The Metabolic Syndrome in Children and Adolescents: Shifting the Focus to Cardiometabolic Risk Factor Clustering

Endocrinology, Section on; Obesity, Section On

doi:10.1542/peds.2017-1603

Cited by 319 publications

(314 citation statements)

References 87 publications

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“…These findings have important implications for screening childhood brain tumor survivors at risk of hypothalamic injury for features of MetS. This view is consistent with current recommendations for identification and treatment of cancer-free, pediatric cases at risk for MetS 59. It is also equally compelling to focus future research on elucidation of the mechanism of metabolic syndrome in survivors of childhood brain tumors to gain insight into improved treatment approaches.…”

Section: Discussionsupporting

confidence: 77%

Metabolic syndrome is a sequela of radiation exposure in hypothalamic obesity among survivors of childhood brain tumors

Cooksey

Klesse

et al. 2019

Journal of Investigative Medicine

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Survivors of childhood brain tumors may be at risk for early onset of metabolic syndrome, possibly secondary to surgery and/or radiation exposure. This study examines effects of radiation exposure to hypothalamus-pituitary-adrenal axis (HPA) on metabolic risk among survivors of childhood brain tumors. One hundred forty-two met inclusion criteria; 60 had tumor surgery plus radiation exposure (>1 Gray (Gy)) to HPA. The second subgroup of 82 subjects had surgery only and were not exposed to radiation. Both subgroups had survived for approximately 5 years at the time of study. All had clinical evaluation, vital signs, anthropometry, measurement of body composition by dual X-ray absorptiometry and fasting laboratory assays (metabolic panel, insulin, C-peptide, insulin-like growth factor-1, leptin and adiponectin). Body composition data for both subgroups was compared with the National Health and Nutrition Survey (NHANES) subgroup of similar age, gender and body mass index. Cranial surgery was associated with obesity of similar severity in both subgroups. However, survivors exposed to radiation to the HPA also had increased visceral fat mass and high prevalence of growth hormone deficiency and metabolic syndrome. Fat mass alone did not explain the prevalence of the metabolic syndrome in radiation exposure subgroup. Other factors such as growth hormone deficiency may have contributed to metabolic risk. We conclude that prevalence of metabolic syndrome among subjects exposed to hypothalamic radiation was higher than expected from hypothalamic obesity alone. Radiation exposure may exert untoward endocrinopathies due to HPA exposure that worsens metabolic risk. Early screening for metabolic syndrome in this population is indicated.

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Section: Discussionsupporting

confidence: 77%

Metabolic syndrome is a sequela of radiation exposure in hypothalamic obesity among survivors of childhood brain tumors

Cooksey

Klesse

et al. 2019

Journal of Investigative Medicine

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“…Though the definitions have many similarities, there are important differences between them with respect to cut-off points for various parameters. These are summarized in Tables 1 and 2 (13,14,(18)(19)(20)(21).…”

Section: Definitionmentioning

confidence: 99%

“…Transl Pediatr 17;6(4):397-407 tp.amegroups.com syndrome and implications for clinical care in pediatrics (13).…”

Section: Introductionmentioning

confidence: 99%

Metabolic syndrome in children and adolescents

2017

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Prevalence of metabolic syndrome in children and adolescents is increasing, in parallel with the increasing trends in obesity rates. Varying definitions of this syndrome have hindered the development of a consensus for the diagnostic criteria in the pediatric population. While pathogenesis of metabolic syndrome is not completely understood, insulin resistance and subsequent inflammation are thought to be among its main mechanistic underpinnings. Overweight and obesity are cardinal features, along with abnormal glucose metabolism, dyslipidemia, and hypertension. Other disorders associated with metabolic syndrome include fatty liver, polycystic ovarian syndrome (PCOS), and pro-inflammatory states. Prevention and management of this condition can be accomplished with lifestyle modifications, behavioral interventions, pharmacological and surgical interventions as needed.

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“…8 In 2017, American Academy of Pediatrics (AAP) created a clinical report on metabolic syndrome and emphasized the need to focus on cardiometabolic risk factor clustering over individual risk factors. 9 Given this recommendation to focus on risk factor clustering, we chose to examine ≥2 CVD risk factors in this study.…”

Section: Introductionmentioning

confidence: 99%

Trends in Prevalence of Cardiovascular Risk Factors from 2002‐2012 among Youth Early in the Course of Type 1 and Type 2 Diabetes. The SEARCH for Diabetes in Youth Study

et al. 2019

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Background: Given diabetes is an important risk factor for cardiovascular disease (CVD), we examined temporal trends in CVD risk factors by comparing youth recently diagnosed with type 1 diabetes (T1D) and type 2 diabetes (T2D) from 2002 through 2012. Methods: The SEARCH for Diabetes in Youth Study identified youth with diagnosed T1D (n = 3954) and T2D (n = 706) from 2002 to 2012. CVD risk factors were defined using the modified Adult Treatment Panel III criteria for metabolic syndrome: (a) hypertension; (b) high-density lipoprotein cholesterol ≤40 mg/dL; (c) triglycerides ≥110 mg/dL; and (d) waist circumference (WC) >90th percentile. Prevalence of CVD risk factors, stratified by diagnosis year and diabetes type, was reported. Univariate and multivariate logistic models and Poisson regression were fit to estimate the prevalence trends for CVD risk factors individually and in clusters (≥2 risk factors). Results: The prevalence of ≥2 CVD risk factors was higher in youth with T2D than with T1D at each incident year, but the prevalence of ≥2 risk factors did not change across diagnosis years among T1D or T2D participants. The number of CVD risk factors did not change significantly in T1D participants, but increased at an annual rate of 1.38% in T2D participants. The prevalence of hypertension decreased in T1D participants, and high WC increased in T2D participants. Conclusion: The increase in number of CVD risk factors including large WC among youth with T2D suggests a need for early intervention to address these CVD risk factors. Further study is needed to examine longitudinal associations between diabetes and CVD.

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The Metabolic Syndrome in Children and Adolescents: Shifting the Focus to Cardiometabolic Risk Factor Clustering

Cited by 319 publications

References 87 publications

Metabolic syndrome is a sequela of radiation exposure in hypothalamic obesity among survivors of childhood brain tumors

Metabolic syndrome is a sequela of radiation exposure in hypothalamic obesity among survivors of childhood brain tumors

Metabolic syndrome in children and adolescents

Trends in Prevalence of Cardiovascular Risk Factors from 2002‐2012 among Youth Early in the Course of Type 1 and Type 2 Diabetes. The SEARCH for Diabetes in Youth Study

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