In adulthood, metabolic syndrome is often associated with cardiovascular disease and type 2 diabetes mellitus. However, it is more complicated to decide when a child has metabolic syndrome because there is no 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 risk factors and risk factor assessments when it comes to addressing the prevention of metabolic syndrome in children and adolescents.
Steps to reduce your child’s chances of developing risk factors for metabolic syndrome:
Improve what your child eats and drinks. It is known that a lack of whole grains and fiber intake is highly correlated with the development of insulin resistance among the many dietary factors associated with obesity. Increased consumption of fruits and vegetables is known to provide dietary fiber in addition to micronutrients and reduce the risk of atherosclerotic cardiovascular disease in adulthood. Eating a diet high in calories and low in nutrients, and consuming a lot of fast food and sugary drinks can put children at risk for metabolic syndrome.
Get enough exercise. Physical activity is beneficial for weight control. By spending just one of the hours spent in front of a screen per day doing something that gets the blood circulating, children can dramatically improve their blood pressure, cholesterol, and sensitivity to the effects of insulin.
Control screen time. The number of hours a child spends in front of a screen each day is directly related to body mass index (BMI) and calories consumed per day. The AAP discourages screen use, except for video calls, before 18 to 24 months of age, and recommends pediatricians help families develop a child-specific Family Media Use Plan that ensures that screen time for recreational purposes does not take the place of healthy behavioral factors such as adequate sleep and physical activity.
Get enough sleep. Insufficient sleep increases metabolic risk in adolescents with obesity, even when the degree of obesity and physical activity levels are controlled. Some studies in adults and children have found that too much or too little sleep is problematic.
Avoid exposure to second-hand smoke. This is nothing new: it’s the worst thing a person can do to their heart and lungs. Whether by itself or combined with metabolic syndrome risk factors, smoking greatly increases your child’s risk of heart disease.
Assessment of risk factors in control visits:
Obesity. An annual obesity assessment is recommended for all children using the BMI formula. Pediatricians can transfer children with BMI at the 95th percentile or above to a comprehensive weight management program (if available locally). Pediatricians with special expertise in this area may also be able to help children in their own practice.
High blood sugar (glucose abnormalities). The AAP recommends that children 10 years of age or older (or pubertal) with a BMI at the 85th percentile or higher and 2 additional risk factors undergo evaluation with fasting glucose testing every 2 years. Children who exhibit prediabetes or type 2 diabetes mellitus during an evaluation may be transferred to a pediatric endocrinologist for management or control.
High blood pressure (hypertension). All children should have annual evaluations for elevated blood pressure. This can be done during your child’s annual well-child visit.
Cholesterol. A nonfasting non-HDL cholesterol screening, or fasting lipid profile, should be done in all children between the ages of 9 and 11 years. The AAP further recommends a fasting lipid profile for children with a BMI at or above the 85th percentile. For more information, see Cholesterol levels in children and adolescents.
Treatment of risk factors:
If your child has several risk factors for acquiring metabolic syndrome, this does not necessarily mean he or she will develop heart disease or diabetes, but it is more likely, especially if the risk factors involved are not improved or eliminated. For some children, lifestyle changes may be enough to reduce the risk of serious disease. Remember that it is easier for children to make better choices if they see their parents doing the same.
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