Treatment of childhood syndrome X

Hyperinsulinemia, hyperlipidemia, hypertension, and coronary artery disease comprise a quartet known as Syndrome X. This syndrome was first described in adults, but has recently been described in children and adolescents. The purpose of our study was to determine if diet or exercise is able to change the clinical profile of Syndrome X in children.

We recruited 36 obese (% ideal body weight = 170.3 +/- 31.1), children (9 to 12 yrs old) known to have high fasting cholesterol levels (177.5 +/- 33.5 mg/dL). Each participated in a 6-week protocol in one of three groups: control (C), diet (D), or exercise (E). Twenty-five of the patients completed the study with full compliance. At the beginning and end of the study, we measured weight, height, blood pressure, serum insulin, and a lipid profile including: cholesterol, low density lipoprotein, high density lipoprotein (HDL), triglycerides, and apolipoprotein A (ApoA). All subject groups were similar before the study. The D group had the greatest attrition (40%) and all of the E group completed the study.

After the 6-week study period, there was no significant weight loss or change in body mass index for any group. There was no significant change in blood pressure and there was no significant decline of fasting cholesterol or low density lipoprotein levels in any of the groups. HDL levels were low in all groups and did not significantly change with treatment. There was a significant decline in the triglyceride levels in both the diet and exercise groups after the study (preD = 150 +/- 60; postD = 122 +/- 50; preE = 165 +/- 50; postE = 116 +/- 39). Both the D and E groups also demonstrated a significant decrease in ApoA levels (preD = 174 +/- 33; postD = 142 +/- 24; preE = 200 +/- 50; postE = 161 +/- 23). Most impressively, fasting insulin levels significantly decreased with both diet and exercise, but did not change in controls during the 6 weeks (preC = 52 +/- 19; postC = 53 +/- 21; preD = 54 +/- 23; postD = 15 +/- 8; preE = 48 +/- 21; postE = 9).

The findings of this study are consistent with previous studies describing the presence of Syndrome X in childhood. Both diet and exercise were effective in lowering triglyceride, ApoA levels, and insulin levels. However, due to the large rate of noncompliance in the diet group, exercise seems to be the best treatment for improvement in Syndrome X in children.