Aggiornamento
La sindrome metabolica in età pediatrica
METABOLIC SYNDROME IN THE PAEDIATRIC AGE
Ebe D’Adamo1,2, Angelika Mohn1, Francesco Chiarelli1
1Clinica Pediatrica, Università di Chieti
2Department of Pediatrics, Yale University, New Haven, USA
Febbraio 2010 - pagg. 92 -97
Abstract
Metabolic syndrome (MS) is a cluster of metabolic abnormalities, including hypertension,
dyslipidemia, central obesity and impaired glucose tolerance (IGT); it represents an important
risk factor for the development of cardiovascular diseases and type 2 diabetes
(T2DM). Because of the increasing prevalence of childhood obesity, the prevalence of MS
is rising among children and adolescents. Although the literature generally agrees that MS
is a common finding already in the pediatric age group, there is no general consensus on
how to define MS in children and adolescents. However, given the progressive increase in
metabolic and cardiovascular complications in this age group affected by obesity, an early
diagnosis of these metabolic disorders results relevant in order to prevent development of
further consequences related to the persistence and exacerbation of metabolic abnormalities
during adolescence and adult life. This review aims at summarizing the most relevant
and recent findings concerning the MS in children and adolescents.
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Bibliografia
1. Cali AM, Caprio S. Obesity in children and
adolescents. J Clin Endocrinol Metab 2008;93:
31-6.
2. Zimmet P, Alberti KG, Kaufman F, et al. IDF Consensus Group. The metabolic syndrome in children and adolescents - an IDF consensus report. Pediatr Diabetes 2007;8:299-306.
3. Reaven GM. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes 1988;37:1595-607.
4. Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet 2005;365:1415-28.
5. Grundy SM. Drug therapy of the metabolic syndrome: minimizing the emerging crisis in polypharmacy. Nat Rev Drug Discov 2006;5: 295-309.
6. Weiss R, Caprio S. The metabolic consequences of childhood obesity. Best Pract Res Clin Endocrinol Metab 2005;19:405-19.
7. Lien FL, Guyton JR. Metabolic syndrome. Dermatologic Therapy 2008;21:362-75.
8. Cook S, Weitzman M, Auinger P, et al. Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination Survey, 1988-1994. Arch Pediatr Adolesc Med 2003; 157:821-7.
9. De Ferranti SD, Gauvreau K, Ludwig DS, et al. Prevalence of the metabolic syndrome in American adolescents: findings from the third national health and nutrition examination survey. Circulation 2004;110:2494-7.
10. Cruz ML, Weigensberg MJ, Huang TT, et al. The metabolic syndrome in overweight Hispanic youth and the role of insulin sensitivity. J Clin Endocrinol Metab 2004;89:108-13.
11. Ford ES, Ajani UA, Mokdad AH; National Health and Nutrition Examination. The metabolic syndrome and concentrations of C-reactive protein among U.S. youth. Diabetes Care 2005;28:878-81.
12. Goodman E, Daniels SR, Morrison JA, et al. Contrasting prevalence of and demographic disparities in the World Health Organization and National Cholesterol Education Program Adult Treatment Panel III definitions of metabolic syndrome among adolescents. J Pediatr 2004;145:445-51.
13. Chi CH, Wang Y, Wilson DM, et al. Definition of metabolic syndrome in preadolescent girls. J Pediatr 2006;148:788-792.
14. Freedman DS, Serdula MK, Srinivasan SR, et al. Relation of circumferences and skinfold thicknesses to lipid and insulin concentrations in children and adolescents: the Bogalusa Heart Study. Am J Clin Nutr 1999;69:308-17.
15. Invitti C, Maffeis C, Gilardini L, et al. Metabolic syndrome in obese Caucasian children: prevalence using WHO-derived criteria and association with nontraditional cardiovascular risk factors. Int J Obes (London) 2006; 30:627-33.
