Paediatric metabolic syndrome

The metabolic syndrome is a cluster of metabolic disorders. It is most prevalent in adults, but children and adolescents can be also affected. The central disorders of the paediatric metabolic syndrome are the same as for adults: abdominal obesity, elevated blood triglycerides, decreased HDL-cholesterol, elevated blood glucose, and increased blood pressure. Because blood pressure, anthropometrics, and blood parameters change with growth and development, the definition for paediatric metabolic syndrome vary from those of adults (Higgins & Adeli, 2017).

In 2007, the International Diabetes Federation (IDF) defined diagnosis criteria for children and adolescents between 10-16 years and from 16 years of age onwards is based on percentiles for different age groups.

The paediatric metabolic syndrome is diagnosed when abdominal obesity plus two additional features are prevalent. The definition criteria are the following (Zimmet et al., 2007):

Abdominal obesity:

  • Age 10 - <16 years: waist circumference ≥ 90th percentile
  • Age ≥16 years: adult criteria

Elevated blood triglycerides:

  • Age 10 - <16 years: ≥ 1.7 mmol/l (150 mg/dl)
  • Age ≥16 years: adult criteria

Decreased HDL-cholesterol:

  • Age 10 - <16 years:  <1.03 mmol/l (<40 mg/dl)
  • Age ≥16 years: adult criteria

Increased blood pressure:

  • Age 10 - <16 years: ≥ 130/85 mmHg
  • Age ≥16 years: adult criteria

Elevated fasting blood glucoseconcentrations

  • Age 10 - <16 years: ≥ 5.6 mmol/l (100 mg/dl)
  • Age ≥16 years: adult criteria

The IDF definition does not provide diagnosis criteria for children below 10 years of age, because of the lack of reference data (Zimmet et al., 2007).

In 2014, the Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants (IDEFICS) study provided reference values, obtained from a cohort of 16224 European children.

Children are diagnosed with metabolic syndrome when three of the features are prevalent. The reference values for children between 2 and 11 years of age are the following (Ahrens et al., 2014):

Abdominal obesity:

  • ≥90th percentile of the IDEFICS reference values

Elevated blood triglycerides:

  • ≥90th percentile of the IDEFICS reference values

Decreased HDL-cholesterol:

  • ≥90th percentile of the IDEFICS reference values

Increased blood pressure:

  • Systolic or diastolic blood pressure:  ≥90th percentile of the IDEFICS reference values

Elevated fasting blood glucoseconcentrations

  • ≥90th percentile of the IDEFICS reference values