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CO-MORBIDITIES , continued

12. Metabolic Syndrome (Ferranti, 2004; Johnson, 2009; Katzmarzyk, 2004; Weiss, 2004; Yang, 2008)

The metabolic syndrome is described as a set of risk factors for cardiovascular disease and diabetes mellitus and is related to obesity and insulin resistance. The definition of metabolic syndrome includes abnormalities in the following five areas:

  1. Increased waist circumference or abdominal adiposity
  2. Increased serum triglycerides
  3. Decreased HDL
  4. Elevated blood pressure
  5. Abnormal plasma glucose level

There is no standardized definition of metabolic syndrome for children and adolescents, but the adult guidelines have been adapted in a variety of different ways.

Adult definition of metabolic syndrome

ATP III (Adult Treatment Panel III) IDF (International Diabetes Federation)
Waist circumference in men >102 cm (40 in) and in women >88 cm (35 in) increased - different waist circumference thresholds set for different race/ethnicity groups (George, 2005) (must be present for the diagnosis)
Serum triglycerides ≥150 mg/dL or drug treatment for elevated triglycerides

Triglycerides >150 mg/dL or treatment for elevated triglycerides

Serum HDL cholesterol <40 mg/dL in men and <50 mg/dL in women or drug treatment for low HDL-C <40 mg/dL in men or <50 mg/dL in women, or treatment for low HDL
Blood pressure ≥130/85 mmHg or drug treatment for elevated blood pressure Systolic blood pressure >130, diastolic blood pressure >85, or treatment for hypertension
Fasting plasma glucose plasma ≥100 mg/dL or drug treatment for elevated blood glucose. >100 mg/dL or previously diagnosed type 2 diabetes
Diagnosis > 3 of the above criteria increased waist circumference plus > 2 of the other criteria

Definition for children

The broad definition of metabolic syndrome includes obesity (especially abdominal or central adiposity), elevated triglyceride concentrations, low HDL concentrations, elevated blood pressure and elevated fasting glucose concentrations (Johnson, 2009).

Three or more of the five criteria are suggested for the diagnosis of metabolic syndrome. But, again, the cutoffs vary by institution and no one set of guidelines is accepted in all of pediatrics.

The International Diabetes Federation's definition of metabolic syndrome in children 10 to 16 years old is similar to that used for adults, except that the definition for adolescents uses ethnic-specific waist circumference percentiles and one cutoff level for HDL rather than a sex-specific cutoff. For children 16 years and older, the adult criteria can be used. For children younger than 10 years of age, metabolic syndrome cannot be diagnosed, but vigilance is recommended if the waist circumference is ≥90 percentile (Zimmet, 2007).

Adult Treatment Panel III definition (Ferranti, 2004): > 3 of the following criteria:

  • Waist circumference > 75th% for age and gender (Katzmarzyk, 2004)
  • Fasting blood glucose > 110 mg/dL
  • Fasting triglycerides > 100 mg/dL
  • HDL cholesterol < 50 mg/dL (except in adolescent boys 15-19 years where they used < 45 mg/dL)
  • Systolic blood pressure > 90th% for gender, age, and height

Updated version of above definition (Yang, 2008):

  • Waist circumference > 90th% for age and gender
  • Fasting blood glucose > 100 mg/dL
  • Fasting triglycerides > 110 mg/dL
  • HDL cholesterol <35 mg/dL
  • Systolic or diastolic blood pressure >90th% for height, age, and gender or currently taking antihypertensive medication