Metabolic syndrome in children: risk factors, diagnostic features and treatment

Abstract

Introduction: The prevalence of metabolic syndrome in children is increasing, in parallel with the increasing trends of obesity rates and his fact requires the early diagnosis of risk factors through the use of non-invasive biomarkers. Aim of the study: Estimation of risk factors contributing to the onset of metabolic syndrome in children, as well as some particularities of diagnosis and treatment. Material and methods: The results are obtained from the research project titled «Evolutionary aspects of the metabolic syndrome in children under treatment with gastrointestinal lipase inhibitors», with code 20.80009.8007.33, within the State Program 2020-2023, carried out in the scientific laboratory of pediatric cardiology of the IMSP Institute ofCardiology, Republic of Moldova. The study included 43 children aged 10-18 years (general research group), diagnosed with metabolic syndrome (MS), estimated according to the IDF 2007 criteria. The gender ratio was: 24 (55.8%) boys and 19 (44.2%) girls. The control group consisted of 50 children (normotensive and normoweight), of similar age (25 children each (50% in each age category) 26 (52%) boys and 24 (48%) girls), without hereditary and family anamnesis aggravated by cardiovascular pathologies, obesity and type II diabetes. Depending on the treatment received in addition to the non-pharmacological treatment, the children were divided into 3 groups: group I received ACE inhibitors (angiotensin converting enzyme inhibitors), group II gastrointestinal lipase inhibitors (orlip), group III ACE inhibitors and gastro lipase inhibitors -intestinal (orlip). Risk factors were assessed according to a specially developed questionnaire. Serum adipokines (leptin, adiponectin) and TNF-α were evaluated by the immunoenzymatic ELISA method, hs-CRP by the latex-immunoturbidimetry method, and serum insulin by the immunochemical method with electrochemiluminescence detection (ECLIA). The study protocol was approved by the Medical Ethics Committee.Results: Most of the children were sedentary, had poor nutrition, as well as a hereditary history aggravated by hypertension and obesity. Also, in the families of these children, more harms were encountered: chronic stress (divorced parents, conflicts with parents, schoolmates, teachers, etc.), as well as exposure to passive smoking. The serum level of leptin (35,4±2,61 vs 7,9±0,23 ng/ml; p<0.001), hs CRP (3,0±0,44 vs 0,2±0,01 mg/l; p<0.001), TNFα (9,1±0,43 vs 3,1±0,09pg/ml; p<0.001) was higher, and adiponectin (5,1±0,38 vs 11,0±0,33 µg/ml; p<0.001) lower in children with metabolic syndrome, compared to the control group. Regardless of the medication administered, all drug combination formulas contributed to the decrease in the degree of obesity, blood pressure values, blood fat levels, as well as serum insulin values in the interval of 3 months after the initiation of the medication.Conclusion: The causes of metabolic syndrome in children are multiple and involve interactions between genetic, environmental (sedentary, high-calorie diet), hormonal and metabolic factors that ultimately lead to the appearance of the conditions that characterize this syndrome. Hypoadiponectinemia, hyperleptinemia, and increased serum PCRhs and TNFα values suggested that these adipokines/cytokines contribute to subclinical inflammation in children with MS and may also serve as biomarkers of MS. In combination with a low-calorie diet, regular exercise, and behavioral changes, treatment with gastrointestinal lipase inhibitors may help reduce the degree of obesity and hypertension, respectively.