Focus on Clusters of Cardiometabolic Risk Factors, AAP Says

Troy Brown, RN

July 25, 2017

A clinical report from the American Academy of Pediatrics (AAP) recommends that clinicians focus on clusters of cardiometabolic risk factors in obese children and adolescents, rather than on cut points used for metabolic syndrome (MetS) in adults.

Sheela N. Magge, MD, director of research, Division of Endocrinology and Diabetes, Children's National Health System, Washington, DC, and colleagues published the clinical report online July 24 in Pediatrics.

"In so many areas of medicine, we find that strategies designed for adults simply do not meet the unique needs of children and adolescents," Dr Magge said in a Children's National Health System news release.

"Rather than focusing on specific cut-off levels of risk factors or whether a child's condition fits a particular definition of [MetS], we propose that pediatricians look for youth with multiple component risk factors, such as high blood sugar, hypertension, obesity and abnormal lipid levels. These children should be targeted for more intensive intervention efforts."

Clinicians should also screen children and adolescents for comorbidities including obstructive sleep apnea, polycystic ovarian syndrome, and fatty liver disease. The AAP recommends treating individual risk factors and comorbidities as indicated, but says that as evidence does not currently support medication treatment of pediatric MetS as a whole, the recommended treatment for children is weight loss through healthy diet and physical activity.

"The factors leading to obesity are complex, and there are no easy solutions," coauthor Sarah Armstrong, MD, said in a journal news release. "But pediatricians can help ensure that obesity does not have metabolic consequences by screening for known obesity-associated risks like hypertension, dyslipidemia, and prediabetes."

Recommendations

The recommendations include:

  • measuring body mass index annually to screen for obesity;

  • measuring blood pressure annually to screen for elevated blood pressure;

  • performing nonfasting non-high-density lipoprotein-C or fasting lipid screen for children aged 9 to 11 years to identify those with abnormal cholesterol levels; and

  • screening for abnormal glucose tolerance and type 2 diabetes in those with body mass index at or above the 85th percentile, aged 10 years or older (or pubertal), with two additional risk factors, such as family history, high-risk race/ethnicity, hypertension, or maternal gestational diabetes.

MetS is difficult to define in pediatric populations, the authors write. In adults, it consists of a group of at least three of five risk factors: increased central adiposity, elevated triglycerides, decreased high-density lipoprotein-C, elevated blood pressure, and hyperglycemia.

The presence of MetS in adults "is predictive of [cardiovascular disease] and type 2 diabetes mellitus," the authors write. "In children and adolescents, however, many different definitions of MetS have been proposed, and there is no clear consensus on which to use. In addition, because the majority of MetS cases in childhood and adolescence occur in individuals with obesity, the utility of MetS as a construct above and beyond obesity itself has been questioned."

"Metabolic health in childhood lays the foundation for lifelong metabolic health in adulthood," coauthor Elizabeth Goodman, MD, said in the journal news release. "Pediatricians can help improve lifelong health by identifying children who are at greater risk for heart disease and diabetes earlier in life."

Pediatrics. Published online July 24, 2017. Full text

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