Factoring the metabolic X syndrome
Metabolic X syndrome is a multisystem disease that requires screening, counseling, assessment, and treatment for a wide variety of metabolic problems.
Polycystic ovarian syndrome
Polycystic ovarian syndrome (PCOS) occurs when women have 2 of the following: 1) oligomenorrhea/anovulation; 2) hyperandrogenism, either clinical or biochemical: 3) polycystic ovaries on ultrasound.21
Hyperandrogenism independently increases risk of metabolic syndrome, and PCOS increases risk of metabolic syndrome by a factor of 4, necessitating screening for other components of metabolic syndrome in affected patients.
Elevated C-reactive protein is also noted in obese children, and obesity is increasingly recognized as a proinflammatory state. Despite its link with negative cardiovascular outcomes, inflammatory markers have not been conclusively linked to metabolic syndrome or insulin resistance.4 There are no current recommendations for assessing inflammatory markers as part of screening or treatment.
Care for children with metabolic syndrome involves the following treatments:
Weight reduction and/or weight maintenance
Even small reductions in weight are beneficial. Calculated BMI is standard practice in pediatric practices. Calorie restriction to decrease weight or BMI percentile is the goal without impacting growth. In general, more intensive programs are more successful. Although waist circumference is not currently recommended as part of an obesity assessment because of a lack of pediatric-specific data, waist-to-height ratio of greater than 0.6 predicts a future risk of metabolic syndrome and cardiovascular disease. The pediatrician must also be mindful that the prevalence of depression and mood disorders is increased among obese children. Consider referral to a nutritionist, intensive weight management program, and useful websites such as www.choosemyplate.gov.5
Increased physical activity
Few children get recommended amounts of exercise. Tell parents to think of physical activity like a medication: Children need regular doses to get a benefit. Children both with and without glucose impairment are advised to exercise for 60 minutes daily.22,23
There are a number of simple recommendations the pediatrician can make to patients to help improve diet and decrease calories (Table 3). These include:
1. Drink more water. Sugary drinks have few benefits for the pediatric patient and can significantly increase calories. Zero-calorie or low-calorie drinks and skim milk are excellent options when the child wants to consume something other than water.24
2. Eat more whole grains. Whole grain intake is inversely associated with BMI and waist circumference, and both the Physicians’ Health Study and the Nurses’ Health Study demonstrated consumption of more whole grain foods was associated with lower weight.25
3. Eat breakfast daily. Breakfast eaters are less likely to be overweight or obese.26 If children are already overweight or obese, beginning the day with a good breakfast can help their weight control plan.
4. Eat fewer processed foods. Processed foods are more energy dense and often contain extra sugars. A fresh banana is better than banana pudding or a dehydrated banana chips.
5. Avoid junk foods. If parents buy healthier options, their children simply will not have as many opportunities to consume calorie-rich, low-nutrition foods. Small incremental changes in purchasing decisions lead to changes in eating habits that may lead to big differences in the nutritional state of children and adolescents.
6. Add vitamin D. Research indicates that low vitamin D levels are associated with a number of the changes associated with metabolic syndrome. Other research has indicated that there also may be an independent association with cardiovascular and cancer risk. The National Academy of Medicine, the Endocrine Society, and the AAP recommend 600 international units of vitamin D daily.27-29