The dilemma of the metabolic syndrome in children and adolescents: disease or distraction?

Background:  The alarming increase of obesity in children occurring globally is raising concern about the implications for development, at earlier ages, of atherosclerosis and cardiovascular disease and is driving efforts to evaluate and predict risk in the young. A major component of this undertaking has been directed to adapting for children the criteria described in adults as the metabolic syndrome (MS). Methods:  This article briefly examines the status of and controversy about definition of the MS in adults and its value, and then it moves on to review the descriptions of the MS in the pediatric age group. This is done primarily from the point of view of its usefulness to the clinician. The ranges of the criteria used by different investigators, the differences in their prevalence and their effectiveness in predicting cardiovascular risk are discussed. Current information about cardiovascular risk factors in children, their progression into adulthood and their correlation with atherosclerosis in children and young adults is outlined. Finally, the current information and recommendations for treatment, in children, of cardiovascular risk factors including those composing the MS are reviewed. Conclusions:  One conclusion is that there needs to be consensus about the criteria for defining the MS in children if its use as a diagnosis is to be helpful in this age group. A second conclusion questions the value of using this syndromic collection of risk factors in children rather than concentrating on the risk factors themselves, evaluating their importance in early cardiovascular risk and assessing the safety and efficacy of intervention in early life.