By: Sheela N. Magge, MD, MSCE, FAAP
In adulthood, metabolic syndrome—a group of at least 3 of 5 risk factors including central obesity, high blood pressure, high blood sugar, abnormal cholesterol, and high triglycerides—predicts cardiovascular disease and type 2 diabetes mellitus. But it turns out that deciding when a child has metabolic syndrome is more complicated, because there is not a uniform definition for metabolic syndrome in children.
The American Academy of Pediatrics (AAP) recognizes that children are not small adults. That's why the AAP recommends pediatricians (and parents) focus more on the risk factors and risk factor screenings when approaching metabolic syndrome prevention in children and adolescents.
Steps to Lessen Your Kids' Chances of Developing Metabolic Syndrome Risk Factors:
Improve what your child eats and drinks. Among the multiple dietary factors associated with obesity, lack of whole grain, and fiber intake is most strongly correlated with the development of insulin resistance. Higher consumption of fruits and vegetables—which contribute dietary fiber as well as micronutrients—is known to reduce risk of atherosclerotic cardiovascular disease in adulthood. 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 for metabolic syndrome.
Get enough exercise. Physical activity is beneficial for weight management. 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, kids can dramatically improve their blood pressure, cholesterol, and sensitivity to the effects of insulin.
Monitor screen time. The number of hours a child spends each day in front of a screen is directly related to body mass index (BMI) and calories consumed per day. The AAP discourages screen use except for video chatting before 18 to 24 months of age and recommends that pediatricians help families develop a Family Media Use Plan specific for each child that ensures entertainment screen time does not displace healthy behavioral factors, such as adequate sleep and physical activity.
Get enough sleep. Short sleep duration inversely predicts cardiometabolic risk in teens with obesity—even when controlling for degree of obesity and levels of physical activity. Some studies in adults and children have found either too much or too little sleep is problematic.
Avoid tobacco smoke exposure. 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.
Risk Factor Screenings at Well-Child Visits:
Obesity. An annual obesity screening is recommended for all children using the BMI formula. Pediatricians can refer children with BMI at or greater than the 95th percentile for a comprehensive weight-management program (if available locally). Pediatricians with a special expertise in this area may also be able to help children within their own practice.
High blood sugar (glucose abnormalities). The AAP recommends children 10 years or older (or pubertal) with a BMI at or greater than the 85th percentile and 2 additional risk factors be screened with a fasting glucose test every 2 years. Children found to have prediabetes or type 2 diabetes mellitus on screening can be referred to a pediatric endocrinologist for management and/or monitoring.
High blood pressure (hypertension). All children should be screened annually for elevated blood pressure. This can be done at your child's annual well-child visit.
Cholesterol. A nonfasting non-HDL cholesterol or fasting lipid screening should be performed in all children between the ages of 9 and 11 years. The AAP also recommends a fasting lipid panel in children with a BMI at or greater than the 85th percentile. See Cholesterol Levels in Children and Adolescents for more information.
Treating Risk Factors:
If your child has multiple risk factors for 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, lifestyle changes may be enough to reduce the risk for serious disease. Remember, it's easier for kids to make better choices if they see their parents doing the same!
Additional Information & Resources:
About Dr. Magge:
Sheela N. Magge, MD, MSCE, FAAP, is an Associate Professor of Pediatrics at the George Washington University School of Medicine and Health Sciences and pediatric endocrinologist at the Children's National Health System (CNHS). She serves as the Director of Research for the Division of Endocrinology and Diabetes, Director of the Participant and Clinical Interactions (formerly CRC) of the Clinical and Translational Science Institute at CNHS, and Associate Director of the Center for Translational Science. She is a member of the American Academy of Pediatrics (AAP) Committee on Nutrition and Section of Endocrinology. Dr. Magge served as the lead author of the AAP Clinical Report, "The Metabolic Syndrome in Children and Adolescents: Shifting the Focus to Cardiometabolic Risk Factor Clustering."