N 2 (187) 2024. P. 57–64

MODERN VIEWS ON METABOLIC SYNDROME IN CHILDREN AND ADOLESCENTS

V. I. Velychko, V. E. Khatsko, D. O. Lahoda, Ya. I. Bazhora, G. O. Pencho

Odesa National Medical University, Odesa, Ukraine
Municipal  Non-Commercial  Enterprise  “Children’s  Advisory  and  Diagnostic  Center  named  after  Academician
B. Ya. Reznik” of the Odesa City Council, Odesa, Ukraine

DOI 10.32782/2226-2008-2024-2-10

Introduction. Historically, metabolic syndrome has emerged as a concept rather than a diagnosis and has been described by several other names over the years.

The research aim is to find out the latest views and approaches to the management of metabolic syndrome in children.

Materials and methods. Information from scientific sources, such as PubMeD, Medscape, Researchgate, and V. I. Vernadskyi National Library of Ukraine, was used to identify the latest views on metabolic syndrome in children.

Results. Obesity is an integral component of metabolic syndrome and the possible development of type 2 diabetes and cardiovascular disease. This is evident in the strong association between obesity and the prevalence of metabolic syndrome and insulin resistance. The integration of waist measurements is believed to improve cardiometabolic risk stratification among children, suggesting that waist measurements should be considered in routine paediatric screening. Discussion. Weight loss in obese children and adolescents after comprehensive non-surgical interventions, including diet, physical activity, education and behavioural therapy, is associated with improvements in several metabolic parameters such as lipid profile and blood pressure. The US Food and Drug Administration (FDA) has approved pharmacotherapy for obese children and adolescents that should be considered after an intensive lifestyle change programme has failed to reduce body weight, namely liraglutide and simaglutide. Practitioners should note that in Ukraine, liraglutide is now registered for children over 12 years of age, and semaglutide is registered for adults over 18 years of age. Other weight-loss medications for adults are still being studied for the use by children and represent a wide range of future possibilities. Conclusions. It is essential that practitioners of any speciality identify patients at risk and provide guidance on the prevention and treatment of metabolic syndrome.

Key words: metabolic syndrome, obesity, diabetes mellitus, children, adolescents, treatment of metabolic syndrome.

