This article is a collaboration between MedPage Today and:
Identifying cardiometabolic risk factors in children can help to prevent chronic health problems such as heart disease and type 2 diabetes, suggested a new clinical report from the American Academy of Pediatrics.
While pediatricians can use metabolic syndrome (MetS) -- defined as a specific cluster of at least three of five diagnostic criteria -- as an organizing frame, clinical screening in children should focus on cardiometabolic risk factors, wrote Sheela N. Magge, MD, MSCE, of the George Washington University School of Medicine and Health Sciences, and colleagues in .
"Rather than worrying about how to diagnose metabolic syndrome, we should consider each risk factor individually and treat as its own problem, and recognize that some clusters of risk factors commonly occur together, and should be treated seriously as they are accompanied by high risk for future illness," co-author Sarah Armstrong, MD, of Duke University, told MedPage Today.
Magge echoed that sentiment, commenting that "rather than focus on a particular cut point to fit a definition, it makes more sense to screen children for the risk factors."
These factors include obesity, high blood sugar, high triglycerides, low HDL cholesterol, and high blood pressure.
The AAP report noted that there are currently more than 40 different definitions of MetS with no clear consensus on whether the condition should even be defined in the pediatric population. Part of this confusion stems from the instability of MetS during childhood, as well as racial and ethnic differences in rates of obesity and MetS components.
In line with recommendations from the American Diabetes Association and the American Heart Association, the authors suggested that primary care physicians perform annual obesity screening for all children with BMI at or greater than the 95th percentile, as well as annual screenings for elevated blood pressure. They also recommended screening for glucose abnormalities, dyslipidemia, obstructive sleep apnea, polycystic ovarian syndrome, and fatty liver disease.
Armstrong noted that while "there are no easy solutions," screening for these known obesity-associated risks can help pediatricians ensure that obesity doesn't lead to metabolic consequences.
Treatment of MetS should focus on both behavioral and pharmacotherapeutic interventions that target individual risk factors. The report specifically mentioned moderate- to high-intensity weight-loss programs which have been shown to both decrease weight and improve cardiometabolic risk factors such as dyslipidemia and hypertension. Even small amounts of weight loss can offer big benefits, noted the researchers.
Pharmacotherapeutic treatment options for childhood obesity are limited; only orlistat (Xenical) has an FDA indication for weight loss in adolescents as young as 12 years of age. And bariatric surgery in adolescents is reserved for only the most severely affected.
Looking forward, the team called for continued efforts to prevent and treat obesity and its associated metabolic abnormalities, as well as focus on the early diagnosis of diabetes.
"Metabolic health in childhood lays the foundation for lifelong metabolic health in adulthood. Pediatricians can help improve lifelong health by identifying children who are at greater risk for heart disease and diabetes earlier in life," concluded co-author Elizabeth Goodman, MD, of Harvard Medical School.
Disclosures
The authors reported no financial disclosures of interest.
Primary Source
Pediatrics
Magge SN, et al "The metabolic syndrome in children and adolescents: shifting the focus to cardiometabolic risk factor clustering" Pediatrics 2017; DOI: 10.1542/peds.2017-1603.