Síndrome metabólico en niños: problemática, componentes y criterios diagnósticos
DOI:
https://doi.org/10.17533/udea.penh.v17n2a06Palabras clave:
síndrome metabólico, factores de riesgo, enfermedades cardiovasculares, obesidad, diabetes mellitus tipo 2, hipertensión, dislipidemias, niños.Resumen
Antecedentes: el síndrome metabólico en niños aumenta el riesgo de diabetes mellitus tipo 2 y enfermedad cardiovascular en la adultez. Objetivo: describir los componentes del síndrome metabólico en niños, su prevalencia y criterios diagnósticos propuestos por diferentes organizaciones y autores. Materiales y métodos: se realizó una búsqueda bibliográfica en las siguientes bases de datos: Pubmed, Science Direct, Embase, Lilacs y Scielo. Resultados y discusión: varias organizaciones han establecido definiciones para diagnosticar el síndrome metabólico en niños, algunas abordando criterios utilizados en adultos o adoptando puntos de corte derivados de poblaciones seleccionadas como niños obesos o sin incluir niños pre-adolescentes, aduciendo en estos últimos una baja prevalencia de alteraciones. Así, la prevalencia de este síndrome en una misma población puede variar (0,9 a 11,4%) según la definición empleada. Sin embargo, dicha prevalencia aumenta con el grado de obesidad infantil y se han demostrado prevalencias altas en pre-púberes, independiente de la clasificación empleada. Recientemente, se propuso usar puntajes continuos para mejorar la evaluación en niños. Conclusión: los puntos de corte actualmente empleados ponderan de forma diferente los componentes del síndrome metabólico. Por tanto, se recomienda emplear percentiles según edad, sexo y población para cada componente y evaluar la utilidad de puntajes continuos en esta población.
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Reaven GM. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes. 1988;37:1595-607.
Grundy SM, Brewer HB, Cleeman JI, Smith SC, Lenfant C. Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation. 2004;109:433-8.
WHO. Cardiovascular disease (CVDs). Geneva; 2015. [citado febrero de 2015]. Fact sheet N°317. Disponible en: http://www.who.int/mediacentre/factsheets/fs317/en/
WHO. Diabetes. Geneva; 2015. [citado febrero de 2015]. Nota descriptiva N°312. Disponible en: http://www.who.int/mediacentre/factsheets/fs312/es/
Wilson PWF. Metabolic syndrome as a precursor of cardiovascular disease and type 2 diabetes mellitus. Circulation. 2005;112:3066-72.
Wannamethee SG. The metabolic syndrome and cardiovascular risk in the British Regional Heart Study. Int J Obes (Lond). 2008;32(Suppl 2):S25-9.
Srinivasan SR, Bao W, Wattigney W a, Berenson GS. Adolescent overweight is associated with adult overweight and related multiple cardiovascular risk factors: The Bogalusa Heart Study. Metabolism. 1996;45:235-40.
Gidding SS, Bao W, Srinivasan SR, Berenson GS. Effects of secular trends in obesity on coronary risk factors in children: The Bogalusa Heart Study. J Pediatr. 1995;127:868-74.
Srinivasan SR, Myers L, Berenson GS. Predictability of childhood adiposity and insulin for developing insulin resistance syndrome (syndrome X) in young adulthood: The Bogalusa Heart Study. Diabetes. 2002;51:204-9.
Morrison JA, Friedman LA, Gray-McGuire C. Metabolic syndrome in childhood predicts adult cardiovascular disease 25 years later: the Princeton Lipid Research Clinics Follow-up Study. Pediatrics. 2007;120:340-5.
Holman RL, McGill HC, Strong JP, Geer JC. The natural history of atherosclerosis: the early aortic lesions as seen in New Orleans in the middle of the of the 20th century. Am J Pathol. 1958;34:209-35.
Strong JP, Mcgill HC, Tejada C, Holman RI. The natural history of atherosclerosis; comparison of the early aortic lesions in New Orleans, Guatemala and Costa Rica. Am J Pathol. 1958;34:731-44.
