Use of the metabolic syndrome in pediatrics: a blessing and a curse.

The clustering of traditional cardiovascular disease risk factors is known as the metabolic syndrome. The metabolic syndrome was first characterized as a distinct entity by Dr. Gerald Reaven in 1988. The intent was to identify individuals at greatest risk for cardiovascular disease mortality and those in urgent need of lifestyle intervention. Since then the metabolic syndrome has evolved into a diagnosable entity recognized by the National Cholesterol Education Program, Adult Treatment Panel III, World Health Organization, and the International Diabetes Foundation. However, the metabolic syndrome as a diagnosis faces considerable controversy, particularly when applied to the pediatric population. Due to the changes in growth and development, the adult criteria for the metabolic syndrome cannot be applied to children and adolescents. In fact, currently no all-inclusive definition for the metabolic syndrome exists for pediatrics. Despite its controversies, the identification of the metabolic syndrome and its component disorders in childhood and adolescence offers important information about risk for cardiovascular disease. Emerging evidence points to the presence of early functional and morphologic changes to the heart and blood vessels among obese children with the metabolic syndrome phenotype. Yet, the plasticity of the cardiovascular system during childhood and adolescence allows for the reversal of cardiovascular damage, but only if risks are identified early and treated aggressively. Recent national recommendations and screening directives offer pediatricians a comprehensive guide to risk prevention, assessment, and treatment.