Metabolic Syndrome and Larger Waists in Youth Point to Health Risks on Horizon

The information on this page has been compiled and edited from previously published articles, by Dr. Connie Guttersen.  The articles are not intended as health advice, nor do they necessarily reflect the views and opinions of the California Olive Committee. Always consult your physician on matters of health and wellness.

by Connie Guttersen, RD PhD.

The magnitude and the prevalence of childhood obesity have increased at unprecedented levels over the past decade. This has renewed an interest in the study of metabolic syndrome in children. Researcher Dr. Ram Weiss states that metabolic syndrome is far more common among children and adolescents than previously reported, and its prevalence is directly related to the degree of obesity.

The NHANES III study, conducted between 1988 and 1994, estimated the prevalence of metabolic syndrome at 6.8% among overweight adolescents and 28% among obese adolescents. The occurrence reached 39% in moderately obese and 50% in severely obese youngsters. Furthermore, Weiss found that biomarkers of an increased risk of adverse cardiovascular outcomes are already present in obese youngsters.

Health professionals  have been aware of the epidemic of obesity among children and sensitive to the epidemic of diabetes among adolescents. Now, on the horizon, is the prediction of cardiovascular disease for this generation. Weiss comments, "A dramatic increase in the incidence of type II diabetes may represent the tip of the iceberg and may herald the emergence of an epidemic of advanced cardiovascular disease due to the synergistic effects of other components of the metabolic syndrome, as well as chronic low grade inflammation, as obese adolescents become obese young adults."

The astonishing factor is that this may be occurring at an earlier age than most would imagine. A study led by Katrina DuBose, presented at the 53rd annual meeting of the American College of Sports Medicine, shows that out of 375 second and third graders, 5% had metabolic syndrome and 45% had one or more risk factors for it. The most common risk factor to be diagnosed was hypertension.

Researchers from Tufts University found that individuals who eat three or more servings of whole grains a day, especially high fiber ones, had better insulin sensitivity and were less likely to have metabolic syndrome. Similar implications were found in the New England Journal of Medicine, led by Sonia Caprio, MD. She concluded that obese children, some not yet attending elementary school, are already displaying warning signs of cardiovascular risk factors that in past generations took years to develop. In her study, researchers found that 40 – 50% of children who were moderately to severely obese had metabolic syndrome. Caprio tracked 20 normal weight children, 31 overweight children, and 439 obese children between the ages of 4 and 20. Overall, the heavier the children the more likely they were to have hypertension, dyslipidemia and insulin resistance, lower levels of good HDL cholesterol and higher blood markers of inflammation associated with heart disease. In children as young as 4-6 years old, one in every three studied developed significant health risks very quickly, in particular for high blood pressure. There were no reported differences for ethnicity as Caprio concludes, "being obese is dangerous for children and adults, no matter who you are."

Early Treatment of Childhood Obesity Offers Healthiest Future

The compelling message from this study is that there is a dose response effect. For each step increase in body weight and obesity, there is an increase in cardiovascular risk factors. Many times people will say that children will grow out of their obesity as they get older and taller, but unfortunately for the 15% of children who are classified as clinically obese this will not prove to be true. Treating obesity in children before puberty is important since the success rate is better than treating them as adults.

The number of prescriptions for type II diabetes drugs taken by children ages 5 – 19 years doubled between 2002 and 2005, according to an analysis by one of the nation's largest pharmacy benefit management companies. The increase in the use of the diabetes drugs was most pronounced in children 10-14 years, rising 106% during the study period. What may be compelling is that the study may have underestimated the prevalence of diabetes in children, since the disease is often undiagnosed for 5 to 10 years. The next phase of this study may examine diabetes related complications, such as cardiovascular disease related to the increase in childhood obesity.

BMI Calculator Determining Childhood Cardiovascular Disease Risk

In the March 2006 issue of the American Journal of Cardiology, a group of investigators revealed that children who met the criteria for metabolic syndrome had significantly greater stiffness of the carotid artery and higher levels of C-reactive protein than those without the condition. Researcher Weiss and his colleagues in a separate study also found biomarkers of inflammation (C-reactive protein and interleukin-6 levels) and potential predictors of adverse cardiovascular outcomes to increase as obesity increased. In addition, adiponectin, a biomarker of insulin sensitivity decreased as obesity increased. Adiponectin is a cytokine secreted by adipose tissue, which has been shown to improve insulin sensitivity, regulate glucose and lipid metabolism, and to have pronounced anti-atherosclerotic effects. Other studies have also shown that lower plasma adiponectin concentrations are associated with insulin resistance and cardiovascular disease.

Waist Circumference Identifies Metabolic Syndrome Risk

Measuring a child's waist could be a simple way to identify kids at risk of metabolic syndrome. Waist circumference is a strong predictor for the risk factors associated with metabolic syndrome. Below are some examples of risky waist sizes for children.

* 5 year old girl or boy with a waist size of 22 inches or more

* 10 year old boy with a waist size of 26 inches or more

* 10 year old girl with a waist size of 25 inches or more

* 15 year old boy with a waist size of 31 inches or more

* 15 year old girl with a waist size of 28 inches or more

Metabolic Syndrome in Childhood

Obese children, some not yet attending elementary school, are already displaying warning signs of cardiovascular risk factors that in past generations took years to develop. A decreased response to insulin in late childhood, along with the degree of change in insulin resistance between ages 13 and 19, is significantly associated with insulin resistance in early adulthood and is highly correlated with a clustering of cardiovascular risk factors, according to the results of a new study by Sinaiko et al. Although investigators showed that childhood insulin resistance significantly predicts these future risk factors, the effects of childhood insulin resistance were independent of the effects of obesity. In the multiple-regression analysis, insulin resistance at age 13 significantly predicted systolic blood pressure, triglyceride levels, and the insulin-resistance metabolic-syndrome. The change in insulin resistance between late childhood and early adulthood also significantly predicted future triglyceride levels and insulin-resistance metabolic-syndrome score. "The message is that while obesity is really important, it might not be the whole answer," said Sinaiko. "There are other things that are important in establishing risk and we need to be looking at them."
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