16. World Health Organization. Obesity. Preventing and Managing the Global Epidemic. Publication WHO/NUT/NCD/98.1.1998. Geneva, Switzerland: World Health Organization; 1998.
17. Centers for Disease Control and Prevention (CDC). http://www.cdc.gov/obesity/ childhood/defining.html.
18. Freedman DS, Mei Z, Srinivasan SR, Berenson GS, Dietz WH. Cardiovascular risk factors and excess adiposity among overweight children and adolescents: the Bogalusa Heart Study. J Pediatr 2007;150:12-7.
19. Fernández JR, Redden DT, Pietrobelli A, et al. Waist circumference percentiles in nationally representative samples of African- American, European-American, and Mexican- American children and adolescents. J Pediatr 2004;145:439-44.
20. Janssen I, Katzmarzyk PT, Srinivasan SR, et al. Combined influence of body mass index and waist circumference on coronary artery disease risk factors among children and adolescents. Pediatrics 2005;115:1623-30.
21. Pouliot MC, Després JP, Lemieux S, et al. Waist circumference and abdominal sagittal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women. Am J Cardiol 1994;73:460-8.
22. Dobbelsteyn CJ, Joffres MR, MacLean DR, et al. A comparative evaluation of waist circumference, waist-to-hip ratio and body mass index as indicators of cardiovascular risk factors. The Canadian Heart Health Surveys. Int J Obes Relat Metab Disord 2001;25:652-61.
23. Maffeis C, Pietrobelli A, Grezzani A, et al. Waist circumference and cardiovascular risk factors in prepubertal children. Obes Res 2001;9:179-87.
24. Lee S, Bacha F, Gungor N, Arslanian SA. Waist circumference is an independent predictor of insulin resistance in black and white youths. J Pediatr 2006;148:188-94.
25. Terán-García M, Bouchard C. Genetics of Metabolic Syndrome. Appl Physiol Nutr Metab 2007;32:89-114.
26. Kraja AT, Hunt SC, Pankow JS, et al. An evaluation of the metabolic syndrome in the HyperGEN study. Nutr Metab 2005;18:2.
27. Weiss R, Shaw M, Savoy M, et al. Obesity dynamics and cardio-vascular risk factor stability in obese adolescents. Pediatric Diabetes 2009;10:360-7.
28. Steinberger J, Daniels SR, Eckel RH, et al. Progress and challenges in metabolic syndrome in children and adolescents: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in the Young Committee of the Council on Cardiovascular Disease in the Young; Council on Cardiovascular Nursing; and Council on Nutrition, Physical Activity, and Metabolism. Circulation 2009; 119:628-47.
29. Assimacopoulos-Jeannet F, Brichard S, Rencurel F, et al. In vivo effects of hyperinsulinemia on lipogenic enzymes and glucose transporter expression in rat liver and adipose tissues. Metabolism 1995;44:228-33.
30. Freedman DS, Dietz WH, Srinivasan SR, et al. The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Pediatrics 1999;103:1175-82.
31. Taittonen L, Uhari M, Nuutinen M, et al. Insulin and blood pressure among healthy children. Cardiovascular risk in young Finns. Am J Hypertens 1996;9:194-9.
32. Bao W, Scrinivansan SR, Berenson GS. Persistent elevation of plasma insulin levels is associated with increased cardiovascular risk in children and young adults: the Bogalusa Heart Study. Circulation 1996;93:54-9.
33. Sinaiko AR, Steinberger J, Moran A, et al. Relation of insulin resistance to blood pressure in childhood. J Hypertens 2002;20:509-17.
34. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabet Care 2008;31:55-60.
35. Fagot-Campagna A, Pettitt DJ, Engelau MM, et al. Type 2 diabetes among North American children and adolescents: an epidemiologic review and a public health perspective. J Pediatr 2000;136:664-72.
36. Sinha R, Fisch G, Teague B, et al. Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med 2002;346:802-10.
37. Invitti C, Gilardini L, Viberti G. Impaired glucose tolerance in obese children and adolescents. N Engl J Med 2002;347:290-2.
