Gliomatose leptomeníngea primária difusa: uma doença rara em pacientes pediátricos

Abstract

We want to thank the authors for the comments on our article. The authors explain that, at any moment, they have focused their concerns on the criteria to define metabolic syndrome, because if such definition does exist, 1 consensus criteria for diagnosis in adults do not exist, 2,3 neither do they in adolescents. In our article, our concern lay in demonstrating the presence of risk factors in a randomly selected sample and that these risk factors exist in such proportions that they can be grouped together, and, according to one of the several criteria suggested in the literature, based on pediatric reference values, they can give rise to the so-called metabolic syndrome. Therefore, we have not proposed an analysis of the associations between risk factors.The authors believe that discussing criteria which have not reached consensus 2,3 leads to a shift in focus from the seriousness of the presence of isolated or associated risk factors at such an early life stage, and that a simple aggregate of such and such factor, in order to reach a diagnosis of metabolic syndrome, would mean admitting that the syndrome implies a higher risk than its components or that it is more severe than other risk factors for cardiovascular disease. For this reason, due to lack of scientific support, we do not concur with such conclusions. It is worth mentioning that some studies 4-6 have shown that risks attributed by the metabolic syndrome are not higher than the sum of its components, that is, the syndrome is not greater than the sum of its parts. Thus, all risk factors need to be fought individually, with no need for percentages of the syndrome for such and such criterion in order to enhance treatment, prescription and encouragement of healthy life habits.Finally, the precursor of the idea of metabolic syndrome, Reaven, 7 in a recent review, has questioned the syndrome: "metabolic syndrome -rest in peace."