Metabolic Syndrome

About Metabolic Syndrome

Not to be confused with metabolic disease (which occurs when hormones and other chemicals in the body fail to interact properly), metabolic syndrome describes a cluster of risk factors that put kids on the road to heart disease and type 2 diabetes.

Kids with metabolic syndrome have at least three of these risk factors:

• excessive belly fat
• high blood pressure (hypertension)
• abnormal levels of blood fats (lipids), including cholesterol and triglycerides
• hyperglycemia (high blood sugar)

You might be surprised to learn that these are problems kids can have. After all, high blood pressure and high cholesterol are usually things older people grumble about.

Not so anymore. Thanks to the rising obesity epidemic in young people, kids and teens are getting these conditions — and they're getting them earlier than ever before. Some estimates say that nearly 1 in 10 teens — and over a third of obese teens — have metabolic syndrome. And a study of 375 second- and third-graders found that 5% had metabolic syndrome and 45% had one or two risk factors for it.

This is something parents should know about, especially because they can take steps to lessen their kids' chances of developing metabolic syndrome or the risk factors that lead to it.

Causes

Because it's a precursor to heart disease and type 2 diabetes, metabolic syndrome (also called dysmetabolic syndrome or syndrome X) is brought on by the same problems that cause those diseases. So, having a diet that's high in calories and low in nutrients and consuming lots of fast food and sweetened beverages can put kids at risk.

Playing video games for most of the day or sitting in front of the computer and not getting enough (or any) exercise also can increase a child's chance of developing factors like obesity, high LDL ("bad") cholesterol, hypertension, and high blood sugar that define metabolic syndrome.

The risk of developing the condition appears to be highest around puberty. That may be because body fat, blood pressure, and lipids are all affected by the hormones that bring about the many changes of puberty.

Kids who have a family history of heart disease or diabetes are at greater risk for metabolic syndrome. But, as with many things in life, the lifestyle habits a child adopts can push things in one direction or another. So kids who are active, fit, and eat a lot of fruits and vegetables may drastically decrease their chances of developing metabolic syndrome — even if a close relative already has it.

Effects

Metabolic syndrome itself often has no noticeable symptoms early on. But when its risk factors are left to snowball for too long, major changes may start to develop in the body, such as:

• Arteriosclerosis. This happens when cholesterol hardens and begins to build up in the walls of arteries, causing blockages that can lead to high blood pressure, heart attack, and stroke.
• Poor kidney function. The kidneys become less able to filter toxins out of the blood, which can also increase the risk of high blood pressure, heart attack, or stroke.
• Insulin resistance. This occurs when the body's cells don't respond to insulin (the hormone that helps to regulate sugar in the blood) normally, and that can lead to high blood sugar levels and diabetes.
• Polycystic ovarian syndrome. Thought to be related to insulin resistance, this disorder involves the release of extra male hormones by the ovaries, which can lead to abnormal menstrual bleeding, excessive hair growth, acne, and fertility problems. It is also associated with an increased risk for obesity, hypertension, and — in the long-term — diabetes, heart disease, and cancer.
• Acanthosis nigricans. A skin disorder that causes thick, dark, velvet-like patches of skin around the neck, armpits, groin, between the fingers and toes, or on the elbows and knees.

Diagnosis

For a diagnosis of metabolic syndrome, a child must have at least three of the four risk factors. The most common risk factors in teens are hypertension and high LDL cholesterol. However, even when just one risk factor is present, a doctor will likely check for the others. This is especially true if a child is overweight, has a family member with type 2 diabetes, or has acanthosis nigricans.

These exams and tests can help doctors make a diagnosis of metabolic syndrome:

• Body mass index (BMI) and waist measurement. By calculating someone's BMI and checking for extra weight around the middle, doctors can judge if these problems are likely to have a negative effect on health. A waist measurement at or above the 90th percentile for a child's age and sex would be considered a risk factor.
• Blood pressure. Blood pressure is the force the blood exerts against the blood vessel walls as the heart pumps. When this force is at or above the 90th percentile for a child's age and sex, it is considered a risk factor.
• Blood tests, including:
  • Lipid profile. This test measures the levels of fats in the blood. Having low levels of good cholesterol (HDL) and high levels of bad cholesterol (LDL) or triglycerides would be considered a risk factor.
  • Fasting glucose. The fasting blood glucose test measures the amount of glucose in the blood after an 8-hour fast. After several hours without eating, a healthy person's blood glucose level should not be higher than a certain level. A glucose level higher than this could be a risk factor.
  • Insulin. A blood insulin test may also be performed in some cases as part of a check for insulin resistance.

Diagnosing metabolic syndrome in kids and teens can be a little bit like trying to hit a moving target. That's because as kids' bodies change and grow, the cutoff numbers for many of these tests change too. To standardize some of this information, doctors use special charts (a lot like growth charts) to plot where a child's numbers fall according to his or her age, sex, weight, and height. This also helps them follow the child's progression over time.

Treating Risk Factors

If your child is diagnosed with metabolic syndrome, it does not necessarily mean that he or she will develop heart disease or diabetes, but the chances are increased — especially if the risk factors involved aren't improved or eliminated.

For some kids, a lifestyle change may be enough to reduce the risk for serious disease. A doctor may recommend:

• Dropping excess pounds. If your child is overweight, even a moderate amount of weight loss can translate to big improvements in blood pressure, blood lipid levels, and the body's ability to use insulin.
• Getting more exercise. By taking just one of those hours spent in front of a screen each day and spending it on something that gets the blood flowing, your child can dramatically improve his or her blood pressure, cholesterol, and sensitivity to the effects of insulin.
• Eating mindfully. A child who learns to see food as fuel and not emotional compensation can start to make better choices at mealtime — for example, selecting complex instead of simple carbs (such as whole-grain instead of white bread, and brown rice instead of white); increasing fiber intake with more beans, fruits, and vegetables; choosing "healthy" fats like olive oil and nuts; and avoiding too many empty calories from soda and sweets.
• Fiber supplements. If your child might not be getting enough fiber through food, a fiber supplement may provide an added boost to help reduce the amount of LDL cholesterol in the blood.
• Not smoking. No surprise here — it's just about the worst thing people can do to their heart and lungs. Either alone or in combination with metabolic syndrome risk factors, smoking greatly increases your child's risk for developing heart disease.

When lifestyle changes aren't enough, a child may be prescribed medications to treat individual risk factors. So, kids with high blood pressure might be put on antihypertension drugs. Others with high LDL cholesterol might be prescribed statins or other lipid-lowering drugs. Children with high blood sugar, who are on the brink of developing diabetes, may be given medication to decrease insulin resistance.

Although weight-loss drugs that are helpful to adults are still investigational in children, some kids who are morbidly obese (double or more the healthy weight for kids their sex, age, and height) might benefit from these medications.

While bariatric surgery for weight loss is not yet approved by the U.S. Food and Drug Administration (FDA) in kids, some teens with morbid obesity or those who are obese and have developed heart disease or diabetes may be candidates for the procedure.

Changing Course

Here's a great thing kids can learn about cause-and-effect: they have the power to positively influence many health outcomes. Eating right and staying active are two ways they can help ensure a healthier tomorrow.

Of course, it's easier for kids to make better choices if they see their parents doing the same. So make a plan to help your entire family choose a new, healthier direction. After all, getting a late start on the right path beats staying on the wrong one.

Reviewed by: Steven Dowshen, MD
Date reviewed: February 2010