38. Gungor N, Arslanian S. Progressive beta cell failure in type 2 diabetes mellitus of youth. J Pediatr 2004;44:656-9.
39. Weiss R, Taksali SE, Tamborlane WV, et al. Predictors of change in glucose tolerance status in obese youth. Diabetes Care 2005;28: 902-9.
40. West NA, Hamman RF, Mayer-Davis EJ, et al. Cardiovascular risk factors among youth with and without type 2 diabetes: differences and possible mechanisms. Diabetes Care 2009;32:175-80.
41. American Diabetes Association. Type 2 diabetes in children and adolescents. Diabetes Care 2000;23:381-9.
42. Roberts CK, Won D, Pruthi S, et al. Effect of a short-term diet and exercise intervention on oxidative stress, inflammation, MMP-9, and monocyte chemotactic activity in men with metabolic syndrome factors. J Appl Physiol 2006;100:1657-65.
43. Schmitz KH, Jacobs DR, Hong CP, et al. Association of physical activity with insulin sensitivity in children. Int J Obes Relat Metab Disord 2002;26:1310-6.
44. Steffen LM, Jacobs DR, Stevens J, et al. Associations of whole grain, refined grain, and fruit and vegetable consumption with all-cause mortality and incident coronary heart disease and ischemic stroke: the Atherosclerosis Risk in Communities (ARIC) Study. Am J Clin Nutr 2003;78:383-90.
45. Kromhout D, Menotti A, Kesteloot H, et al. Prevention of coronary heart disease by diet and lifestyle: evidence from prospective crosscultural, cohort, and intervention studies. Circulation 2002;105:893-8.
46. Song Y, Ridker PM, Manson JE, et al. Magnesium intake, C-reactive protein, and the prevalence of metabolic syndrome in middleaged and older US women. Diabetes Care 2005;28:1438-44.
47. Estruch R, Martínez-González MA, Corella D, et al. PREDIMED Study Investigators. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med 2006;145:1-11.
48. Gidding SS, Dennison BA, Birch LL, et al. Dietary recommendations for children and adolescents: a guide for practitioners: consensus statement from the American Heart Association Circulation 2005;112:2061-75.
49. Burgert TS, Duran EJ, Goldberg-Gell R, et al. Short-term metabolic and cardiovascular effects of metformin in markedly obese adolescents with normal glucose tolerance. Pediatr Diabetes 2008;9:567-76.
50. Iughetti L, Predieri B, Balli F, et al. Rational approach to the treatment for heterozygous familial hypercholesterolemia in childhood and adolescence: a review. J Endocrinol Invest 2007;30:700-19.
2. Zimmet P, Alberti KG, Kaufman F, et al. IDF Consensus Group. The metabolic syndrome in children and adolescents - an IDF consensus report. Pediatr Diabetes 2007;8:299-306.
3. Reaven GM. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes 1988;37:1595-607.
4. Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet 2005;365:1415-28.
5. Grundy SM. Drug therapy of the metabolic syndrome: minimizing the emerging crisis in polypharmacy. Nat Rev Drug Discov 2006;5: 295-309.
6. Weiss R, Caprio S. The metabolic consequences of childhood obesity. Best Pract Res Clin Endocrinol Metab 2005;19:405-19.
7. Lien FL, Guyton JR. Metabolic syndrome. Dermatologic Therapy 2008;21:362-75.
8. Cook S, Weitzman M, Auinger P, et al. Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination Survey, 1988-1994. Arch Pediatr Adolesc Med 2003; 157:821-7.
9. De Ferranti SD, Gauvreau K, Ludwig DS, et al. Prevalence of the metabolic syndrome in American adolescents: findings from the third national health and nutrition examination survey. Circulation 2004;110:2494-7.
10. Cruz ML, Weigensberg MJ, Huang TT, et al. The metabolic syndrome in overweight Hispanic youth and the role of insulin sensitivity. J Clin Endocrinol Metab 2004;89:108-13.
