"The metabolic syndrome in adults is defined as a cluster of risk factors for cardiovascular disease and type 2 diabetes mellitus, which include abdominal obesity, dyslipidemia, glucose intolerance, and hypertension," write Paul Zimmet, MD, PhD, from the International Diabetes Institute in Melbourne, Victoria, Australia, and colleagues from the IDF Task Force on Epidemiology and Prevention of Diabetes. "In 2005, the [IDF] published its definition of the metabolic syndrome in adults. However, to date no unified definition exists to assess risk or outcomes in children and adolescents."

To meet the need for an easy-to-use, clinically accessible diagnostic tool to identify metabolic syndrome in children and adolescents, the IDF developed a new, simple definition, extending previous studies using modified adult criteria to investigate prevalence in young people.

Because of insufficient data in children younger than 6 years, this age group was excluded from the definition.

In children aged 6 to younger than 10 years, the IDF definition of the at-risk group for later development of metabolic syndrome consists of obesity (waist circumference ≥ 90th percentile). Although metabolic syndrome should not be diagnosed in this age group, a strong message for weight reduction should be delivered for those with abdominal obesity, and further measurements should be made if there is a family history of metabolic syndrome, type 2 diabetes, dyslipidemia, cardiovascular disease, hypertension, or obesity.

In adolescents aged 10 to younger than 16 years, metabolic syndrome can be diagnosed by abdominal obesity (waist circumference ≥ 90th percentile, or adult cutoff if lower) and the presence of 2 or more other clinical features (triglycerides ≥ 1.7 mmol/L; high-density lipoprotein cholesterol < 1.03 mmol/L; blood pressure ≥ 130 mm Hg systolic or ≥ 85 mm Hg diastolic; glucose ≥100mg/dL( 5.6 mmol/L) [oral glucose tolerance test recommended]; or known type 2 diabetes).
For adolescents older than 16 years, existing IDF criteria for adults should be used.

"Early identification of children who are at risk of developing the syndrome, type 2 diabetes mellitus, and cardiovascular disease in later life is important," the authors write. "Circumstances in utero and in early childhood predispose a child to disorders such as obesity, dysglycemia, and the metabolic syndrome. Furthermore, urbanization, unhealthy diet, and sedentary lifestyle are major contributors to such disorders."

"Early detection followed by treatment — particularly lifestyle intervention — is vital to halt the progression of the metabolic syndrome in children and adolescents," the authors conclude. "Such action should reduce morbidity and mortality in adulthood and help keep to a minimum the global burden of cardiovascular disease and type 2 diabetes mellitus. Governments and society must be made more aware of the problems associated with obesity and the likelihood of progression to the metabolic syndrome in children and adolescents."

Lancet. 2007;369:2059-2061.

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