Identifying and evaluating the metabolic syndrome in children and adolescents

The prevalence of the metabolic syndrome phenotype in children and adolescents has increased over the last decade in parallel with sharp increases in childhood overweight and obesity. Insulin resistance, blood pressure elevation, glucose intolerance, and dyslipidemia all increase with increasing body mass index (BMI). These relationships between elements of the metabolic syndrome and excess adiposity are apparent even in children as young as 2-5 years of age. Among obese 12- to 19-year-olds, 25% have elevated blood pressure and more than 30% have at least three elements of the metabolic syndrome. Height, weight, BMI and blood pressure are simple, noninvasive measures routinely obtained during periodic visits to primary care providers. In order to identify children and adolescents with features of metabolic syndrome who may require further evaluation or treatment, primary care providers should evaluate these simple measures relative to age- and sex-specific norms. This review focuses on methods for assessing BMI and blood pressure in routine clinical practice and on recommendations for further clinical evaluation and interventions of children and adolescents with abnormalities.