Indian J Pediatr (January 2015) 82(1):3–4 DOI 10.1007/s12098-014-1644-8
EDITORIAL COMMENTARY
Childhood Obesity, Metabolic Syndrome and Pentraxin-3 P. S. N. Menon
Received: 25 November 2014 / Accepted: 26 November 2014 / Published online: 13 December 2014 # Dr. K C Chaudhuri Foundation 2014
Childhood obesity has become a major global health problem with an alarming escalating trend in the recent years. The World Health Organization perceives this as the most grim public health challenge for the 21st century, not only due to the rapidly increasing prevalence rates among children and adolescents but the tracking seen into adulthood. Current estimates predict that by 2015, children and adolescents will constitute around 15 % of the 1.5 billion obese population; 75 % of them from the developing countries! Unhealthy diet, increasingly sedentary lifestyle and urbanization, have contributed to this situation, particularly in developing countries [1]. Coupled with this, the rising worldwide prevalence of type 2 diabetes mellitus (T2DM) in the young highlights the need for the identification and treatment of children and adolescents at risk of progression to T2DM [2]. There is a corresponding surge of metabolic disorders such as abnormal glucose tolerance (or insulin resistance), dyslipidemia and hypertension in pediatric age groups, which is attributed to increased prevalence of obesity. Current treatment strategies based on physical activity and diet have not helped to limit the relentless progression of adiposity-associated morbidities. Pharmacotherapy and bariatric surgery also have not helped either. The combination of metabolic disturbances, now termed as the metabolic syndrome (MetS), initially included a cluster of hypertension, hyperglycemia and gout and the importance of association with increase in visceral fat was observed much later. Lessons have been learned that measuring waist circumference is probably more crucial than a mere body mass index. For the diagnosis of MetS, an adult must have central obesity
P. S. N. Menon (*) Department of Pediatrics, Jaber Al-Ahmed Armed Forces Hospital, PO Box No 5891, Salmiya 22069, Kuwait e-mail: [email protected]
plus any two of four additional criteria – elevated triglycerides, reduced HDL–cholesterol, raised blood pressure and raised fasting plasma glucose [1]. Adults with MetS have a five-fold greater risk of developing T2DM [3]. Cardiovascular complications are thrice more likely to develop compared to those without MetS and death from these disease are twice more likely [4, 5]. Large cohort studies on MetS in children have been relatively recent and few. Partly this has been due to the absence of precise criteria for defining MetS in children. The recent IDF classification has defined the syndrome in children between 6 and 16 y as combination of visceral obesity (≥ 90th percentile of the waist circumference) with any two of the following yardsticks – triglycerides ≥ 1.7 mmol/L (≥ 150 mg/ dl); HDL-cholesterol < 1.03 mmol/L (
EDITORIAL COMMENTARY
Childhood Obesity, Metabolic Syndrome and Pentraxin-3 P. S. N. Menon
Received: 25 November 2014 / Accepted: 26 November 2014 / Published online: 13 December 2014 # Dr. K C Chaudhuri Foundation 2014
Childhood obesity has become a major global health problem with an alarming escalating trend in the recent years. The World Health Organization perceives this as the most grim public health challenge for the 21st century, not only due to the rapidly increasing prevalence rates among children and adolescents but the tracking seen into adulthood. Current estimates predict that by 2015, children and adolescents will constitute around 15 % of the 1.5 billion obese population; 75 % of them from the developing countries! Unhealthy diet, increasingly sedentary lifestyle and urbanization, have contributed to this situation, particularly in developing countries [1]. Coupled with this, the rising worldwide prevalence of type 2 diabetes mellitus (T2DM) in the young highlights the need for the identification and treatment of children and adolescents at risk of progression to T2DM [2]. There is a corresponding surge of metabolic disorders such as abnormal glucose tolerance (or insulin resistance), dyslipidemia and hypertension in pediatric age groups, which is attributed to increased prevalence of obesity. Current treatment strategies based on physical activity and diet have not helped to limit the relentless progression of adiposity-associated morbidities. Pharmacotherapy and bariatric surgery also have not helped either. The combination of metabolic disturbances, now termed as the metabolic syndrome (MetS), initially included a cluster of hypertension, hyperglycemia and gout and the importance of association with increase in visceral fat was observed much later. Lessons have been learned that measuring waist circumference is probably more crucial than a mere body mass index. For the diagnosis of MetS, an adult must have central obesity
P. S. N. Menon (*) Department of Pediatrics, Jaber Al-Ahmed Armed Forces Hospital, PO Box No 5891, Salmiya 22069, Kuwait e-mail: [email protected]
plus any two of four additional criteria – elevated triglycerides, reduced HDL–cholesterol, raised blood pressure and raised fasting plasma glucose [1]. Adults with MetS have a five-fold greater risk of developing T2DM [3]. Cardiovascular complications are thrice more likely to develop compared to those without MetS and death from these disease are twice more likely [4, 5]. Large cohort studies on MetS in children have been relatively recent and few. Partly this has been due to the absence of precise criteria for defining MetS in children. The recent IDF classification has defined the syndrome in children between 6 and 16 y as combination of visceral obesity (≥ 90th percentile of the waist circumference) with any two of the following yardsticks – triglycerides ≥ 1.7 mmol/L (≥ 150 mg/ dl); HDL-cholesterol < 1.03 mmol/L (
