Clinicians should screen for and treat the individual risk factor components of “metabolic syndrome” (MetS) and avoid trying to define what the syndrome means in pediatric care, according to a new AAP clinical report.
In adults, the term MetS is used to identify those at risk of diabetes and cardiovascular disease when they have at least three of five cardiometabolic risk factors: hyperglycemia, increased central adiposity, elevated triglycerides, decreased high-density lipoprotein cholesterol and elevated blood pressure.
In children, however, MetS “is difficult to define and has unclear implications for clinical care,” according to The Metabolic Syndrome in Children and Adolescents: Shifting the Focus to Cardiometabolic Risk Factor Clustering. The report from the AAP Committee on Nutrition, Section on Endocrinology and Section on Obesity is available at https://doi.org/10.1542/peds.2017-1603 and will be published in the August issue of Pediatrics.
The report discusses the pathophysiology, the nuances of the definitions of MetS, the determinants of metabolic risk factor clustering, comorbidities, screening and treatment.
Following are key points:
- The focus for clinical screening and treatment should be on cardiometabolic risk factors, many of which cluster together and are associated with obesity.
- Pediatricians should not focus on the specific levels of cardiometabolic risk factors from the multitude of MetS definitions because the risk lies on a continuum and in the context of the whole child.
- To address the major MetS-associated cardiometabolic risks in pediatric populations, follow recommendations for screening and treatment of obesity, glucose abnormalities, hypertension and dyslipidemia.
- By identifying children with multiple component risks, pediatricians can apply the most intensive intervention efforts to the patients in greatest need of risk reduction.
- Increase awareness of comorbid conditions — such as nonalcoholic fatty liver disease, mental health disorders, polycystic ovary syndrome and obstructive sleep apnea — to address these issues and refer patients to specialists as needed.