[Does the metabolic syndrome in children and youth exist?].
There is an increasing incidence rate of overweight and obesity in last years. It concerns approximately 20% of children 7 to 11 years in our country, and even 30% in high developed countries. There is also simultaneous increase in frequency of the disturbances, that are dependent from obesity and insulin resistance, such as glucose and fats metabolism disorders, and arterial hypertension. They cause complications of cardiovascular system detected in the youngest children, such as thickening of the carotid wall and atherosclerotic lesions in the arteries. The metabolic syndrome (MS) may be recognized on the basis of appearance of these disorders in approximately 1-10% children in that group of age in general population, and in 10-67% in obese children. The differences depend on applied criteria (Cook, 2003; de Ferranti, 2004; Cruz, 2004; Weiss, 2004; Ford, 2005; IDF 2007), patients' age, and obesity duration, and may lead to non-recognition of MS in approximately 10-25% of obese children (using IDF 2007 criteria). The lack of recognition can lead to postponement of the treatment of each individual component of the syndrome, while every of them, and especially visceral obesity, is the independent risk factor of cardiovascular disorders, as well as preterm mortality. With passed regards, an attempt to establish or exclude the MS diagnosis is pointless, and even harmful, as well as searching for and specifying criteria of its recognition. The next arguments against MS recognizing are showed in adults: i) the weaker correlation between the MS recognized in patients using recently recommended IDF 2005 criteria and later cardiovascular complications, in contrary to earlier criteria (ATP III) ii) no proof for higher risk of complications development in cases with three components of the MS, in comparison to cases with only two criteria (ATP III), and iii) the lack of influence of MS diagnosis on the way of treatment of each component. It is necessary to start the treatment in case of revealing of any risk factor, as well as to look for other disorders. They can be recognized on the basis of specific for sex and age MS diagnostic criteria. However it has to be considered, that in IDF 2007 criteria the value of upper limit of normal arterial pressure in children (> or =130/85 mmHg) has been settled arbitrarily, without taking into account the age nor the sex, and the waist circumference, as the indicator of visceral obesity, does not correlate in children, contrary to subcutaneous fat tissue content, with the degree of insulin resistance. The basis of the therapy of metabolic disorders in MS, is the treatment of obesity, and especially its prophylaxis. The settlement of the pharmacological treatment modality and the age of its beginning needs further investigations.
Starzyk
Jerzy
J
Klinika Endokrynologii Dzieci i Młodziezy Katedry Pediatrii, Polsko-Amerykański Instytut Pediatrii, Uniwersytet Jagielloński Collegium Medium w Krakowie. jerzy.starzyk@interia.pl
Wójcik
Małgorzata
M
Nazim
Joanna
J
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000628:therapy; D002648:Child; D003937:Diagnosis, Differential; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D015994:Incidence; D007333:Insulin Resistance; D024821:Metabolic Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D012307:Risk Factors