McGill HC, McMahan CA, Zieske AW, Sloop GD, Walcott J V, Troxclair DA, et al. Associations of coronary heart disease risk factors with the intermediate lesion of atherosclerosis in youth. The pathobiological determinants of atherosclerosis in youth (PDAY) Research Group. Arterioscler Thromb Vasc Biol. 2000;20:1998-2004.
Friend A, Craig L, Turner S. The prevalence of metabolic syndrome in children: a systematic review of the literature. Metab Syndr Relat Disord. 2013;11:71-80.
Cruz M, Weigensberg MJ, Terry T-KH, Ball G, Shaibi GQ, Goran MI. The metabolic syndrome in overweight hispanic youth and the role of insulin sensitivity. J Clin Endocrinol Metab. 2004;89:108-13.
Cook S, Weistzman M, Auinger P, Nguyen M. Prevalence of a Metabolic Syndrome Phenotype in Adolescents. Arch Pediatr Adolesc Med. 2003;157:821–7.
Ferranti SD, Gauvreau K, Ludwig DS, Neufeld EJ, Newburger JW, Rifai N. Prevalence of the metacolic syndrome in american asolescents: findings from the third. Circulation. 2004;110:2494-7.
NHLBI. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Bethesda; 2012. NIH Publication No. 12-7486A
Weiss R, Dziura J, Burgert T, Tamborline W, Taksali S. Obesity and metabolic syndrome in children and adolescents. New Engl J Med. 2004;350:2362-74.
Zimmet P, Alberti KG, Kaufman F, Tajima N, Silink M, Arslanian S, et al. The metabolic syndrome in children and adolescents: The IDF consensus. Pediatr Diabetes. 2007;8:299-306.
Capurso C, Capurso A. From excess adiposity to insulin resistance: the role of free fatty acids. Vascul Pharmacol. 2012;57:91-7.
Carr DB, Utzschneider KM, Hull RL, Kodama K, Retzlaff BM, Brunzell JD, et al. Intra-abdominal fat is a major determinant of the treatment. Panel III criteria for the metabolic syndrome. Diabetes. 2004;53:2087-94.
Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:766-81.
ICBF, Profamilia, Instituto Nacional de Salud, Ministerio de la Protección Social, Encuesta nutricional de situación nutricional en Colombia (ENSIN) 2010. Bogotá; 2011.
Baker J, Olsen L, Sorensen T. Childhood body-mass index and the risk of coronary heart disease in adulthood. N Engl J Med. 2007;357:2329-37.
CDC. About BMI for children and teens. Atlanta; 2014. [citado febrero de 2015]. Disponible en: http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html
Onis M, Onyango A, Borghi A. Elaboración de un patrón OMS de crecimiento de escolares y adolescentes. Bol OMS. 2007;85:660-7.
WHO. Child growth standards. Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age. Methods and development. Geneva; 2006.
Janssen I, Katzmarzyk PT, Ross R. Waist circumference and not body mass index explains obesity-related health risk. Am J Clin Nutr. 2004;79:379-84.
Nahuelcura RO. Correlación entre índice de masa corporal y circunferencia de cintura en una muestra de niños, adolescentes y adultos con discapacidad de Temuco, Chile. Int J Morphol. 2011;29:1326-30.
Ferreira AP, Ferreira CB, Brito CJ, Gondim Pitanga JF, Moraes CF, Naves LA, et al. Predicción del síndrome metabólico en niños por indicadores antropométricos. Arch Bras Cardiol. 2011;96:121-5.
Colombia. Ministerio de la Protección Social. Resolución 2121 de 2010. patrones de crecimiento. Bogotá;2010.
McDowell M, Fryar CD, Ogden CL. Anthropometric reference data for children and adults: United States, 1988-1994. Washington: NCHS; 2009. Vital and health statistics. Series 11; no. 249.
Benjumea M, Molina D, Arbelaez P, Agudelo L. Circunferencia de la cintura en niños y escolares manizaleños de 1 a 16 años. Rev Colomb Cardiol. 2008;15:23-34.
Colombia. Ministerio de Salud. Guia de atencion de la obesidad. Bogotá; 2002.