11. Ford ES, Ajani UA, Mokdad AH; National Health and Nutrition Examination. The metabolic syndrome and concentrations of C-reactive protein among U.S. youth. Diabetes Care 2005;28:878-81.
12. Goodman E, Daniels SR, Morrison JA, et al. Contrasting prevalence of and demographic disparities in the World Health Organization and National Cholesterol Education Program Adult Treatment Panel III definitions of metabolic syndrome among adolescents. J Pediatr 2004;145:445-51.
13. Chi CH, Wang Y, Wilson DM, et al. Definition of metabolic syndrome in preadolescent girls. J Pediatr 2006;148:788-792.
14. Freedman DS, Serdula MK, Srinivasan SR, et al. Relation of circumferences and skinfold thicknesses to lipid and insulin concentrations in children and adolescents: the Bogalusa Heart Study. Am J Clin Nutr 1999;69:308-17.
15. Invitti C, Maffeis C, Gilardini L, et al. Metabolic syndrome in obese Caucasian children: prevalence using WHO-derived criteria and association with nontraditional cardiovascular risk factors. Int J Obes (London) 2006; 30:627-33.
16. World Health Organization. Obesity. Preventing and Managing the Global Epidemic. Publication WHO/NUT/NCD/98.1.1998. Geneva, Switzerland: World Health Organization; 1998.
17. Centers for Disease Control and Prevention (CDC). http://www.cdc.gov/obesity/ childhood/defining.html.
18. Freedman DS, Mei Z, Srinivasan SR, Berenson GS, Dietz WH. Cardiovascular risk factors and excess adiposity among overweight children and adolescents: the Bogalusa Heart Study. J Pediatr 2007;150:12-7.
19. Fernández JR, Redden DT, Pietrobelli A, et al. Waist circumference percentiles in nationally representative samples of African- American, European-American, and Mexican- American children and adolescents. J Pediatr 2004;145:439-44.
20. Janssen I, Katzmarzyk PT, Srinivasan SR, et al. Combined influence of body mass index and waist circumference on coronary artery disease risk factors among children and adolescents. Pediatrics 2005;115:1623-30.
21. Pouliot MC, Després JP, Lemieux S, et al. Waist circumference and abdominal sagittal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women. Am J Cardiol 1994;73:460-8.
22. Dobbelsteyn CJ, Joffres MR, MacLean DR, et al. A comparative evaluation of waist circumference, waist-to-hip ratio and body mass index as indicators of cardiovascular risk factors. The Canadian Heart Health Surveys. Int J Obes Relat Metab Disord 2001;25:652-61.
23. Maffeis C, Pietrobelli A, Grezzani A, et al. Waist circumference and cardiovascular risk factors in prepubertal children. Obes Res 2001;9:179-87.
24. Lee S, Bacha F, Gungor N, Arslanian SA. Waist circumference is an independent predictor of insulin resistance in black and white youths. J Pediatr 2006;148:188-94.
25. Terán-García M, Bouchard C. Genetics of Metabolic Syndrome. Appl Physiol Nutr Metab 2007;32:89-114.
26. Kraja AT, Hunt SC, Pankow JS, et al. An evaluation of the metabolic syndrome in the HyperGEN study. Nutr Metab 2005;18:2.
27. Weiss R, Shaw M, Savoy M, et al. Obesity dynamics and cardio-vascular risk factor stability in obese adolescents. Pediatric Diabetes 2009;10:360-7.
28. Steinberger J, Daniels SR, Eckel RH, et al. Progress and challenges in metabolic syndrome in children and adolescents: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in the Young Committee of the Council on Cardiovascular Disease in the Young; Council on Cardiovascular Nursing; and Council on Nutrition, Physical Activity, and Metabolism. Circulation 2009; 119:628-47.
29. Assimacopoulos-Jeannet F, Brichard S, Rencurel F, et al. In vivo effects of hyperinsulinemia on lipogenic enzymes and glucose transporter expression in rat liver and adipose tissues. Metabolism 1995;44:228-33.
