How is metabolic syndrome diagnosed and managed in children?

From the Guidelines

Metabolic syndrome in children is diagnosed when at least three of the following criteria are present: elevated waist circumference, elevated triglycerides, low HDL cholesterol, high blood pressure, and elevated fasting glucose, with management primarily focusing on lifestyle modifications rather than medications. The diagnosis of metabolic syndrome in children is complex due to the lack of a universally accepted definition, with various criteria being proposed, including those by the International Diabetes Federation 1. According to these criteria, for children 6 to 10 years old, obesity (defined as the 90th percentile of waist circumference) is a key factor, followed by further measurements as indicated by family history. For children 10 to 16 years old, obesity (defined as waist circumference at the 90th percentile) is also crucial, followed by the adult criteria for triglycerides, high-density lipoprotein cholesterol (HDL-C), blood pressure, and glucose.

Key components of the diagnosis include:

• Elevated waist circumference (above the 90th percentile for age and sex)
• Elevated triglycerides (≥110 mg/dL)
• Low HDL cholesterol (<40 mg/dL)
• High blood pressure (≥90th percentile for age, sex, and height)
• Elevated fasting glucose (≥100 mg/dL)

Management of metabolic syndrome in children primarily involves lifestyle modifications, including:

• A balanced diet rich in fruits, vegetables, whole grains, and lean proteins, while limiting processed foods, sugary beverages, and excessive carbohydrates
• At least 60 minutes of moderate to vigorous physical activity daily
• Weight management, with a goal of slowing weight gain rather than weight loss in growing children
• Regular monitoring of blood pressure, lipid profiles, and glucose levels

In severe cases where lifestyle changes are insufficient, medications may be considered, such as metformin for insulin resistance, statins for persistent dyslipidemia, or antihypertensives for uncontrolled hypertension, though these are used cautiously in pediatric patients 1. Family involvement is critical for successful management, as parents control the food environment and serve as role models for healthy behaviors. Early intervention is vital because metabolic syndrome in childhood significantly increases the risk of type 2 diabetes, cardiovascular disease, and other health complications in adulthood.

From the Research

Diagnostic Criteria for Metabolic Syndrome in Children

• The main features defining metabolic syndrome (MetS) in children include:
  • Disturbed glucose metabolism
  • Arterial hypertension
  • Dyslipidemia
  • Abdominal obesity 2
• There is no international commonly used definition of MetS in children and adolescents, but all definitions include obesity as a precondition for the development of MetS 3
• The World Health Organization (WHO) definition of overweight and obesity in children and adolescents is recommended to avoid conflicts concerning the definition of overweight and obesity 3

Laboratory Assessment and Diagnosis

• The complex physiology of growing and developing children and adolescents adds to the difficulties in standardizing laboratory assessment, diagnosis, and prognosis for the diverse pediatric population 4
• Establishing a consensus definition is critical to identifying and managing children and adolescents at high risk of developing MetS 4
• Novel metabolic syndrome biomarkers that can detect metabolic abnormalities early with high specificity and sensitivity in the pediatric population are of interest 4

Management and Treatment

• Lifestyle interventions, such as nutritional education and physical activity, are the first approach to managing MetS in children 5
• Pharmacological intervention, such as metformin, may be needed in some cases to improve insulin sensitivity, but long-term and consistent data are still missing 5
• Bariatric surgery might be helpful in selected cases 5
• Management includes addressing each of the syndrome's components individually with weight loss and lifestyle modifications as the basic approach 6

Clinical Significance and Prediction of Future Risk

• MetS in children and adolescents remains a controversial issue despite extensive research in the field 6
• It is still uncertain which definition should be used for its diagnosis in this age group, what is the clinical significance of such a diagnosis, and how reliably it can predict the future risk of developing cardiovascular disease and type 2 diabetes mellitus 6
• MetS in children and adolescents should be used clinically as a conceptual framework for the identification of risk factors clustered around obesity and insulin resistance rather than a syndrome that needs to be diagnosed by measuring absolute "all-or-none" criteria 6