Martínez García J, Rojas Pérez GG, León Sicairos NM. Prevalencia de la resistencia a la insulina y síndrome metabólico en niños obesos que acuden a la Clínica de Obesidad del Hospital Pediátrico de Sinaloa. Pediatr México. 2010;12:18-22.
Ghergherechi R, Tabrizi A. Prevalence of impaired glucose tolerance and insulin resistance among obese children and adolescents. Ther Clin Risk Manag. 2010;6:345-9.
Viner RM, Segal TY, Lichtarowicz-Krynska E, Hindmarsh P. Prevalence of the insulin resistance syndrome in obesity. Arch Dis Child. 2005;90:10-4.
Dabelea D, Bell R, D’Agostino RB, Imperatore G, Johansen JM, Linder B, et al. Incidence of diabetes in youth in the United States. JAMA. 2007;297:2716-24.
Pinhas-Hamiel O, Zeitler P. Acute and chronic complications of type 2 diabetes mellitus in children and adolescents. Lancet. 2007;369:1823-31.
Matthews DR, Hosker JP, Rudenski a S, Naylor B a, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28:412-9.
Levy JC, Matthews DR, Hermans MP. Correct homeostasis model assessment (HOMA) evaluation uses the computer program. Diabetes Care. 1998;21:2191-2.
Myrlene S, Michel S, Greg Miller W, Michel S, Scott C. Insulin assay standardization: leading to measures of insulin sensitivity and secretion for practical clinical care. Diabetes Care. 2010;33:205-6.
Aradillas-García C, Rodríguez-Morán M, Garay-Sevilla ME, Malacara JM, Rascon-Pacheco RA, Guerrero-Romero F. Distribution of the homeostasis model assessment of insulin resistance in Mexican children and adolescents. Eur J Endocrinol. 2012;166:301-6.
Tresaco B, Bueno G, Pineda I, Moreno LA, Garagorri JM, Bueno M. Homeostatic model assessment ( HOMA ) index cut-off values to identify the metabolic syndrome in children. J Physiol Biochem. 2005;61:381-8.
Burrows R a, Leiva LB, Weisstaub G, Lera LM, Albala CB, Blanco E, et al. High HOMA-IR, adjusted for puberty, relates to the metabolic syndrome in overweight and obese Chilean youths. Pediatr Diabetes. 2011;12(3 Pt 2):212-8.
Gallo J, Ochoa J, Balparda J AD. Puntos de corte del perímetro de la cintura para identificar sujetos con resistencia a la insulina en una población colombiana. Acta Med Colomb. 2013;38:118-26.
Gallo J, Aristizabal D, Segura A, Correa M ZM. Relación de la resistencia a la insulina con la estructura , la función cardiaca y el metabolismo en adultos jóvenes no obesos. Acta Med Colomb. 2008;33:117-26.
Valerio G, Licenziati MR, Iannuzzi A, Franzese A, Siani P, Riccardi G, et al. Insulin resistance and impaired glucose tolerance in obese children and adolescents from Southern Italy. Nutr Metab Cardiovasc Dis. 2006;16:279-84.
ADA. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2014;37:S81-90.
ADA. Standards of medical care in diabetes:2014. Diabetes Care. 2014;37:S14-80.
Nathan DM. International expert committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care. 2009;32:1327-34.
Zhang X, Gregg EW, Williamson DF, Barker LE, Thomas W, Bullard KM, et al. A1C level and future risk of diabetes: a systematic review. Diabetes Care. 2010;33:1665-73.
Tester J, Sharma S, Jasik CB, Mietus-Snyder M, Tinajero-Deck L. Gender differences in prediabetes and insulin resistance among 1356 obese children in Northern California. Diabetes Metab Syndr. Diabetes India. 2013;7:161-5.
Colombia. Ministerio de la Protección Social. Guía de práctica clínica sobre diabetes tipo 1: niños, niñas y adolescentes. Bogotá; 2009.
Klop B, Elte JWF, Cabezas MC. Dyslipidemia in obesity: mechanisms and potential targets. Nutrients. 2013;5:1218-40.