BIBLIOGRAPHY

  1. Ogden CL, Carroll MD, Lawman HG, et al. Trends in Obesity Prevalence Among Children and Adolescents in the United States, 1988–1994. Through 2013–2014. JAMA. 2016; 315(21): 2292–2299. doi: 10.1001/jama.2016.6361.
  2. Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. 2012; 307(5): 491–497. doi: 10.1001/jama.2012.39.
  3. Morrison JA, Friedman LA, Gray-McGuire C. Metabolic syndrome in childhood predicts adult cardiovascular disease 25 years later: the Princeton Lipid Research Clinics Follow-up Study. 2007; 120(2): 340–345. doi: 10.1542/ peds.2006-1699.
  4. Morrison JA, Friedman LA, Wang P, Glueck CJ. Metabolic syndrome in childhood predicts adult metabolic syndrome and type 2 diabetes mellitus 25 to 30 years later. J Pediatr. 2008; 152(2): 201–206. doi: 10.1016/j.jpeds.2007.09.010.
  5. Wu YE, Zhang CL, Zhen Q. Metabolic syndrome in children (Review). Exp Ther Med. 2016; 12(4): 2390–2394. doi: 10.3892/etm.2016.3632.
  6. Bhat RC, Santhosh T, Sudha KM. Metabolic syndrome: a comprehensive review. Int J Basic Clin Pharmacol. 2024; 13(1): 181–183. doi: https://doi.org/10.18203/2319-2003.ijbcp20233913.
  7. Kylin E. Studien ueber das Hypertonie-Hyperglyca “mie-Hyperurika” miesyndrom. Zentralblatt fuer Innere Medizin. 1923; 44: 105–127.
  8. Vague J. Sexual Differentiation, a Factor Affecting the Forms of Obesity. La Presse Médicale. 1947; 55: 339–340.
  9. Avogaro P, Crepaldi G. Essential hyperlipidemia, obesity and diabetes. 1965; 1: 137.
  10. Reaven GM. Banting lecture 1988. Role of insulin resistance in human disease. 1988; 37(12): 1595–607. doi: 10.2337/diab.37.12.1595.
  11. Kaplan NM. The deadly quartet. Upper-body obesity, glucose intolerance, hypertriglyceridemia, and hypertension. Arch Intern Med. 1989; 149(7): 1514–20. doi: 10.1001/archinte.149.7.1514.
  12. Haffner SM, Valdez RA, Hazuda HP, Mitchell BD, Morales PA, Stern MP. Prospective analysis of the insulin-resistance syndrome (syndrome X). 1992; 41(6): 715–22. doi: 10.2337/diab.41.6.715.
  13. Magge SN, Goodman E, Armstrong SC. The Metabolic Syndrome in Children and Adolescents: Shifting the Focus to Cardiometabolic Risk Factor Clustering. 2017; 140(2): e20171603. doi: 10.1542/peds.2017-1603.
  14. Wittcopp C, Conroy R. Metabolic Syndrome in Children and Adolescents. Pediatr Rev. 2016; 37(5): 193–202. doi: 10.1542/ pir.2014-0095.
  15. Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention. 2009; 120(16): 1640–5. doi: 10.1161/ CIRCULATIONAHA.109.192644.
  16. Roberts CK, Hevener AL, Barnard RJ. Metabolic syndrome and insulin resistance: underlying causes and modification by exercise training. Compr Physiol. 2013; 3(1): 1–58. doi: 10.1002/cphy.c110062.
  17. Panda PK. Metabolic Syndrome in Children: Definition, Risk Factors, Prevention and Management – A Brief Overview. Pediatr Oncall J. 2019; 16: 67–72. doi: 10.7199/ped.oncall.2019.17.
  18. Bitew ZW, Alemu A, Ayele EG, Tenaw Z, Alebel A, Worku T. Metabolic syndrome among children and adolescents in low and middle income countries: a systematic review and meta-analysis. Diabetol Metab Syndr. 2020; 12: 93. doi: 10.1186/ s13098-020-00601-8.
  19. Cook S, Weitzman M, Auinger P, Nguyen M, Dietz WH. Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination Survey, 1988–1994. Arch Pediatr Adolesc Med. 2003; 157(8): 821–7. doi: 10.1001/archpedi.157.8.821.
  20. Reisinger C, Nkeh-Chungag BN, Fredriksen PM, Goswami N. The prevalence of pediatric metabolic syndrome – a critical look on the discrepancies between definitions and its clinical importance. Int J Obes (Lond). 2021; 45(1): 12–24. doi: 10.1038/s41366-020-00713-1.
  21. Agudelo GM, Bedoya G, Estrada A, Patiño FA, Muñoz AM, Velásquez CM. Variations in the prevalence of metabolic syndrome in adolescents according to different criteria used for diagnosis: which definition should be chosen for this age group? Metab Syndr Relat Disord. 2014; 12(4): 202–9. doi: 10.1089/met.2013.0127.
  22. Friend A, Craig L, Turner S. The prevalence of metabolic syndrome in children: a systematic review of the literature. Metab Syndr Relat Disord. 2013; 11(2): 71–80. doi: 10.1089/met.2012.0122.
  23. D’Adamo E, Santoro N, Caprio S. Metabolic syndrome in pediatrics: old concepts revised, new concepts discussed. Curr Probl Pediatr Adolesc Health Care. 2013; 43(5): 114–23. doi: 10.1016/j.cppeds.2013.02.004.
