The metabolic syndrome in children and adolescents ? an IDF consensus report
Abstract
The growing worldwide prevalence of type 2 diabetes mellitus in the young, as underlined by an earlier International Diabetes Federation (IDF) Consensus Statement 1, has highlighted a significant shortfall of data on the epidemiology of the disorder and the identification and treatment of children and adolescents at risk of progression to this disease. Urbanization, unhealthy diets, and increasingly sedentary lifestyles have contributed to increase the prevalence of childhood obesity, particularly in developing countries 2. Current treatment initiatives include school-based programs addressing physical activity and diet, which have been conducted with mixed success in reducing adiposity. There are limited safety data supporting the use of drugs for the treatment of obesity and related conditions such as type 2 diabetes in children and adolescents, and non-compliance in this population suggests that pharmacotherapy is unlikely to be effective long term 1. Although criteria have now been developed for bariatric surgery in teenagers 3, there are few evidence-based data available to support the increasing use of this modality in adolescents. Governments and society in general must be made more aware of the problems associated with obesity and the likelihood of progression to the metabolic syndrome in children and adolescents. Obesity, particularly in the central (abdominal) region, has been determined as a key factor in the etiology of type 2 diabetes 2. The prediction of health risks associated with obesity in youth is improved by the additional inclusion of waist circumference (WC) measure to the body mass index (BMI) percentile 4, 5. Such observations reinforce the importance of including WC in the assessment of childhood obesity to identify those at increased metabolic risk as a result of excess abdominal fat 5. The role of obesity can clearly be demonstrated in Japan, where a parallel increase in type 2 diabetes and obesity in children has occurred over the past few decades 6. Central (abdominal) obesity is also a key component in the IDF definition of metabolic syndrome in adults 2. The link between obesity, metabolic syndrome, and type 2 diabetes has already been characterized in adult populations 2. At present, 50–80% of almost 250 million adults worldwide with diabetes 7 are at risk of death from cardiovascular disease. Those with the metabolic syndrome are also at increased risk being twice as likely to die from, and three times as likely to have, cardiovascular complications as compared with those without the syndrome 8, 9. In addition, adults with the metabolic syndrome have a fivefold greater risk of developing type 2 diabetes 10. Already, one-quarter of the world's adult population have metabolic syndrome 11, 12, and this condition is appearing with increasing frequency in children and adolescents, driven by the growing obesity epidemic in this young population 13-15. In 2004, the World Health Organization (WHO) reported that an estimated 22 million children younger than 5 yr of age and 10% of school-aged children, between 5 and 17 yr, were overweight or obese 16. WHO predicts that the prevalence of childhood obesity in developed and developing countries will continue to increase as has been seen in recent years. For example, from 1985 to 1997, in young Australians, the prevalence of overweight and obesity combined doubled and that of obesity trebled 17. In Thailand, the prevalence of obesity in those aged 5–12 yr increased from 12.2 to 15.6% in just 2 yr 18. In 2003–2004, 17.1% of children aged 2–19 yr in the USA were obese 19. Obesity is associated with an increase in cardiovascular risk factors (also indicators of metabolic syndrome) 20, and the persistence of these indicators from childhood and adolescence to young adulthood has been shown in several studies, including the Quebec Family Study 21, 22. Recently, the IDF released its guidelines for defining and diagnosing the metabolic syndrome in adults 2. The intention was to rationalize the existing multiple definitions of the syndrome and to avoid the confusion that arose as a result of conflicting opinions on the value of each set of criteria. The use of a single unified definition makes it possible to estimate the global prevalence of metabolic syndrome and make valid comparisons between nations. However, to date, there has not been a unified definition that can be used to assess risk in children and adolescents, and existing adult-based definitions of the metabolic syndrome may not be appropriate to address the problem in this age group. A study of adolescents using modified National Cholesterol Education Program (NCEP) [Adult Treatment Panel III (ATP III)] criteria 23 identified that 12% of the study group had the metabolic syndrome 24. When the ≥95th percentile of BMI was used as a cutoff point in the same study group, 31.3% were identified as having the syndrome, more than double of those previously found to be at risk. Duncan et al. 25
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For diagnosis of metabolic syndrome in children and adolescents, as well as in adults, WC rather than BMI is used as a diagnostic criterion.
“For diagnosis of metabolic syndrome (MS) in children and adolescents, as well as in adults, WC rather than BMI is used as a diagnostic criterion.13-15”
From Reference Values for Waist Circumference and Waist–Height Ratio in Korean Children and Adolescents (2022) · cites this paper as [15]
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- Authors
- Zimmet, P., Alberti, K. G. M., Kaufman, F., Tajima, N., Silink, M., Arslanian, S., Wong, G., Bennett, P., Shaw, J., Caprio, S., & IDF Consensus Group
- Affiliations
- St Mary's Hospital (GB)
- Children's Hospital Los Angeles (US)
- Jikei University School of Medicine (JP)
- Children's Hospital at Westmead (AU)
- Children's Hospital of Pittsburgh (US)
- Chinese University of Hong Kong (HK)
- National Institutes of Health (US)
- Yale University (US)
- Corresponding author
- Zimmet, Paul
- ORCID
- Venue
- Pediatric Diabetes
- Publisher
- Wiley
- Published
- 2007-10
- Volume
- 8
- Issue
- 5
- Pages
- 299-306
- ISSN
- 1399-543X (ISSN-L)
- 1399-5448
- OpenAlex
- W2008283534
- Cited by
- 2,013
- References
- 68
- Citations by year
- 2026: 65 · 2025: 99 · 2024: 110 · 2023: 139 · 2022: 143 · 2021: 138 · 2020: 122 · 2019: 116 · 2018: 113 · 2017: 126 · 2016: 108 · 2015: 107 · 2014: 136 · 2013: 125 · 2012: 110
- FWCI
- 38.14
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pediatric Diabetes (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Sanofi
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
- Keywords
- metabolic syndrome, children, adolescents, type 2 diabetes, childhood obesity, abdominal obesity, waist circumference, abdominal fat, cardiovascular risk, obesity pharmacotherapy, school-based obesity prevention, sedentary lifestyle, urbanization, Japan, diagnostic criteria, treatment guidelines, prevention, Southeast Asia
- MeSH terms
- Adolescent, Body Weight, Child, Humans, International Cooperation, Magnetic Resonance Imaging, Obesity, Prevalence, Metabolic Syndrome
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