Pediatric practitioners also need to have an increased awareness for metabolic syndrome. This syndrome comprises a group of risk factors that indicates an increase in the risk for developing type 2 DM and premature cardiovascular disease in adults (5,6). The concept that insulin resistance and associated metabolic abnormalities, including lipid and blood pressure abnormalities and type 2 DM, increase the risk of atherosclerotic cardiovascular disease in adults was first proposed by Reaven in 1988 at the American Diabetes Association’s annual meeting (7). The metabolic syndrome is known by many names, including syndrome X, insulin resistance syndrome, dysmetabolic syndrome, Reaven’s syndrome, and metabolic cardiovascular syndrome.
Several diagnostic criteria have been proposed for metabolic syndrome, with the two most widely used definitions in adults established by the World Health Organization (WHO) (8) and the U.S. National Cholesterol Education Program (NECP) (9). Table 4 outlines these criteria. Although diagnostic criteria exist for adults, the definition of metabolic syndrome in the pediatric population is nonexistent (10). However, metabolic syndrome in adults has been shown to have its roots in childhood (11). Early recognition and intervention by the pediatrician is therefore critical to the treatment of metabolic syndrome.
Table 4. Diagnostic Criteria of Metabolic Syndrome in Adults
|US National Cholesterol Education Program (NCEP)*||World Health Organization (WHO) †|
|High fasting plasma glucose ≥110mg/dL||Dysglycemia: type 2 diabetes, impaired glucose tolerance, impaired fasting glucose, or insulin resistance|
|Abdominal obesity: waist circumference >40 inches (men) or >35 inches (women)||Obesity in adults, BMI >30 or waist-hip ratio >0.90 (men) or >0.85 (women)|
|Hypertriglyceridemia: TG ≥150 mg/dL||Dyslipidemia: TG ≥ 150 mg/dL, HDL <35 mg/dL (men), HDL <39 mg/dL (women)|
|HDL <40 mg/dL (men)
HDL <50 mg/dL (women)
|Hypertension ≥160/90 mm Hg)|
|Blood pressure ≥130/85 mm Hg||Microalbuminuria: urinary albumin excretion rate ≥20 μg/min or albumin/creatinine ratio ≥20 mg/g|
*NCEP: must meet three of five criteria.
†WHO: must meet glucose/insulin criterion and two more.