  24. Privitera G, Spadaro L, Alagona C, et al. Hepatic insulin resistance in NAFLD: relationship with markers of atherosclerosis and metabolic syndrome components. Acta Diabetol. 2016; 53(3): 449–59. doi: 10.1007/s00592-015-0816-y.
  25. Zhang J, Xiang L, Zhang B, Cheng Y. Endothelial dysfunction in normoglycaemic first-degree relatives of type 2 diabetes mellitus complicated with hyperuricaemia. Diab Vasc Dis Res. 2017; 14(2): 88–93. doi: 10.1177/1479164116678158.
  26. Fernández JR, Redden DT, Pietrobelli A, Allison DB. Waist circumference percentiles in nationally representative samples of African-American, European-American, and Mexican-American children and adolescents. J Pediatr. 2004; 145(4): 439–44. doi: 10.1016/j.jpeds.2004.06.044.
  27. Cong X, Liu S, Wang W, Ma J, Li J. Combined consideration of body mass index and waist circumference identifies obesity patterns associated with risk of stroke in a Chinese prospective cohort study. BMC Public Health. 2022; 22(1): 347. doi: 10.1186/s12889-022-12756-2.
  28. Steinfath M, Vogl S, Violet N, et al. Simple changes of individual studies can improve the reproducibility of the biomedical scientific process as a whole. PLoS One. 2018; 13(9): e0202762. doi: 10.1371/journal.pone.0202762.
  29. Khoury M, Manlhiot C, McCrindle BW. Role of the waist/height ratio in the cardiometabolic risk assessment of children classified by body mass index. J Am Coll Cardiol. 2013; 62(8): 742–51. doi: 10.1016/j.jacc.2013.01.026.
  30. Abaturov OE, Yur’eva LM, Velychko VI, ta in. Obesity and disorders of food behavior: diagnosis, prevention and therapy: basic method. / Abaturov OE, Yur’eva LM, editors. Lviv: Vidavets Marchenko TV; 2021. 267 p.
  31. Kavey RW. Combined Dyslipidemia in Children and Adolescents: a Proposed New Management Approach. Curr Atheroscler Rep. 2023; 25(5): 237–245. doi: 10.1007/s11883-023-01099-x.
  32. Standards of Medical Care in Diabetes-2017: Summary of Revisions. Diabetes Care. 2017; 40 (Suppl 1): S4–S5. doi: 10.2337/dc17-S003.
  33. Velychko VI, Lahoda DO, Kornovan GV, Bazhora YI. The role of family in treating obesity in children. Clinical decline. Healthy child. 2023; 18(1). doi: http://dx.doi.org/10.22141/2224-0551.18.1.2023.1560.
  34. Mann JP, Valenti L, Scorletti E, Byrne CD, Nobili V. Nonalcoholic Fatty Liver Disease in Children. Semin Liver Dis. 2018; 38(1): 1–13. doi: 10.1055/s-0038-1627456.
  35. Artyomenko VV, Velychko VI, Lahoda DO, Nastradina NM, Nitochko KO. Polycystic ovarian syndrome: competencies of a family doctor. Reproductive endocrinology. 2023; 67(5): 63–67. doi: http://dx.doi.org/10.18370/2309-4117.2023.67.63-67.
  36. Fu L, Xie N, Qu F, Zhou J, Wang F. The Association Between Polycystic Ovary Syndrome and Metabolic Syndrome in Adolescents: a Systematic Review and Meta-analysis. Reprod Sci. 2023; 30(1): 28–40. doi: 10.1007/s43032-022-00864-8.
  37. Codazzi V, Frontino G, Galimberti L, Giustina A, Petrelli A. Mechanisms and risk factors of metabolic syndrome in children and adolescents. 2023 Dec 22. doi: 10.1007/s12020-023-03642-x.
  38. Podeanu MA, Turcu-Stiolica A, Subțirelu MS, et al. C-Reactive Protein as a Marker of Inflammation in Children and Adolescents with Metabolic Syndrome: A Systematic Review and Meta-Analysis. 2023; 11(11): 2961. doi: 10.3390/biomedicines11112961.
  39. Barlow SE. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. 2007; 120 (Suppl 4): S164–92. doi: 10.1542/peds.2007-2329C.
  40. Velychko VI, Mankovsky BM, Lahoda DO, Danylchuk GO, Wenger YI. Treatment of excess body mass or obesity in children. DOMC [Internet]. 2021 [cited 2024 ber. 22]; 6: 34–39. Available from: https://doms.org.ua/wp-content/uploads/2022/08/ DOMS_1_2022_full-for-net-3.pdf.
  41. Johnston BC, Merdad R, Sherifali D, et al. Updating the Canadian clinical practice guideline for managing pediatric obesity: a protocol. CMAJ Open. 2022; 10(1): E155-E164. doi: 10.9778/cmajo.20200289.
  42. O’Hara V, Cuda S, Kharofa R, Censani M, Conroy R, Browne NT. Clinical review: Guide to pharmacological management in pediatric obesity medicine. Obes Pillars. 2023; 6: 100066. doi: 10.1016/j.obpill.2023.100066.
  43. Hoelscher DM, Kirk S, Ritchie L, Cunningham-Sabo L. Position of the Academy of Nutrition and Dietetics: interventions for the prevention and treatment of pediatric overweight and obesity. J Acad Nutr Diet. 2013; 113(10): 1375–94. doi: 10.1016/j.jand.2013.08.004.
