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.
Limit screen time
Reducing sedentary behaviors provides more time for physical activity among busy children. The AAP recommends no more than 1 hour of screen time daily for children aged 2 to 5,30 and for children and adolescents aged 5 through 18 years, says families need to develop an appropriate balance for traditional and social media time that does not interfere with physical activity and sleep.31 Limiting screen time is an intervention as screen time is associated with eating.23
First-line therapy for children with lipid abnormalities is generally lifestyle changes and modifications to diet and exercise regimens. Pharmacotherapy with statins is usually not indicated in patients aged younger than 10 years and is started for those children aged older than 10 years and after a 6-month trial of lifestyle modification based on low-density lipoprotein (LDL) levels.16 Whereas adverse effects are rare and patients generally tolerate them,32 patients need to be mindful of them. Adverse effects of statins include myopathy, elevation of liver function tests, and new onset T2DM. Adolescent females on statins also need to use appropriate contraception during sexual activity because of potential teratogenic effects.
Nonemergent treatment of hypertension follows a stepwise approach initially with nonpharmacologic measures such as weight reduction, exercise, and dietary modification. Pharmacologic management is beyond the scope of this article, but the 2004 National High Blood Pressure Education Program Working Group (NHBPEP) and the 2016 European Society of Hypertension are guidelines that can help guide the pediatrician’s management.33,34
Much is known and even more is left to be discovered related to pediatric metabolic syndrome. Pediatricians need to familiarize themselves with the risks, screening, and treatment of all its components to ensure a healthy transition to adult life for their patients.
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15. Morrison JA, Friedman LA, Harlan WR, et al. Development of the metabolic syndrome in black and white adolescent girls: a longitudinal assessment. Pediatrics. 2005;116(5):1178-1182.
16. Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents; National Heart, Lung, and Blood Institute. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics. 2011;128 suppl 5:S213-S256.
17. El Tawil D. Non-alcoholic fatty liver disease-a multisystem disease. Presented at: Grand Rounds, Department of Pediatrics, Lehigh Valley Health Network; March 15, 2016; Allentown, PA.
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20. Weiss R, Dufour S, Taksali SE, et al. Prediabetes in obese youth: a syndrome of impaired glucose tolerance, severe insulin resistance, and altered myocellular and abdominal fat partitioning. Lancet. 2003;362(9388):951-957.
21. Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004;19(1):41-47.
22. Physical Activity Guidelines for Americans Midcourse Report Subcommittee of the President’s Council on Fitness, Sports and Nutrition. Physical Activity Guidelines for Americans Midcourse Report: Strategies to Increase Physical Activity Among Youth. Washington, DC: US Department of Health and Human Services; 2012. Available at: https://health.gov/paguidelines/midcourse/pag-mid-course-report-final.pdf. Accessed January 24, 2017.
23. Copeland KC, Silverstein J, Moore KR, et al; American Academy of Pediatrics. Management of newly diagnosed type 2 diabetes mellitus (T2DM) in children and adolescents. Pediatrics. 2013;131(2):364-382. Erratum in: Pediatrics. 2013;131(5):1014.
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27. American Academy of Pediatrics. Dietary reference intakes for calcium and vitamin D. Pediatrics. 2012;130(5):e1424.
28. Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium; Ross AC, Taylor CL, Yaktine AL, Del Valle HB, eds. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: National Academies Press; 2011:1132.
29. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al; Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(7):1911-1930. Erratum in: J Clin Endocrinol Metab. 2011;96(12):3908.
30. Council on Communications and Media. Policy statement: Media and young minds. Pediatrics. 2016;138(5):e20162591.
31. Council on Communications and Media. Policy statement: Media use in school-aged children and adolescents. Pediatrics. 2016;138(5):e20162592.
32. Braamskamp MJ, Kusters DM, Avis HJ, et al. Long-term statin treatment in children with familial hypercholesterolemia: more insight into tolerability and adherence. Paediatr Drugs. 2015;17(2):159-166.
33. Lurbe E, Agabiti-Rosei E, Cruickshank JK, et al. 2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. J Hypertens. 2016;34(10):1887-1920.
34. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114(2 suppl 4th report):555-576.