS but a set of fundamental questions about what the MetS means in a clinical or research setting.It calls attention to the fact that the stability of the MetS, especially for adolescents, is low, which raises questions about the utility of the MetS in a clinical context.For these reasons, we have focused on cardiometabolic risk factors and have called for the types of research that would hopefully provide much needed answers in this area.This statement aims to represent a balanced and critical appraisal of the strengths and weaknesses of the MetS concept in pediatric patients.It focuses on the pediatric issues related to cardiometabolic risk factors, primarily on the progress that has been made in recognizing the components of the MetS in children, their interrelations, and their importance as predictors of longitudinal risk for ASCVD and T2DM, based on evidence accumulated over recent years and on the consensus of experts in the field.It also addresses the need for early detection and preventive measures regarding cardiometabolic risk factors in children and adolescents, with a strong focus on obesity, inflammation, insulin resistance, dyslipidemia, and hypertension, which emerge as core elements of morbidity.Because of the limited data that track individuals from childhood to adulthood, little is known about how well pediatric MetS predicts adult disease.This statement also defines the limits of our current knowledge and provides suggestions for needed future research.To provide more insightful and concrete recommendations for clinicians and families as we face the increasing burden of childhood obesity, lipid abnormalities, diabetes mellitus, high blood pressure, and other associated morbidities, the urgent need for vigorous research at the national and international level is obvious, so that lifestyle modification and at times medication may be used to reduce ASCVD risk to follow.The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel.Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.