The pediatric metabolic syndrome

The metabolic syndrome is a frequent subject of attention, discussion, and debate in medical research, because of its linkages to the growing problem of obesity on the one hand and both diabetes mellitus and cardiovascular disease on the other. It is also the grounds for contention, as respected researchers disagree on its definition and even on its validity as a construct. This clustering of obesity, dyslipidemia, elevated blood pressure, impaired glucose metabolism, and acute phase reactants can be seen in children as well as in adults. There are at least five definitions of adult metabolic syndrome promulgated by different societies and organizations, and as many as 40 different definitions of the syndrome have been used in pediatric studies. In 2007, the International Diabetes Federation published a definition of pediatric metabolic syndrome; whether it unifies the field remains to be seen. In addition, long term cohort studies have furnished data showing that clusters of the factors used to identify metabolic syndrome do predict the presence of type 2 diabetes and cardiovascular disease defined as myocardial infarction, stroke, coronary artery bypass graft, and/or positive angiogram. In addition, longitudinal studies have demonstrated compromised vascular function in young adults with metabolic syndrome, variously defined, as children and adolescents. This review discusses the background and development of the concept of a metabolic syndrome, the inter-relationships among its constitutive elements, the debates surrounding the uses of the concept and possible treatment avenues.