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Sheela N. Magge, MD, MSCE, FAAP, Elizabeth Goodman, MD, MBA, FAAP, Sarah C. Armstrong, MD, FAAP, COMMITTEE ON NUTRITION, SECTION ON ENDOCRINOLOGY, SECTION ON OBESITY. The Metabolic Syndrome in Children and Adolescents: Shifting the Focus to Cardiometabolic Risk Factor Clustering. Pediatrics. 2017;140(2):e20171603.


Metabolic syndrome (MetS) was developed by the National Cholesterol abstract Education Program Adult Treatment Panel III, identifying adults with at least 3 of 5 cardiometabolic risk factors (hyperglycemia, increased central adiposity, elevated triglycerides, decreased high-density lipoprotein cholesterol, and elevated blood pressure) who are at increased risk of diabetes and cardiovascular disease. The constellation of MetS component risk factors has a shared pathophysiology and many common treatment approaches grounded in lifestyle modification. Several attempts have been made to define MetS in the pediatric population. However, in children, the
construct is difficult to define and has unclear implications for clinical care. In this Clinical Report, we focus on the importance of screening for and treating the individual risk factor components of MetS. Focusing attention on children with cardiometabolic risk factor clustering is emphasized over the need to define a pediatric MetS.


Cardiovascular disease (CVD) risk factor clustering has been well
recognized for decades in both children and adults, but it was not until 1988 when Gerald Reaven described a specific clustering of cardiometabolic risks as “syndrome X” that the concept that evolved into “the metabolic syndrome” (MetS) was born. Reaven’s syndrome X was an explanatory framework to understand the myriad effects of hyperinsulinemia and insulin resistance on physiology, not a diagnostic category.‍ His formulation of syndrome X described mechanisms underlying insulin resistance and the effects of hyperinsulinemia on glucose and lipid metabolism, blood pressure, and coronary artery disease risk. Over time, the risk factors associated with syndrome X grew to include other factors, such as central obesity, microalbuminuria, abnormalities in fibrinolysis, and inflammation.

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