Metabolic Syndrome in Children

Metabolic syndrome is an emerging concern in children and adolescents across the world because of significant changes in the lifestyle i.e. unhealthy diet and sedentary life. It was believed to be a health problem that only affects adults, but in the past 20 years, now it has been identified more and more in children and teens. Paediatric endocrinologists are now treating young children who have a combination of obesity, high cholesterol levels, high blood sugar levels, high liver enzymes and high blood pressure. This trend is similar across the world and this has huge impacts on long-term health of children.

Metabolic syndrome is not a single disease. Instead, it is a combination of at least three to four interconnected distinct risk factors that tend to happen together and greatly raise the risk of developing type 2 diabetes and heart disease later in life.

Metabolic syndrome is when a person has more than one metabolic risk factor. In children, these usually include deposition of fat around the waist (abdominal obesity), high blood pressure(hypertension), high liver enzymes (Metabolic dysfunction associated fatty liver disease for short MAFLD), abnormal lipid levels like high triglycerides and low HDL cholesterol(dyslipidaemia), and problems with sugar regulation (prediabetes/ type 2 diabetes).

From a paediatric endocrinology perspective, insulin resistance is the core of this condition. Insulin is the hormone that lets sugar to move from the blood into the cells of the body. When tissues stop responding to insulin (insulin resistance), the pancreas makes more insulin to make up for it. Over time, this compensation stops working, eventually blood sugar levels raise and children develop diabetes.

A lot of parents want to know why metabolic syndrome is occurring so early in life. There are many reasons for this. A big challenge is that more and more children are becoming overweight /obese, especially with the fat being deposited in the waist. Diets that are high in processed foods, sugary drinks, and refined carbs are the main reason for this problem. At the same time, not moving around enough, spending too much time in front of screens, and not getting enough sleep all make metabolic health worse.

Genetic predisposition is also a risk factor. Children who have a family history of type 2 diabetes, high blood pressure, or heart disease are more likely to get these conditions. Puberty makes things even more complicated because it naturally causes a temporary state of insulin resistance, which can unmask metabolic conditions that were already there.

Majority of children with metabolic syndrome look healthy and don't show any signs. Some children develop a skin condition called acanthosis nigricans. It means thicker and darker patches usually in the skin creases and folds, such as the sides and back of the neck, armpits, elbow pits, and groin. However, it can show up anywhere on the body. It may look velvety or warty, or have a dirty appearance. It is a sign that the body isn't responding to insulin. Some children may only be taken to the doctor after their routine blood tests are noted to be abnormal.

Paediatric endocrinologists stress the need for preventive care for these children which means screening overweight/obese children and also those with other risk factors even before the condition develops.

It is harder to diagnose metabolic syndrome in children than in adults because children are still growing and going through puberty. There is no one definition that everyone agrees on, but most criteria focus on the presence of waist obesity along with at least two other problems i.e. High lipid levels or high blood pressure or high liver enzymes or high blood sugar levels.

Evaluation usually involves a careful look at growth parameters, waist circumference, and blood pressure using age, gender and height specific normal ranges. Blood tests may include fasting glucose, HbA1c, lipid profile, and liver enzymes.

Changing your child's lifestyle is the most important part of treating metabolic syndrome. This method works best when the whole family is involved, not just the child. The goal is not to lose weight quickly, but to build habits that will help your metabolism stay healthy over lifetime.

Eating a balanced diet, exercising for at least 60 minutes a day, cutting back on sugary foods and drinks, and limiting screen time can all help make your body more sensitive to insulin. Even minor fluctuations in weight and activity can significantly impact metabolism.

In some cases, paediatric endocrinologists may recommend pharmacological interventions like medications or bariatric surgery which is a last resort. People often give metformin to children who have prediabetes or have a lot of insulin resistance. If changing your lifestyle isn't enough, you may also need to take medicines to lower your cholesterol or blood pressure. However, there is no one drug that can treat metabolic syndrome.

Metabolic syndrome in childhood frequently continues into adulthood without interventions, elevating the risk of early cardiovascular disease and type 2 diabetes. The good news is that if you find it early and do something about it right away, you can change this. A lot of children’s metabolic health gets better when they get regular follow-up care and help from paediatric endocrinologists and dietitians.

Ankura's Paediatric Endocrinology services help children and teens with complicated hormonal and metabolic problems. Our well-trained healthcare professionals take a child centered approach to treating diabetes both type 1 & type 2, insulin resistance, metabolic syndrome, and growth disorders. Ankura helps families promote their children’s lifelong metabolic health and well-being by providing support from various compassionate health care professionals and advanced diagnostic tools. Ankura supports paediatric endocrinology curriculum by enabling high-quality, patient-centered care. We partner with health care leaders to help manage complications, reduce risks, and support sustainable growth in specialty paediatric services.