Meshkani R, Adeli K. Hepatic insulin resistance, metabolic syndrome and cardiovascular disease. Clin Biochem. 2009;42:1331-46.
Li J, Motsko SP, Jr ELG, Tave A, Pezzullo JC, Jones JK. Prevalence of pediatric dyslipidemia : comparison of a populationbased claims database to national surveys y. Pharmocoepidemiol Drug Saf. 2010;19:1031-40.
Rosini N, Machado MJ, Webster IZ, Moura S a ZO, Cavalcante LDS, da Silva EL. Simultaneous prediction of hyperglycemia and dyslipidemia in school children in Santa Catarina State, Brazil based on waist circumference measurement. Clin Biochem. 2013;46:1837-41
Kalra S, Gandhi A, Kalra B, Agrawal N. Management of dyslipidemia in children. Diabetol Metab Syndr. 2009;1:1-5.
Daniels SR, Greer FR. Lipid screening and cardiovascular health in childhood. Pediatrics. 2008;122:198-208.
Segundo consenso nacional sobre detección, evaluación y tratamiento de las dislipoproteinemias en adultos. Rev Colomb Cardiol. 2005;11:406-91.
Suárez-Ortegón MF, Ramírez-Vélez R, Mosquera M, Méndez F, Aguilar-de Plata C. Prevalence of metabolic syndrome in urban Colombian adolescents aged 10-16 years using three different pediatric definitions. J Trop Pediatr. 2013;59:145-9.
Agudelo GM, Bedoya G, Estrada A, Patiño FA, Muñoz AM, Velásquez CM. Variations in the prevalence of metabolic syndrome in adolescents according to different criteria used for diagnosis: which definition should be chosen for this age group? Metab Syndr Relat Disord. 2014;12:202-9.
Oparil S, Zaman MA, Calhoun DA. Pathogenesis of hypertension. Am Coll Physic. 2003;139:761-76.
Alcalá-López JE, Refoyo Salicio E, Bellido Maicas C, Lázaro Fernández E, Rodríguez Padial L. Diagnóstico de la afectación cardíaca en la hipertensión arterial. Monocardio. 2003;4:196-206.
Franco GPP, Scala LCN, Alves CJ, França GVA de, Cassanelli T, Jardim PCBV. Síndrome metabólica em hipertensos de Cuiabá - MT: prevalência e fatores associados. Arq Bras Cardiol. 2009;92:472-8.
Franks PW, Hanson RL, Knowler WC, Sievers ML, Bennett PH, Looker HC. Childhood obesity, other cardiovascular risk factors, and premature death. N Engl J Med. 2010;362:485-93.
Bancalari R, Diaz C, Martinez A, Aglony M, Zamorano J, Cerda V. Prevalencia de hipertensión arterial y su asociación con la obesidad en edad pediátrica. Rev Med Chile. 2011;139:872-9.
Koebnick C, Black MH, Wu J, Martinez MP, Smith N, Kuizon BD, et al. The prevalence of primary pediatric prehypertension and hypertension in a real-world managed care system. J Clin Hypert. 2013;15:784-92.
Falkner B. Hypertension in children and adolescents: epidemiology and natural history. Pediatr Nephrol. 2010;25:1219-24.
NHLBI. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114(2 Suppl):555-76.
Ford ES, Li C, Cook S, Choi HK. Serum concentrations of uric acid and the metabolic syndrome among US children and adolescents. Circulation. 2007;115:2526-32.
Olza J, Gil-Campos M, Leis R, Bueno G, Aguilera CM, Valle M, et al. Presence of the metabolic syndrome in obese children at prepubertal age. Ann Nutr Metab. 2011;58:343-50.
Ahrens W, Moreno LA, Marild S, Molnár D, Siani A, De Henauw S, et al. Metabolic syndrome in young children: definitions and results of the IDEFICS study. Int J Obes (Lond). 2014;38(Suppl 2):S4-14.
Pandit D, Chiplonkar S, Khadilkar A, Kinare A, Khadilkar V. Efficacy of a continuous metabolic syndrome score in Indian children for detecting subclinical atherosclerotic risk. Int J Obes (Lond). 2011;35:1318-24.
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