  44. Rajjo T, Mohammed K, Alsawas M, et al. Treatment of Pediatric Obesity: An Umbrella Systematic Review. J Clin Endocrinol Metab. 2017; 102(3): 763b75. doi: 10.1210/jc.2016-2574.
  45. Gow ML, Ho M, Burrows TL, et al. Impact of dietary macronutrient distribution on BMI and cardiometabolic outcomes in overweight and obese children and adolescents: a systematic review. Nutr Rev. 2014; 72(7): 453–70. doi: 10.1111/nure.12111.
  46. Styne DM, Arslanian SA, Connor EL, et al. Pediatric Obesity-Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2017; 102(3): 709–757. doi: 10.1210/jc.2016-2573.
  47. Bremer AA, Auinger P, Byrd RS. Relationship between insulin resistance-associated metabolic parameters and anthropometric measurements with sugar-sweetened beverage intake and physical activity levels in US adolescents: findings from the 1999–2004 National Health and Nutrition Examination Survey. Arch Pediatr Adolesc Med. 2009; 163(4): 328–35. doi: 10.1001/archpediatrics.2009.21.
  48. Al-Mansoori L, Al-Jaber H, Prince MS, Elrayess MA. Role of Inflammatory Cytokines, Growth Factors and Adipokines in Adipogenesis and Insulin Resistance. Inflammation. 2022; 45(1): 31–44. doi: 10.1007/s10753-021-01559-z.
  49. Herouvi D, Paltoglou G, Soldatou A, Kalpia C, Karanasios S, Karavanaki K. Lifestyle and Pharmacological Interventions and Treatment Indications for the Management of Obesity in Children and Adolescents. Children (Basel). 2023; 10(7): 1230. doi: 10.3390/children10071230.
  50. Singhal V, Sella AC, Malhotra S. Pharmacotherapy in pediatric obesity: current evidence and landscape. Curr Opin Endocrinol Diabetes Obes. 2021; 28(1): 55–63. doi: 10.1097/MED.0000000000000587.
  51. McDonagh MS, Selph S, Ozpinar A, Foley C. Systematic review of the benefits and risks of metformin in treating obesity in children aged 18 years and younger. JAMA Pediatr. 2014; 168(2): 178–84. doi: 10.1001/jamapediatrics.2013.4200.
  52. Bruemmer D. Obesity and Weight Loss in Adolescents. 2020. Available from: https://www.acc.org/Latest-in-Cardiology/ Articles/2020/08/19/08/06/Obesity-and-Weight-Loss-in-Adolescents (Last accessed: 26.02.2024).
  53. Tamborlane WV, Barrientos-Pérez M, Fainberg U, et al. Liraglutide in Children and Adolescents with Type 2 Diabetes. N Engl J Med. 2019; 381(7): 637–646. doi: 10.1056/NEJMoa1903822.
  54. Cornejo-Estrada A, Nieto-Rodríguez C, León-Figueroa DA, Moreno-Ramos E, Cabanillas-Ramirez C, Barboza JJ. Efficacy of Liraglutide in Obesity in Children and Adolescents: Systematic Review and Meta-Analysis of Randomized Controlled Trials. Children (Basel). 2023; 10(2): 208. doi: 10.3390/children10020208.
  55. Kelly AS, Auerbach P, Barrientos-Perez M, et al. A Randomized, Controlled Trial of Liraglutide for Adolescents with Obesity. N Engl J Med. 2020; 382(22): 2117–2128. doi: 10.1056/NEJMoa1916038.
  56. Weghuber D, Barrett T, Barrientos-Pérez M, et al. Once-Weekly Semaglutide in Adolescents with Obesity. N Engl J Med. 2022; 387(24): 2245–2257. doi: 10.1056/NEJMoa2208601.
  57. Krewson C. FDA approves semaglutide for obesity in adolescents. Available from: https://www.contemporarypediatrics. com/view/fda-approves-semaglutide-for-obesity-in-adolescents (Last accessed: 26.02.2024).
  58. Kansra AR, Lakkunarajah S, Jay MS. Childhood and Adolescent Obesity: A Review. Front Pediatr. 2021; 8: 581461. doi: 10.3389/fped.2020.581461.
  59. Nobili V, Vajro P, Dezsofi A, et al. Indications and limitations of bariatric intervention in severely obese children and adolescents with and without nonalcoholic steatohepatitis: ESPGHAN Hepatology Committee Position Statement. J Pediatr Gastroenterol Nutr. 2015; 60(4): 550–61. doi: 10.1097/MPG.0000000000000715.
  60. Schmoke N, Ogle S, Inge T. Adolescent Bariatric Surgery. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. 2000. Available from: https://www.ncbi.nlm.nih.gov/books/NBK575728/ (Last accessed: 26.02.2024).
  61. Velychko VI, Yurchenko IV, Lahoda DO, Yurchenko YeI. Type 2 diabetes mellitus: epidemiology, complications and early diagnosis. Odesa Medical Journal. 2023; 3: 76–83. doi: https://doi.org/10.32782/2226-2008-2023-3-14.
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