30. Freedman DS, Dietz WH, Srinivasan SR, et al. The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Pediatrics 1999;103:1175-82.
31. Taittonen L, Uhari M, Nuutinen M, et al. Insulin and blood pressure among healthy children. Cardiovascular risk in young Finns. Am J Hypertens 1996;9:194-9.
32. Bao W, Scrinivansan SR, Berenson GS. Persistent elevation of plasma insulin levels is associated with increased cardiovascular risk in children and young adults: the Bogalusa Heart Study. Circulation 1996;93:54-9.
33. Sinaiko AR, Steinberger J, Moran A, et al. Relation of insulin resistance to blood pressure in childhood. J Hypertens 2002;20:509-17.
34. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabet Care 2008;31:55-60.
35. Fagot-Campagna A, Pettitt DJ, Engelau MM, et al. Type 2 diabetes among North American children and adolescents: an epidemiologic review and a public health perspective. J Pediatr 2000;136:664-72.
36. Sinha R, Fisch G, Teague B, et al. Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med 2002;346:802-10.
37. Invitti C, Gilardini L, Viberti G. Impaired glucose tolerance in obese children and adolescents. N Engl J Med 2002;347:290-2.
38. Gungor N, Arslanian S. Progressive beta cell failure in type 2 diabetes mellitus of youth. J Pediatr 2004;44:656-9.
39. Weiss R, Taksali SE, Tamborlane WV, et al. Predictors of change in glucose tolerance status in obese youth. Diabetes Care 2005;28: 902-9.
40. West NA, Hamman RF, Mayer-Davis EJ, et al. Cardiovascular risk factors among youth with and without type 2 diabetes: differences and possible mechanisms. Diabetes Care 2009;32:175-80.
41. American Diabetes Association. Type 2 diabetes in children and adolescents. Diabetes Care 2000;23:381-9.
42. Roberts CK, Won D, Pruthi S, et al. Effect of a short-term diet and exercise intervention on oxidative stress, inflammation, MMP-9, and monocyte chemotactic activity in men with metabolic syndrome factors. J Appl Physiol 2006;100:1657-65.
43. Schmitz KH, Jacobs DR, Hong CP, et al. Association of physical activity with insulin sensitivity in children. Int J Obes Relat Metab Disord 2002;26:1310-6.
44. Steffen LM, Jacobs DR, Stevens J, et al. Associations of whole grain, refined grain, and fruit and vegetable consumption with all-cause mortality and incident coronary heart disease and ischemic stroke: the Atherosclerosis Risk in Communities (ARIC) Study. Am J Clin Nutr 2003;78:383-90.
45. Kromhout D, Menotti A, Kesteloot H, et al. Prevention of coronary heart disease by diet and lifestyle: evidence from prospective crosscultural, cohort, and intervention studies. Circulation 2002;105:893-8.
46. Song Y, Ridker PM, Manson JE, et al. Magnesium intake, C-reactive protein, and the prevalence of metabolic syndrome in middleaged and older US women. Diabetes Care 2005;28:1438-44.
47. Estruch R, Martínez-González MA, Corella D, et al. PREDIMED Study Investigators. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med 2006;145:1-11.
48. Gidding SS, Dennison BA, Birch LL, et al. Dietary recommendations for children and adolescents: a guide for practitioners: consensus statement from the American Heart Association Circulation 2005;112:2061-75.
49. Burgert TS, Duran EJ, Goldberg-Gell R, et al. Short-term metabolic and cardiovascular effects of metformin in markedly obese adolescents with normal glucose tolerance. Pediatr Diabetes 2008;9:567-76.
50. Iughetti L, Predieri B, Balli F, et al. Rational approach to the treatment for heterozygous familial hypercholesterolemia in childhood and adolescence: a review. J Endocrinol Invest 2007;30:700-19.
Corrispondenza: chiarell@unich.it