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Diagnosing Pediatric Metabolic Syndrome Is Problematic

Characteristics of metabolic syndrome are not stable in children.

Adult metabolic syndrome is defined as high waist circumference, abnormal fasting glucose, hyperlipidemia, and hypertension. In adults, these factors have high long-term stability (75% during 3 years) and are associated with excess risk for cardiovascular disease and type 2 diabetes. In children, however, metabolic syndrome is not well defined, and some longitudinal studies show poor stability of metabolic syndrome characteristics over time. These investigators examined both short-term and long-term stability of metabolic syndrome in children. The authors defined pediatric metabolic syndrome as three or more of the following: waist circumference, systolic or diastolic blood pressure, and fasting triglycerides 90th percentile; high-density lipoprotein cholesterol 10th percentile; fasting glucose 100 mg/dL.

Short-term stability was examined in 220 obese patients (body-mass index [BMI] 95th percentile; age range, 6–17 years). Eligible children (age range, 6–11 years) also had hyperinsulinemia, and adolescents (age range, 12–17 years) had one of the following: hyperinsulinemia, hyperlipidemia, sleep apnea, elevated liver function tests, abnormal fasting glucose, or hypertension. Most participants were older than 12 years, female, and black. At baseline, 38 patients (17%) exhibited metabolic syndrome, and, at a mean follow-up of 20 days, 70 patients (32%) showed metabolic syndrome. Nearly one third of patients with metabolic syndrome at baseline did not meet criteria at follow-up.

Long-term stability was examined in 146 children (age range, 6–12 years) who were at risk for adult obesity because they were obese (BMI 95th percentile for age) or had one obese parent (BMI 25 kg/m²). None had comorbid conditions. Most participants were younger than 11 years, female, and white. At baseline, 39% were obese, and 8% exhibited metabolic syndrome. At a mean follow-up of 6 years, 47% were obese, and 9% exhibited metabolic syndrome. Nearly half the patients with metabolic syndrome at baseline did not meet criteria at follow-up. No individual component of metabolic syndrome demonstrated short-term or long-term stability.

Comment: This study demonstrates the difficulty of diagnosing metabolic syndrome in a pediatric population, even in patients at high risk for the disease. Perhaps metabolic syndrome is not a stable entity until children are postpubertal, or perhaps the correct criteria that define metabolic syndrome in children have not been identified. Until the pediatric metabolic syndrome is better defined, we need to continue to monitor obese children and adolescents for the individual abnormalities of metabolic syndrome and treat them accordingly.

— Robin Drucker, MD

Published in Journal Watch Pediatrics and Adolescent Medicine January 13, 2010

Citation(s):

Gustafson JK et al. The stability of metabolic syndrome in children and adolescents. J Clin Endocrinol Metab 2009 Dec; 94:4828.

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